Dermatologic Conditions

Question 1

A postterm infant has lesions of varying morphology including wheals, vesicles, and pustules on her trunk. You suspect:

a) cutis marmorata
b) erythema toxicum neonatorum
c) milia
d) contact dermatitis

Answer 1

b) erythema toxicum neonatorum

Question 2

A postterm infant has lesions of varying morphology including wheals, vesicles, and pustules on her trunk. In order to confirm the diagnosis you order a Wright’s stained smear. If your diagnosis is correct, what are the expected results of the smear?

a) presence of eosinophils
b) presence of neutrophils
c) presence of keratinous material
d) presence of staphylococcus bacteria

Answer 2

a) presence of eosinophils

Question 3

A postterm infant has lesions of varying morphology including wheals, vesicles, and pustules on her trunk. In order to confirm the diagnosis you order a Wright’s stained smear. In addition to monitoring the skin for any changes what is the best management?

a) topical antibiotics on lesions
b) topical steroids on lesions
c) a moisturizer on lesions
d) No treatment necessary since the condition will resolve spontaneously in 5-7 days

Answer 3

d) No treatment necessary since the condition will resolve spontaneously in 5-7 days

Question 4

You examine a newborn and observe numerous white papular lesions on the cheeks, forhead, and nose. You suspect either milia or neonatal acne. Which physical finding helps confirm a diagnosis of milia?

a) papular lesions are intermixed with pale yellow macules
b) papular lesions have an erythematous circular ring at the base
c) papular lesions are surrounded by lacy blue are with erythematous mottling
d) papular lesions, yellow in color, are observed on the hard palate

Answer 4

d) papular lesions, yellow in color, are observed on the hard palate

Question 5

A newborn is 3 weeks premature and you observe a macular erythematous lacy appearance to her skin. She has which condition?

a) cutis marmorata
b) erythema toxicum neonatorum
c) salmon patch
d) nevus flammeus

Answer 5

a) cutis marmorata

Question 6

A newborn is 3 weeks premature and you observe a macular erythematous lacy appearance to her skin. In addition to monitoring the skin for any changes, what is the best management?

a) keep pt warm
b) decrease the environmental temperature
c) use a moisturizer on affected skin areas
d) No treatment necessary since the condition will resolve spontaneously in 5-7 days

Answer 6

a) keep pt warm

Question 7

A newborn has a vascular lesion that will not fade as she gets older. What is your diagnosis?

a) salmon patch
b) capillary hemangioma
c) cafe au lait
d) port-wine stain (nevus flammeus)

Answer 7

d) port-wine stain (nevus flammeus)

Question 8

A newborn has a vascular lesion that will not fade as she gets older. Her parents are concerned about her appearance and the psychological effect on their daughter as she becomes aware of her condition. In educating the parents you tell them about several options. Which of the following is not appropriate management?

a) application of topical steroids to the affected area to prevent puritus
b) camouflage affected areas with cosmetics
c) pulsed laser treatment to affected area
d) counseling for psychological concerns

Answer 8

a) application of topical steroids to the affected area to prevent puritus

Question 9

Which condition is thought to be more apparent in darker-skinned individuals or during the summer months?

a) tinea corporis
b) psoriasis
c) pityriasis alba
d) pityriasis rosea

Answer 9

c) pityriasis alba

Question 10

An 8 yo boy has scaly, hyperpigmented lesions in a “fir tree” distribution, predominately on his trunk. One lesion on the buttocks is larger than all the other lesions and measures 4 cm in diameter. What is your likely diagnosis?

a) psoriasis
b) eczema
c) pityriasis alba
d) pityriasis rosea

Answer 10

d) pityriasis rosea

Question 11

An 8 yo boy has scaly, hyperpigmented lesions in a “fir tree” distribution, predominately on his trunk. One lesion on the buttocks is larger than all the other lesions and measures 4 cm in diameter. What symptom is commonly experienced in this condition?

a) pruritus
b) pain at site of lesions
c) nausea
d) headache

Answer 11

a) pruritus

Question 12

An 8 yo boy has scaly, hyperpigmented lesions in a “fir tree” distribution, predominately on his trunk. One lesion on the buttocks is larger than all the other lesions and measures 4 cm in diameter. What management would you not recommend with this condition?

a) cool bath or cool compresses to lesions
b) topical steroids to lesions
c) oral antibiotics
d) monitored and controlled daily sunlight exposure

Answer 12

c) oral antibiotics

Question 13

You have diagnosed a pt with acute atopic dermatitis. which of the following is not correct regarding the incidence of this condition?

