Module 5 Practice Questions

Question 1

Why don’t we want to give steroid refills?

Answer 1

Prolonged use can cause systemic affects, secondary dermatitis, epidermal cysts, etc.

Question 2

What steroids can the APRN prescribe?

Answer 2

Can prescribe potent steroids but will typically give 3-7 (medium to least potent): triamcinolone acetonide, betamethasone valerate, hydrocortisone, desonide, hydrocortisone butyrate.

Question 3

Your patient is concerned about a spot on their face that has been there for about three months. The lesion is raised in the center and has a pearly border, with a distinct margin. What is your diagnosis?

Answer 3

Basal Cell Carcinoma

Question 4

An 80-year-old client has an extremely painful rash along her rib cage on her left side. The rash is raised, red, and has clear vesicles. The best management plan is?

Answer 4

A -cyclovir

Valcyclovir 1,000 mg orally three times daily for seven days

Question 5

Your patient is reporting blisters that have erupted on their lip, body aches, a sore throat, and a headache. This is the first time they have experienced this. The exam reveals, positive cervical lymphadenopathy, a cluster of tiny blisters with red rims and yellow fluid at the corner of her lower lip, and an elevated temperature of 100.8*F, other vital signs are normal. Your most likely diagnosis is:

Answer 5

primary herpes simplex infection

Question 6

Your patient is being treated for Psoriasis. You know that essential education for this patient includes:

Answer 6

Psoriasis is a chronic disease process and the importance of adherence to prescribed regimens

Question 7

When considering which dermatological vehicle of medication to prescribe for the treatment of a skin condition, what principles should a clinician follow?

Answer 7

For dry conditions, use moisture preserving vehicles and for wet conditions, use drying vehicles

Question 8

Tinea is caused by a:

Answer 8

fungus

Question 9

Which of the following vehicles is the most potent?

Answer 9

ointment

Question 10

A patient reports a large area of red, raised, shiny skin that encompasses their right calf. The pain is 7 out of 10. They first noticed a small sore on their ankle the day before. Their temperature is 101.1*F. Other vital signs are normal. On examination, there is positive lymphadenopathy noted in their right groin and the right leg is swollen from the knee down. Which interventions should be included in your non-pharmacologic management plan?

Answer 10

rest, compression and elevation

Question 11

What is true about corticosteroids effect on the skin

Answer 11

corticosteroids can cause thinning and striae of the skin

Question 12

When considering which antibiotic to prescribe for infections of the skin such as cellulitis, effectiveness against group A beta-hemolytic streptococci, and what other pathogen should guide our choice?

Answer 12

Staphylococcus aureus (group A beta-hemolytic streptococci are the most common cause of cellulitis without purulent drainage, but staphylococcus aureus should be considered if purulent drainage is present or a puncture wound)

Question 13

A patient has a raised crusted lesion surrounding a center ulcer found on the top of their right ear, which is about the size of a pencil eraser. It has been present for a couple of months. What is the best plan of care?

Answer 13

Advise them about your suspicion of squamous cell carcinoma, and make them an appointment for a biopsy and follow-up before they leave your office.

Question 14

A medication that can be used initially in the treatment of mild acne :

Answer 14

Topical tretinoin (Retin A)

Question 15

A patient with Type II diabetes mellitus is seen in the clinic complaining of a burning, pruritic rash under both breasts and in the groin area. They tell the provider that the rash is red and moist and the corn starch they have been using is not helping. Your most likely diagnosis is?

Answer 15

Intertrigo with secondary Candida infection (Intertrigo occurs where there is persistent skin-to-skin contact, erythema, and pruritis suggest secondary fungal infection)

Question 16

Place the following dermatological vehicles in order of increasing oil content and ability to potentiate the pharmacological agent placed in the vehicle [from least potentiating to most potentiating].

Answer 16

solution, gel, lotion, cream, ointment

Question 17

What is the difference between a Primary and Secondary outbreak of Oral Herpes Simplex? Include the recommended treatment regimen.

Answer 17

Primary outbreak is when an individual is experiencing their first outbreak. Secondary outbreak the individual has preexisting immunity

Treat with -cyclovir

Question 18

Why is it important to remember the type of vehicle for medication management with dermatologic conditions?

Answer 18

Because the vehicle helps the delivery of the medication into the deeper regions of the skin. If the wrong vehicle is chosen it can be potent and also affect patient compliance. Vehicles are chosen based upon the size and properties of the skin to be treated

Question 19

What are the primary Subjective and Objective data that present with Psoriasis?

Answer 19

Subjective: scale-like patches, areas bleed easily, may have “raindrop” plaques (some can be smaller than 1cm), and the patches are frequently noted on the elbows, knees, scalp, genitals, and intergluteal folds.

Objective: maculopapular lesions that are erythematous and well-circumscribed/demarcated and are covered in silvery white scales (often found in the areas noted in subjective…always look where they report having patches); may have pitting on the nails

Question 20

When and why do you need to refer a patient with Rosacea?

Answer 20

We would want to refer the patient with Rosacea if their symptoms develop into ocular rosacea and the patient experiences light sensitivity, blurred vision, or foreign body sensation of the eye. This might warrant referral to an opthalmologist. The patient may need to see a mental health provider for body image disturbances or a dermatologist if symptoms do not resolve with treatment.

Question 21

If you have a patient who has acne vulgaris and they have a history of a blood clot, what would be your recommended management?

