DERMATOLOGY REVIEW FOR FNP BOARDS EXAM QUESTIONS AND ANSWERS 2024

Presentation: Ex. "Itching in webs of fingers" The Treatment: 1st line treatment; 1st line medication; non-pharmacologic treatment, etc. Name of illness: "Scabies" Permethrin cream. Treat everyone in the house. Wash everything with very hot water. Ring-like, itchy rash, or scaly patch on arms or legs with central clearing that grows bigger "..." on scalp?; on foot?; on groin?; on hands?; fingernail/toenails?; chin? Tinea Corporis; "Tinea" Capitus; "" Pedis; "" Cruris; "" Mannum; "" Unguium (aka Onchycosis); "" Barbea All except scalp & nails (on next slide) treated w/ otc topical antifungals (Clotrimazole, Miconazole, Ketoconazole). Severe cases treated w/ PO antifungals (terbanifine, itraconazole, fluconazole) 1. Tinea Capitus Treatment 2. Tinea Unguium Treatment 1. PO Griseofulvin (Gris-Peg) is Gold Standard 2. PO terbinafine (Lamisil); PO Itraconazole; Topical efinaconazole (Jublia); Topical ciclopirox (PenLac) Get baseline LFTs and recheck 2 weeks post treatment Lesion is an expanding red rash with central clearing. Rash feels warm and rough. "Found a tick on my body." Accompanied with flu-like symptoms Erythema Migrans (Lyme's disease). Other buzz words are "target-shaped" or "bulls-eye" rash. If > 7yrs, give Doxycycline; If <7yrs or pregnant- Amoxicillin Doxy x 21 days of (+)IgM titers Child with low-grade fever, malaise, sore throat followed by an intense red rash that first erupts on cheeks before it spreads to the rest of the body and becomes macular and lacey. May cause intense itching on palms/soles. What is it? What causes it? Treatment? Fifth Disease (Erythema Infectiosum). Parvo B19. Fatal to fetus- isolate from pregnant women. Supportive care- no ASA! *Presence of rash indicates pt is no longer infective* Pt can return to school when fever-free 24hrs. High fever, chills, headache, nausea/vomiting followed by a red spotty rash on the wrists/ ankles and/or the palms/ soles Rocky mountain spotted fever. From tick bite. Doxycycline regardless of age or if pregnant RMSF has >20% fatality if left untreated! Young child who attends daycare and has 3 to 5 days of fever which suddenly disappears and is followed by blanching maculopapular rash lasting 1-2 days. What is the illness? What causes it? Treatment? Roseola aka Exanthem Subitum. HHV-6. Supportive, never give ASA due to RF Reye. Hint: Think "half a dozen roses". Can return to school when fever resolves. Maculopapular rash with cough, choryza, and congestion. What disease? Small, white, round spots on buccal mucosa (What are they?) What treatment? Rubeola aka Measles. Koplik's spots. (Hint: Think KopLik, RubeoLa, MeasLes!). Prevent with MMR vaccine (12 mo and 4yrs). Airborn isolation until 4 days after rash appears. Isolate from pregnant women- danger to fetus Kawasaki disease B/L conjunctivitis Unilateral cervical LAD Strawberry tongue Peeling Rash of hands and feet **Tx with ASA and IV Ig** Starts out looking like tinea corporis (macule with central clearing) which turns into generalized rash of salmon-colored papules that appear parallel to each other on the trunk. Other buzz words "herald patch" & "Christmas tree pattern" Pityriasis Rosea. The macule with central clearing is the iconic "herald patch". The parallel pattern of papules is the "Christmas Tree pattern". Calamine lotion and PO antihistamines. Hint: Think "We *pity *Herald bc he did not get what he wanted for *Christmas". Very pruritic rash that started as multiple small vesicles and erupted into bright red, weepy lesions. Might be exacerbated by stress or cold weather. Typically found in folds (elbows, hands, neck, etc.) Atopic dermatitis aka Eczema. Associated with asthma and allergies. Treatment: Hydrocortisone (mild); Triamcinolone (mod); Halcinonide (Halog) (severe); Antihistamines and skin lubricants for all. Sudden eruption of vesicular lesions that rupture and then crust. These lesions follow a dermatomal pattern on 1 side of the body. Very painful. What is this? What is the treatment? Possible complications and how do we treat that? Shingles or Herpes Zoster. Gold standard lab= PCR (viral culture). Treatment: Acyclovir. Complication: PHN treat w/ TCAs, anticonvulsants, gabapentin, capsaicin cream. If on eyelid/cheek- refer to ED or ophthalmologist stat- potential involvement of trigeminal (CN V) and RF permanent blindness Child with "Dome-shaped" "white plug". Might look like a belly button (umbilication). Molloscum Contagiosum. Viral. Spread by close contact If found in genital region, suspect sexual abuse. Might look like "cellulitis of the face". Red, raised, tender/painful rash that is well demarcated. Might have a fever. Erysipelas Treatment: 1st line PCN or Doxy or Cephalexin (Keflex) Soft, painless macule. Wart-like fleshy growth that looks pasted on the skin Seborrheic Keratosis. Commonly seen on older men. Benign. Leave it alone. Pearly waxing ulcerated lesion Basal cell carcinoma- most common skin cancer Refer to Dermatology Lesion with irregular borders with lots of color variation Melanoma. "ABCDE": Asymmetry, Borders irregular, Color variation, Diameter >6mm, Enlargement Numerous dry, round, pink or red lesions with rough texture that will not heal. Commonly found on sun-exposed areas like neck, arms, back, and face. Actinic Keratosis. Precursor to Squamous Cell Carcinoma. Gold Standard- refer to dermatology for punch biopsy (excisional biopsy if on the face). Treatment: cryotherapy; Fluorouracil (5-FU) cream Red skin with silvery plaques. Or white scales. Itchy. Psoriasis. 1st line: emollients. Others: topical corticosteroids. For infants or use on face- low dose hydrocortisone. Everyone else use Triamcinalone (Kenelog). Patient fell and scraped his elbow. Scab formed. Then silvery plaques develop on top of the scab.- what's this called? The NP lightly scrapes the plaque and pinpoint bleeding occurs- what's this called? When psoriasis forms over a scab -Koebner's Phenomenon. Pinpoint bleeding of a psoriatic plaque- Auspitz Sign