a) most likely an infant
b) has a greater chance of developing asthma later in childhood than the average individual
c) has a greater chance of developing melanoma in adulthood than the average individual
d) has a condition associated with a familial predisposition

Answer 13

c) has a greater chance of developing melanoma in adulthood than the average individual

Question 14

You have diagnosed a pt with acute atopic dermatitis. Which of the following management measures or treatments would you not recommend?

a) topical steroids to affected areas
b) wet compresses to affected areas
c) maintain a dry, warm environment
d) eliminate all substances that dry the skin

Answer 14

c) maintain a dry, warm environment

Question 15

In addition to having atopic dermatitis you have diagnosed this pt with a secondary bacterial infection at the site of several lesions. What is the best management for the infection?

a) topical antibiotics to affected areas
b) oral antibiotics
c) hot compresses to affected areas
d) monitored and controlled daily sun exposure until lesions resolve

Answer 15

b) oral antibiotics

Question 16

You see a 6 week old with a bright red, raised, rubbery lesion of irregular shape and 2 cm in diameter on the occiput. What condition do you suspect?

a) malignant melanoma
b) port-wine stain
c) capillary hemangioma
d) burn

Answer 16

c) capillary hemangioma

Question 17

You see a 6 week old with a bright red, raised, rubbery lesion of irregular shape and 2 cm in diameter on the occiput. Which of the following is not characteristic of the lesion?

a) it was not present at birth, however pt’s mother noticed site was blanched
b) it will continue to grow for the first 9-12 months of life
c) it will begin to gradually resolve when pt is between 12-15 months
d) it is expected to completely resolve by the time pt is 10 years old

Answer 17

b) it will continue to grow for the first 9-12 months of life

Question 18

You notice 10 macular tan lesions of various sizes on a pt and refer him for a medical evaluation to rule out neurofibromatosis or Albright’s syndrome. What kind of lesions are these?

a) malignant melanoma
b) cafe au lait spots
c) mongolian spots
d) vitiligo

Answer 18

b) cafe au lait spots

Question 19

You notice 10 macular tan lesions of various sizes on a pt and refer him for a medical evaluation to rule out neurofibromatosis or Albright’s syndrome. What is characteristic of these lesions?

a) more common in caucasians than dark skinned individuals
b) more common in males than females
c) lesions can be present at birth, however, more lesions may develop at any age
d) lesions usually fade spontaneously and completely resolve in adult life

Answer 19

c) lesions can be present at birth, however, more lesions may develop at any age

Question 20

You suspect that a 9 yo has either pityriasis alba or vitiligo. Which of the following would not confirm the diagnosis of pityriasis alba?

a) skin would be normally pigmented except for areas of depigmentation
b) skin would have one or more scaly areas of hypopigmentation
c) complains of mild itching in areas of hypopigmentation
d) lesions became more pronounced when exposed to sunlight

Answer 20

a) skin would be normally pigmented except for areas of depigmentation

Question 21

Pt was diagnosed with pityriasis alba. Which of the following is proper management of pt’s condition?

a) bland moisturizers to reduce overdrying
b) topical steroids to affected areas
c) expose affected areas to short periods of sunlight
d) burow’s wet compresses to affected areas

Answer 21

d) burow’s wet compresses to affected areas

Question 22

Pt education is a major part of the PNP’s role. What would you teach the patient’s parent regarding the progress and prognosis of pityriasis alba?

a) pt will continue to develop lesions for the rest of her life
b) Pt’s condition should fade appreciably in 3-4 months
c) Pt’s condition is permanent and affected areas will not repigment
d) Pt’s condition will resolve completely, however, the affected areas can become slightly reddened when exposed to sunlight

Answer 22

b) Pt’s condition should fade appreciably in 3-4 months

Question 23

Malignant melanoma is a form of much dreaded skin cancer. Which of the following is not characteristic of this condition?

a) occurs in all ethnic groups but more common in light-skinned individuals
b) severe sunburn or excessive exposure to sunlight before the age of 10 predisposes developing melanoma later in childhood or adult life
c) spreads through the lymphatic system and invades other distant skin surfaces and organs
d) spreads primarily by invading skin surfaces that surround the major lesion

Answer 23

d) spreads primarily by invading skin surfaces that surround the major lesion

Question 24

Which of the following does not characterize the lesion of malignant melanoma?