Answer 21

Start with nonpharmacologic by having the patient use mild cleansers, if they’re not already, for their skin. Have patients use water-based products to not dry out their skin. Refer the patient to a dermatologist if the patient has recalcitrant or severe nodulocystic acne and if needed, a mental health professional related to depression and self-esteem. As a provider topical therapy, considered to be the first line, may not be the way to go since one of the side effects is erythema. In this case, Oral antibiotics would be an option instead of topical. Ok to use spirinolactone

Question 22

What is the most common Subjective and Objective data of a patient who presents with concerns for skin cancer?

Answer 22

melanoma has the most pigment changes, can have several colors and irregularity to it

BCC- the most common- pearly, shiny, normal skin color (or slightly pigmented)

SCC- scaly and scabby, bleeds easily, doesn’t heal, volcano shape- does this mean it grows and sits above the skin like a wart?!

actinic keratosis- rough scaly patch on skin, persistent, reddened

Question 23

What is the difference between Basal Cell Carcinoma and Squamous Cell Carcinoma?

Answer 23

Basal cell carcinoma: commonly appears as a pearly white, dome-shaped papule with prominent telangiectatic surface vessels.

Squamous cell carcinoma: commonly appears as a firm, smooth, or hyperkeratotic papule or plaque, often with central ulceration. “Sore that will not heal”

Question 24

Your patient comes to you and reports that they have chest pain and lately feel anxious, also some shortness of breath. They have acne vulgaris and have been on drospirenone. Do you need to do any diagnostics? What is your plan of care?

Answer 24

Because drospirenone increases the risk of blood clots, you would want the patient to be checked out for a pulmonary embolus with these symptoms. This goes beyond what can be investigated in clinic, so you can have someone call 911 and get a set of vitals and pulse ox while awaiting the ambulance. They’d need increased monitoring, blood work, and imaging at the nearest hospital.

Of course, you can start with basic vital signs in the office, and throw a pulse ox on just so that you can trend their O2 SATs until the EMS gets there.

Question 25

If we are looking at a person 25 years older presenting with Ance Vulgaris would a differential diagnosis be PCOS, due to the circulating androgens?

Answer 25

Yes, because in PCOS androgen is in excess. Androgens increase sebum production, thus giving a predisposition to acne vulgaris.

Question 26

Why don’t you tell me what you know about HSV? Are the current recommendations for treatment that our text/lectures mention?

Answer 26

There are three stages: primary, latent, and reoccurring outbreaks. Infection occurs with direct contact with an individual with active lesions. The virus enters the epithelial cells and replicates. Affects reginal, sensory or autonomic nerves. A good history is needed to aid in dx. It’s okay to treat while awaiting culture. Culture takes 2-7days. Start treatment at the onset and avoid contact when the individual has an active lesion. You can transmit even if an individual has no lesions. Complications are rare but they can happen. Highly contagious and there is no cure and is lifelong

Recommended treatments: Acyclovir, Valacyclovir, Famciclovir

Question 27

What should we be taking away from onychomycosis?

Answer 27

This is chronic and long-term. These patients will report that they have this yellowish-brown discoloration, that they have a greenish tinge on the nail, and that the nail that is affected is thicker than the other meals. When you inspect this patient, you’re going to also see a yellowish-brown discoloration or you could see this greenish tinge nail color that they’re saying, and you’re also going to observe that the nail is thicker than the other surrounding nails.”

Question 28

A patient who works as a cashier at McDonald’s, is complaining of a rash on their hands for two weeks. The rash itches and occasionally burns. They started using a new soap to clean the counters at work. The rash is on the palmar surface of the hands and on all her fingers, irregularly distributed in scaly, maculopapular erythematous patches. The nails are spared. What is your diagnosis?

Answer 28

contact dermatitis

Question 29

A 21-year-old client, who works as a cashier at McDonald’s, is complaining of a rash on her hands for two weeks that her supervisor finds offensive. The rash itches and occasionally burns. She started using a new soap to clean counters at work about 3 weeks ago. Past history is significant for dry skin that she has treated with moisturizers and cortisone cream. The rash is on the palmar surface of her hands and on all her fingers, irregularly distributed in scaly, maculopapular erythematous patches. The nails are spared. In addition to avoiding the offending agent, what client education should be included?

Answer 29

Apply petrolatum after cleaning hands, typically with an alcohol-based cleanser

Question 30

The APRN has diagnosed a client with Tinea Unguium. The education for this patient includes:

Answer 30

A 12-week regimen of oral Terbinafine is recommended

Question 31

Acne Rosacea differs from acne vulgaris in that:

Answer 31

It does not present with comedones

Question 32

A 25-year-old new graduate student, is in the clinic today for a worsening skin condition. The lesions are on their elbows, knees, scalp, and intergluteal cleft. The lesions have a red base and are covered by a silvery scale. These became worse while in school. What is your management plan?

Answer 32

topical glucocorticosteroids and referral to a dermatologist

Question 33

Your patient is reporting blisters that have erupted on their lip, body aches, a sore throat, and a headache. This is the first time they have experienced this. The exam reveals, positive cervical lymphadenopathy, a cluster of tiny blisters with red rims and yellow fluid at the corner of her lower lip, and an elevated temperature of 100.8*F, other vital signs are normal. Your management plan includes:

Answer 33

Acyclovir 400mg PO 3 times daily for 7-10 days