a) irregular asymmetrical nodule with blurred borders
b) raised with distinct symmetrical borders
c) uneven coloring in which blue, black, brown, tan, and red may all be present in the same lesion
d) bleeding, ulceration in later stages

Answer 24

b) raised with distinct symmetrical borders

Question 25

Patient education regarding prevention of malignant melanoma is essential. Which of the following is not considered best prevention education?

a) avoid sunlight, especially during the hours of 0900-1300
b) avoid tanning lamps
c) use cover-up clothing, hats and sunglasses
d) use sun blocks that protect against ultraviolet exposure with 30 SPF

Answer 25

a) avoid sunlight, especially during the hours of 0900-1300

Question 26

You suspect a pt is having chronic psoriasis. Which of the following is characteristic of her lesions if she has psoriasis vulgaris?

a) Scaly erythematous patches and plaques 3 to 10 mm in diameter
b) Round or oval in shape
c) Large scaly silver-white plaque 5 to 10 cm in diameter
d) Located mainly on her trunk

Answer 26

c) Large scaly silver-white plaque 5 to 10 cm in diameter

Question 27

The condition of psoriasis is common in approximately 33% of children. Which of the following is not correct regarding the etiology or incidence of this condition?

a) Occurs more commonly in dark-skinned ethnic individuals
b) Associated with constant rubbing or trauma to exposed affected areas such as elbows
c) Associated with overproduction of epithelial cells
d) Associated with epithelial cells that migrate to the skin surface much more quickly than normal

Answer 27

a) Occurs more commonly in dark-skinned ethnic individuals

Question 28

What would you not advise regarding the management or treatment of psoriasis?

a) Excise lesions
b) Apply topical steroids
c) Apply mineral oil and moisturizers
d) Expose to monitored short periods of sunlight

Answer 28

a) Excise lesions

Question 29

You have diagnosed a pt with contact dermatitis. Which symptom is most characteristic of his condition?

a) Headache
b) Difficulty breathing
c) Pruritus at site of affected areas
d) Pain at site of affected areas

Answer 29

c) Pruritus at site of affected areas

Question 30

Which of the following is not characteristic of contact dermatitis?

a) Hypersensitivity to a substance within the environment when direct contact is made
b) A delayed reaction of several days with re-exposure to an allergen
c) Caused by direct contact with topical medications, soaps, cosmetics, fabrics, or plants
d) Typical response is redness and edema at the site of contact which may progress to papules and vesicles

Answer 30

b) A delayed reaction of several days with re-exposure to an allergen

Question 31

What would you not recommend as management and treatment of contact dermatitis?

a) skin testing during acute episode to determine allergy
b) cool compresses of Burow’s solution to affected areas
c) topical steroids to affected areas for five days
d) oral antihistamines

Answer 31

a) skin testing during acute episode to determine allergy

Question 32

You diagnose a 7 mo with diaper dermatitis. Which of the following should not be included in the differential diagnosis?

a) Atopic dermatitis
b) Child abuse
c) Contact dermatitis
d) Pityriasis alba

Answer 32

d) Pityriasis alba

Question 33

Round or oval patches of hypopigmented (lighter) skin appear on the face, upper arms, neck, and upper middle of the body. There may be flaky skin, called scales. The cause is unknown but is associated with eczema and a history of allergies. The disorder is most common in children and adolescents, and is more noticeable in children with dark skin. Symptoms are treated with moisturizers and mild topical steroid creams:

Answer 33

Pityriasis alba

Question 34

What management measure would you not prescribe to treat diaper dermatitis?

a) oral antihistamines
b) lubricants such as petroleum jelly to mildly affected areas
c) low potency topical steroids to severely affected areas with erythema and papules
d) topical antibiotics to severely affected areas with ulcerations

Answer 34

a) oral antihistamines

Question 35

What would not be an appropriate recommendation to prevent subsequent episodes of diaper dermatitis?

a) expose diaper area to air several times each day
b) increase oral fluids using orange juice to dilute urine
c) make diaper changes immediately after soiling
d) use a double rinse of vinegar and water for home-laundered diapers

Answer 35

b) increase oral fluids using orange juice to dilute urine

Question 36

Seborrhea dermatitis is common in both infants and adolescents. Which of the following is not correct of this condition?

a) can cause irritating pigment changes to include hyperpigmentation and hypopigmentation
b) is associated with an overproduction of sebum in areas abundant with sebaceous glands
c) the condition in infants is known as “cradle cap” in which lesions have erythematous base with yellow crusted areas and greasy scales
d) the condition in adolescents is known as acne with comedomes, papular and pustular lesions

Answer 36

d) the condition in adolescents is known as acne with comedomes, papular and pustular lesions

Question 37

What is the best treatment of seborrhea in the infant?

a) mineral oil to loosen crusts prior to washing affected areas with a nonperfumed baby shampoo
b) topical antibiotics
c) oral antibiotics in severe cases
d) oral steroids for severe cases

Answer 37

a) mineral oil to loosen crusts prior to washing affected areas with a nonperfumed baby shampoo

Question 38

You are evaluating a 3 yo who acutely sustained a burn when she pulled a pan of boiling water onto herself within the past hour. Since burns are classified according to the depth of injury to the skin layers and the amount of area involved, how would you rate the burn if 5% of her body surface is burned involving the epidermis and the upper part of the dermis?

a) she has a minor first and second degree burn
b) she has a major second degree burn
c) she has a major full thickness burn
d) she has major first and second degree burns

Answer 38

d) she has major first and second degree burns

Question 39

Minor first and second degree burns should appear:

a) dry, with mild edema and erythema
b) dry with whitish areas that blanch with pressure
c) dry whitish to brownish areas with edema
d) moist with edema, erythema, and a few vesicles

Answer 39

d) moist with edema, erythema, and a few vesicles

Question 40

What is the best treatment for major first and second degree burns?

a) warm compresses to affected areas and mild analgesic for discomfort
b) topical emollients to affected areas
c) topical steroids to affected areas
d) refer for urgent treatment in an ED

Answer 40

d) refer for urgent treatment in an ED

Question 41

A pt has been diagnosed with folliculitis, an inflammatory condition involving the pilosebaceous follicle. What is the most common cause of this condition?

a) microsporum canis tinea
b) poxvirus
c) staphylococcus aureus
d) streptococcus group A

Answer 41

c) staphylococcus aureus

Question 42

Folliculitis most commonly occurs on which body surface?

a) neck and scalp
b) upper arms
c) chest and abdomen
d) legs

Answer 42

a) neck and scalp

Question 43

A culture confirms that a case of folliculitis has been caused by the most common organism for this condition. What treatment do you prescribe?

a) oral penicillin
b) dicloxacillin
c) tinactin
d) tretinoin

Answer 43

b) dicloxacillin

Question 44

A 12 yo has several vesicles and honey-colored crusted lesions on her face above her right nares. She has a history of having had a scratch in the same area several days ago. What condition do you expect?

a) acne
b) impetigo
c) herpes simplex
d) eczema

Answer 44

b) impetigo

Question 45

A 15 yo has been diagnosed as having acne. Which of the following is not true about this condition?

a) poor hygiene is the primary cause of acne
b) associated with increased adrogenic hormonal activity
c) females can have a “cyclic” component to their acne
d) severe acne having a later onset in puberty is more common in males

Answer 45

a) poor hygiene is the primary cause of acne

Question 46

A 15 yo has a history of remission and exacerbation of acne that has followed the pattern of menses for two years. However, the condition over the past 6 months has worsened to a moderate degree of severity and has been chronic and persistent. You prescribe antibiotic therapy. Which of the following antibiotics would you not consider?

a) topical clindamycin
b) oral erythomycin
c) oral minocycline
d) oral tetracycline

Answer 46

b) oral erythomycin

Question 47

A 13 yo has several firm, small (2mm), white or skin colored umbilicated papules on her neck. The lesions have been present for 3 months and have increased in number. What is your diagnosis?

a) acne
b) molluscum contagiosum
c) warts
d) cellulitis

Answer 47

b) molluscum contagiosum

Question 48

What is the cause of molluscum contagiosum?

a) microsporum canis tinea
b) poxvirus
c) staphylococcus aureus
d) streptococcus group A

Answer 48

b) poxvirus

Question 49

What treatment would you not recommend for molluscum contagiosum?

a) curettage lesions
b) oral antibiotics
c) observation
d) topical imiquimod

Answer 49

b) oral antibiotics

Question 50

A pt has 4 superficial lesions on his anterior lower abdomen of one week duration. The lesions are 4 cm in diameter, scaly, irregular shaped plaques with skin colored centers and erythematous borders. The affected areas are slightly puritic. What condition do you suspect?

a) psoriasis
b) eczema
c) tinea corporis
d) pityriasis rosea

Answer 50

c) tinea corporis

Question 51

A KOH scraping was positive for the presence of hyphae. The wood’s lamp did not fluoresce the lesions. Based on these results you can rule out which fungal infection:

a) epidermophyton floccosum
b) microsporum canis
c) trichophyton tonsurans
d) trichophyton rubrum

Answer 51

b) microsporum canis

Question 52

You see a pt after 8 weeks of treatment for tinia corporis with a topical antifungal. The original lesions have almost resolved, however, the condition has worsened with the development of several other lesions on the abdomen and groin area. Which of the following would you not consider:

a) oral antifungal medication griseofulvin
b) topical antibiotic preparation
c) continue with topical antifungal applications
d) educate again regarding not sharing personal items

Answer 52

b) topical antibiotic preparation

Question 53

A 7 yo is complaining of pain and burning on his right leg where you observe two small red puncture marks surrounded by a blanched area with erythematous border. Pt had been playing in a grassy wooded area near his home and was wearing shorts. You suspect he has been bitten by which insect?

a) mosquito
b) bee
c) recluse spider
d) black widow spider

Answer 53

d) black widow spider

Question 54

Which of the following is not true of insect stings from bees, wasps, and fire ants?

a) greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures
b) for mild reactions, cool compresses to the site of injury is the usual management
c) occurs more often during the spring and summer months
d) most stings occur in self-defense when the nonagressive insect feels threatened or irritated

Answer 54

a) greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures

Question 55

You diagnose a pt with scabies. Which of the following is not characteristic of this condition?

a) several erythematous, papular, pustular, and crusted lesions on the face
b) several excoriated scratched areas around the umbilicus and waist area
c) several linear curved lines approximately 4mm in length with a papule at the proximal end linear line
d) severe pruritus that is worse at night

Answer 55

a) Several erythematous, papular, pustular, and crusted lesions on the face

Question 56

Which of the following is not recommended as a management and treatment strategy for scabies?

a) put nonwashable items in a plastic bag and store for 1 week
b) topical antifungal applications
c) topical antiparasitics
d) topical steroids and/or oral antihistamines for pruritus

Answer 56

b) topical antifungal applications

Question 57

Pediculosis is a highly communicable, common condition in children. Which of the following is not correct of pediculosis humanus?

a) caused by an insect that does not fly or jump
b) gravid females lay ova in seams of clothing
c) prefers hairy areas of the body
d) same medication used for scabies may be used to effectively eradicate this condition

Answer 57

c) prefers hairy areas of the body

Question 58

Hypersensitivity may occur to a variety of substances causing a variety of reactions. It is important to determine if the body’s hypersensitivity reaction will cause erythema multiforme condition. which of the following is not typical of the erythema multiforme reaction?

a) target “bulls-eye” lesion with a necrotic center surrounded by a pale macular middle area and then by an erythematous peripheral ring
b) itching at site of affected skin areas
c) pain at site of affected areas, especially in the oral cavity
d) lesions which all have the same morphology on the trunk

Answer 58

d) lesions which all have the same morphology on the trunk

Question 59

You suspect a pt has a form of erythema multiforme. Erythema multiforme minor must be differentiated from erythema multiforme major. Which of the following is the most important confirming evidence for making a diagnosis of erythema multiforme major?

a) presence of deeper lesions within the dermis
b) presence of lesions on the exposed areas of the body
c) presence of pustules indicating a secondary infectious process
d) occurrence of prodromal systemic symptoms of fever, malaise, sore throat, headache, nausea, and/or vomiting

Answer 59

d) occurance of prodromal systemic symptoms of fever, malaise, sore throat, headache, nausea, and/or vomiting

Question 60

You suspect erythema multiforme major. What treatment or management is most indicated?

a) topical antibiotics due to secondary infection
b) topical steroids to lesions for pruritus
c) refer for medical evaluation
d) no treatment is indicated; condition will resolve spontaniously in one week

Answer 60

c) refer for medical evaluation

Question 61

Urticaria is a hypersensitivity allergic reaction to a variety of substances and agents. You suspect urticaria due to the typical morphology of lesions on the trunk and arms which are:

a) erythematous papules
b) vesicles
c) pustules
d) wheals

Answer 61

d) wheals

Question 62

during an acute episode of urticaria which of the following is not considered an appropriate management or treatment measure?

a) oral antibiotics to prevent secondary infection
b) oral antihistamines for pruitus
c) topical steroids to affected areas to reduce the immune response
d) cool compresses to affected areas

Answer 62

a) oral antibiotics to prevent secondary infection

Question 63

A 7 yo black female presents with several hyperkeratotic, raised, periungual lesions on the two middle fingers of her left hand. She has a history of nail biting. The most likely diagnosis is:

a) impetigo
b) molluscum contagiosum
c) verruca vulgaris
d) herpetic whitlow

Answer 63

c) verruca vulgaris

Common warts are found most usually on fingers, hands, and feet in children and are preceded by trauma such as nail biting or picking at cuticles.

Question 64

Which of the following secondary skin changes is not associated with atopic dermatitis?

a) lichenification
b) striae
c) pigment changes
d) excoriations

Answer 64

b) striae

Skin of atopic dermatitis is thickened, crusted, and hyperpigmented.

Question 65

In infants, the lesions associated with atopic dermatitis are most likely to be distributed on the:

a) cheeks and forehead
b) wrists and ankles
c) antecubital and popliteal fossae
d) flexural surfaces

Answer 65

a) cheeks and forehead

The infantile phase of atopic dermatitis follows a different pattern than that associated with childhood, which may include the face, trunk, and extensor surfaces.

Question 66

During your newborn examination you note a generalized lacy reticulated blue discoloration. This clinical presentation describes:

a) harlequin color change
b) mongolian spots
c) blue nevus
d) cutis marmorata

Answer 66

d) cutis marmorata

Cutis marmorata is the only condition that is generalized. Harlequin color change is more red than pale.

Question 67

During a 3 yo’s physical exam you observe eight light brown macules ranging in size from 0.5 to 0.75 cm on his trunk, arms, and legs. Your management plan would be to:

a) educate the family about applying sunscreen frequently
b) explain that the lesions will fade with time
c) refer to dermatologist
d) document the findings and reevaluate in 6 months

Answer 67

c) refer to dermatologist

The lesions described are cafe au lait spots. Six or more of these lesions may indicate neurofibromatosis and should be referred for further evaluation.

Question 68

A mother is worried about a light pink lesion on the back of her 2 mo child’s neck that darkens with crying. The description is consistent with:

a) sturge-weber disease
b) salmon patch
c) port-wine stain
d) hemangioma

Answer 68

b) salmon patch

Question 69

A 7 yo presents with a beefy red macular-papular rash in the diaper area with satellite lesions on the abdomen. The appropriate treatment would be:

a) clotrimazole
b) A & D ointment
c) gentian violet
d) cornstarch

Answer 69

a) clotrimazole

The rash described is Candida albicans and should be treated with an antifungal agent.

Question 70

A 4 mo infant has been irritable and has not been sleeping well. During the exam you note papular lesions on his feet and erythematous papules over his back. To confirm your suspicion of scabies you would order a:

a) wood’s lamp exam
b) microscopic skin scraping
c) KOH preparation of skin scraping
d) skin culture

Answer 70

b) microscopic skin scraping

Microscopic skin scrapings of burrows will reveal the mite, eggs, or feces if scabies are present. Although skin scrapings are not routinely done, they are definitive if there is any doubt of the diagnosis.

Question 71

A 4 mo infant has been irritable and has not been sleeping well. During the exam you note papular lesions on his feet and erythematous papules over his back. Having confirmed the diagnosis of scabies the treatment of choice would be:

a) permethrin 5%
b) lindane 1%
c) sulfur ointment 6%
d) crotamiton 10%

Answer 71

a) permethrin 5%

Permethrin is the only safe choice in this case. Lindane is contraindicated in infants younger than 6 months of age. Sulfur ointment and crotamiton are not as effective and are difficult to use.

Question 72

Which of the following statements regarding treatment of pediculosis capitis is true?

a) carpeting and furniture must be shampooed and sprayed with a pediculicide
b) nonwashable items that have come into contact with an infected person should be sealed in plastic bags for 2-4 weeks
c) hair must be trimmed close to the scalp to insure elimination of nits
d) frequent shampooing with permethrin 1% will prevent reinfestation

Answer 72

b) nonwashable items that have come into contact with an infected person should be sealed in plastic bags for 2-4 weeks

Objects that cannot be washed should be sealed in plastic bags. Since eggs mature in 7-10 days, 2-4 weeks should be sufficient to prevent reinfestation.

Question 73

You note a single, large, oval, pink patch with central clearing on a 16 yo’s back. Lesions are not present elsewhere. Results of a KOH preparation of the lesion are negative. This would confirm a diagnosis of:

a) seborrheic dermatitis
b) secondary syphilis
c) tinea corporis
d) pityriasis rosea

Answer 73

d) pityriasis rosea

Pityriasis rosea presents with a herald patch, is probably viral, and thus will not reveal hyphae or spores seen in the KOH scrapings of fungal infections such as tinea.

Question 74

A 6 yo is brought in for “hives” described as a red raised rash. Which finding would support a diagnosis of erythema multiforme rather than urticaria?

a) lesions that blanch with pressure
b) eyelid edema
c) lesions that are present for more than 24 hours
d) intense pruritus

Answer 74

c) lesions that are present for more than 24 hours

Urticarial lesions tend to be pruritic and blanch with pressure but generally fade within a few hours. Due to the large number of mast cells present in the eyelids, edema is common with urticaria. The lesions of erythema multiforme are fixed and present for up to 2-3 weeks.

Question 75

When examining a 7 mo you note red, scaly plaques in his diaper area, particularly in the inguinal folds, with satellite lesions on his abdomen. The appropriate treatment would be:

a) petrolatum/lanolin ointment
b) petroleum jelly
c) zinc oxide
d) nystatin

Answer 75

d) nystatin

The presence of satellite lesions indicate a candida rash requiring and antifungal such as nystatin. All of the other options act as barriers for urine and feces.

Question 76

A 15 yo complains of getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Clinical presentation is consistent with:

a) comedonal acne
b) mild acne
c) moderate acne
d) severe acne

Answer 76

c) moderate acne

Moderate acne is characterized by open and closed comedones, papules, and pustules. Mild acne is characterized by open and closed comedones and occasional pustules. Severe acne, in addition to lesions of moderate acne, also involve cysts. Comedonal acne is limited to open and closed comedones only.

Question 77

A 15 yo complains of getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of these medications is the appropriate choice?

a) antiandrogens
b) isotretinoin
c) minocycline
d) corticosteroids

Answer 77

c) minocycline

Oral antibiotics are used to control moderate papulopustular acne in addition to topical keratolytics (salicylic acid). Corticosteroids may be used for more severe forms or the flare ups associated with isotretinoin therapy. Antiandrogens are not recommended.

Question 78

A 15 yo complains of getting pimples all the time. You note open and closed comedones over her forehead and chin. There are more than 15 papules and pustules, but no cysts. Which of the following statements is not consistent with an appropriate management plan for acne?

a) improvement with use of keratolytic agents should occur within 4-6 weeks
b) facial scrubs are recommended before applying topical antibiotics
c) noncomedogenic moisturizers and cosmetics may be used
d) sunscreens should always be used in conjunction with retinoic acid

Answer 78

b) facial scrubs are recommended before applying topical antibiotics

Facial scrubs are not recommended and may exacerbate acne.

Question 79

A 2 do has a rash consisting of redness with yellow-white bumps all over her body except her palms and soles. The infant most likely has:

a) erythema toxicum
b) transient neonatal pustular melanosis
c) molluscum contagiosum
d) milia

Answer 79

a) erythema toxicum

The location (all over the body) and type of lesion (papule as opposed to vesicle) are consistent with the rash seen in erythema toxicum.

Question 80

A 6 yo presents with a solitary nonpruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey-colored crusts. The most likely diagnosis is:

a) herpes
b) varicella
c) nummular eczema
d) impetigo

Answer 80

d) impetigo

Question 81

A 6 yo presents with a solitary nonpruritic lesion around his upper lip. Closer inspection reveals some vesicles and honey-colored crusts. The treatment of choice is:

a) acyclovir
b) topical steroids
c) topical antibiotics
d) petrolatum/lanolin ointment

Answer 81

c) topical antibiotics

Impetigo is most likely caused by the bacteria Staphylococcus aureus, group A beta-hemolytic streptococcus, or Streptococcus pyogenes. Mild cases may be treated with topical antibiotics; if no resolution, systemic antibiotics may be necessary.

Question 82

A 4 yo black child has a depigmented macular lesion on his forehead. The lesion has sharp borders. No scales are present. The most appropriate treatment would be:

a) 1% hydrocortisone
b) alpha hydroxy acid
c) ketoconazole
d) silver sulfadiazine

Answer 82

a) 1% hydrocortisone

The most likely diagnosis is vitiligo, an area of depigmented skin more common in African Americans. It responds to steroids 30-50% of the time. Antifungals, antibiotics, or keratolytics would be of no value.

Question 83

While examining a 7 yo’s scalp you note three small patches of hair loss. broken hair is present, as is erythema and scaling. Based on this information, which of the following is most likely?

a) tinea capitis
b) traction alopecia
c) trichotillomania
d) alopecia areata

Answer 83

a) tinea capitis

Erythema, scaling, and broken hair are characteristic findings associated with tinea capitis. Traction alopecia may have associated erythema but not scaling.

Question 84

First degree/ superficial burns:

Answer 84

Involve epidermis layer only. Will appear red, swollen, and dry with areas of tenderness.

Question 85

Second degree/ partial thickness burns (superficial and deep):

Answer 85

Involve epidermis and part of dermis which may be superficial dermis or deep dermis.
Partial thickness/ superficial dermis burns will appear red, swollen, moist, and blistered with areas of tenderness.
Partial thickness/ deep dermis burns will appear as white dry areas with loss of sensation.

Question 86

Third degree/ full thickness burns:

Answer 86

Involve epidermis, dermis, and dermal appendages. Will appear white, brown, or black with swollen dry areas and loss of sensation.

Question 87

Classification of minor burns:

Answer 87

Less than 10% of body surface if burn is superficial. Less than 2% if burn is partial or full thickness.

Question 88

Classification of major burns:

Answer 88

Equal to or exceeding 10% of body surface if burn is superficial or 2% or more if burn is partial or full thickness.
Hands, feet, face, eyes, ears, and perineal burns are always considered major burns regardless of extent of body surface area affected.

Question 89

Outpatient management for minor burns:

Answer 89

1) monitor healing process daily and document changes
2) cool compresses to affected areas
3) pain control (ibuprofen and/or acetaminophen)
4) topical antimicrobials (silver sulfadiazine* or mupirocin)
5) do not open blisters
6) encourage fluids to prevent dehydration
7) petroleum jelly to maintain skin barrier
* Sulfadiazine should not be used on face due to possibility of hyperpigmentation.

Question 90

First line treatment for cellulitis, widespread impetigo, widespread folliculitis, furuncles:

Answer 90

Streptococcus: cephalexin (Keflex) 25-50 mg/kg/day in divided doses every 12 hours x 10 days (max dose 4g/day)

Stapylococcus aureus:
40 kg: Dicloxacillin 250mg every 6 hours x 10 days

MRSA: Sulfamethoxazole/Trimethoprim (Bactrim) 8-12 mg TMP/kg/day in divided doses every 12 hours x 10 days

Question 91

Mild acne:

Answer 91

Lesions are scattered covering small areas.

1) open comedones/blackheads
2) closed comedones/whiteheads

Question 92

Moderate acne:

Answer 92

Lesions are more numerous covering large areas.

1) all lesions of mild acne present
2) pustules

Question 93

Severe acne:

Answer 93

Lesions are much more numerous covering larger areas.

1) all lesions of mild and moderate acne present
2) erythema
3) nodules and cysts (often with communicating tracks)

Question 94

Managment of acne:

Answer 94

1) wash face daily with mild non-oil-based soap
a) mild acne: topical benzoil peroxide
b) moderate acne: topical benzoyl peroxide and topical trentinoin (Retin-A)
c) severe acne: topical trentinoin, topical antibiotic (clindamycin), and consider oral isotrentinoin* (Accutane)
2) add oral antibiotics for persistent and unresponsive cases of moderate and severe acne
a) tetracycline, doxycycline, minocycline
b) oral clindamycin contraindicated due to adverse GI side effects
* Isotrentinoin is teratogenic. Requires females to use birth control, and enrollment in iPLEDGE is federally mandated.

Question 95

Fist line treatment for tinea capitis (ringworm of scalp):

Answer 95

Griseofulvin 20-25 mg/kg/d by mouth once a day for 6-8 weeks (max dose 1000 mg/day)
*Topical antifungals are not effective

Question 96

First line treatment for tinea corporis (ringworm of body), tinea cruris (jock itch), and tinea pedis (athlete’s feet):

Answer 96

Topical antifungal for 6-8+ weeks:
clotrimazole
miconazole
econazole
terbinafine
ketoconazole
*If topical antifungals are ineffective prescribe oral griseofulvin.

Question 97

Management of scabies:

Answer 97

1) permethrin 5% (treat patient and household/ contacts)
2) topical steroids to reduce inflammation
3) oral antihistamines for pruritus
4) topical antibiotics (mupirocin) for localized secondary infection and oral antibiotics (dicloxacillin or keflex) for extensive secondary infection
5) wash clothing, bed linens, towels, etc. in hot water and dry on high heat
6) store nonwashable items in plastic bags for 1 week