Pathophysiology: Chapter 48: Alterations of the Integument in Children

Question 1

Which immunoglobulin (Ig) is elevated in atopic dermatitis?

a. IgA c. IgE
b. IgM d. IgG

Answer 1

ANS: C
In the acute phase of atopic dermatitis, inflammation is associated with the activation of T
helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]–4, IL-5, and
IL-13) and chemokine ligand 1 (CCL1) and 18 (CCL18) with increases in IgE,
eosinophils, and macrophages. The remaining options will not be elevated as related to
atopic dermatitis.

Question 2

Which leukocytes are elevated in atopic dermatitis?

a. Eosinophils c. Basophils
b. Neutrophils d. Monocytes

Answer 2

ANS: A
In the acute phase of atopic dermatitis, inflammation is associated with the activation of T
helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]–4, IL-5, and
IL13) and chemokine ligand 1 (CCL1) and 18 (CCL 18) with increases in IgE,
eosinophils, and macrophages. Other leukocytes will not be elevated as related to atopic
dermatitis.

Question 3

Which clinical manifestation is considered the hallmark of atopic dermatitis?

a. Papular rash
b. High fever
c. Vesicles that burst and form crusts
d. Itching

Answer 3

ANS: D
Of the options, only itching is considered a hallmark of atopic dermatitis, and rubbing and
scratching to relieve the itch are responsible for many of the clinical changes of atopic
dermatitis.

Question 4

Frequently, diaper dermatitis is secondarily infected with which organism?

a. Escherichia coli c. Proteus spp.
b. Candida albicans d. Staphylococcus aureus

Answer 4

ANS: B
Of the options available, frequently the infant with diaper dermatitis is secondarily
infected with C. albicans.

Question 5

The disruption in cellular adhesion observed in bullous impetigo is caused by an
exfoliative toxin related to which organism?
a. Staphylococcus aureus
b. Streptococcus pyogenes
c. Escherichia coli
d. Candida albicans

Answer 5

ANS: A
Bullous impetigo is a rare variant of impetigo caused by S. aureus. The staphylococci
produce a bacterial toxin called exfoliative toxin (ET), which causes a disruption in
desmosomal adhesion molecules with blister formation characteristic of bullous impetigo.
This selection is the only option that identifies the correct organism.

Question 6

The staff member of a crowed day care center is a source for which bacterial infection?

a. Atopic dermatitis
b. Staphylococcal scalded-skin syndrome
c. Impetigo
d. Tinea capitis

Answer 6

ANS: C
Impetigo is a common bacterial skin infection in infants and children and is particularly
infectious among people living in crowded conditions with poor sanitary facilities or in
settings such as day care facilities. The other options are not as infectious as impetigo.

Question 7

Skin lesions that rupture, creating a thin, flat, honey-colored crust, are the hallmark clinical
manifestation of which skin disorder?
a. Rubella c. Atopic dermatitis
b. Tinea capitis d. Bullous impetigo

Answer 7

ANS: D
Of the options available, only the vesicular impetigo lesions that begin as small vesicles
with a honey-colored serum are the hallmark clinical manifestation of bullous impetigo.
Yellow to white-brown crusts form as the vesicles rupture and extend radially

Question 8

Skin lesions caused by tinea corporis are best described as:

a. Pink-to-red coalescing maculopapular rash on the scalp or trunk
b. Vesicles that rupture, creating a thin, flat, honey-colored crust
c. Circular (round or oval) lesions with erythema and scaling patches
d. Red papules, vesicles, and pustules in clusters

Answer 8

ANS: C
Lesions caused by tinea corporis are often erythematous, round, or oval-scaling patches
that peripherally spread with clearing in the center, creating the ring appearance, which is
why this disease is commonly referred to as ringworm. None of the other options
accurately describe the lesions associated with tinea corporis.

Question 9

What is a common contact source of tinea corporis?

a. Mites c. Ponies
b. Kittens d. Ticks

Answer 9

ANS: B

Contact with only kittens and puppies is considered a common source of tinea corporis.

Question 10

What is the cause of molluscum contagiosum?

a. Bacteria c. Fungi
b. Virus d. Rickettsia

Answer 10

ANS: B
The poxvirus is the only organism that induces epidermal cell proliferation and blocks
immune responses that would control the virus as noted with molluscum contagiosum.

Question 11

Thrush is a superficial infection that commonly occurs in children and is caused by which
organism?
a. Staphylococcus c. Herpesvirus
b. Streptococcus d. Candida albicans

Answer 11

ANS: D
C. albicans infection is a superficial fungal infection that commonly occurs in children. C.
albicans is part of the normal skin flora in certain individuals and invades susceptible
tissue sites if the predisposing factors are not eliminated. This description is not accurate
for any of the other options.

Question 12

How is thrush best defined?
a. Presence of Candida in the mucous membranes of the mouths of infants
b. Presence of bacteria in the nasal mucous membranes of infants
c. Any viral infection of the mucous membranes of the mouths of infants
d. Acute immune response to oral medication, located in the mucosal lining of the
mouths of infants

Answer 12

ANS: A
Thrush is the term used to describe the presence of Candida in the mucous membranes of
the mouth of infants and, less commonly, in the mouth of adults. This selection is the only
option that accurately describes thrush.

Question 13

Which viral disease has an incubation period of 14 to 21 days and duration of 1 to 4 days?
a. Rubeola c. Roseola
b. Rubella d. Varicella
ANS: B

Answer 13

Only rubella has an incubation period that ranges from 14 to 21 days and a duration of 1 to
4 days.

Question 14

Rubella (German or 3-day measles) is a common communicable disease of children
caused by what type of organism?
a. Virus c. Fungus
b. Bacterium d. Yeast

Answer 14

ANS: A
Rubella is a common communicable disease in children and young adults and is caused
only by a ribonucleic acid (RNA) virus that enters the bloodstream through the respiratory
route.

Question 15

Rubeola is a highly contagious acute disease in children caused by which type of
infection?
a. Bacterial c. Yeast
b. Fungal d. Viral

Answer 15

ANS: D

Rubeola, a highly contagious acute disease in children, is a result of only a viral infection.

Question 16

Which clinical manifestation is present in rubeola but not in rubella?

a. Conjunctivitis c. Presence of a cough
b. Enlarged lymph nodes d. Runny nose

Answer 16

ANS: A
Prodromal symptoms of rubeola include high body temperature (up to 40.5 C [104.9 F]),
malaise, enlarged lymph nodes, runny nose, conjunctivitis, and a “barking” cough.
Prodromal symptoms of rubella are few but may include enlarged cervical and
postauricular lymph nodes, low-grade fever, headache, sore throat, runny nose, and cough.

Question 17

What is the cause of chickenpox?

a. Poxvirus
b. Varicella-zoster virus
c. Adenovirus
d. Human papillomavirus

Answer 17

ANS: B
Only a varicella-zoster viral infection produces chickenpox (varicella) and herpes zoster
(shingles).

Question 18

Which contagious disease has clinical manifestations of burrows several millimeters to 1
cm long, papules, and vesicular lesions with severe itching that worsens at night?
a. Pediculosis c. Scabies
b. Tinea capitis d. Rubeola

Answer 18

ANS: C
Only scabies has symptoms that appear 3 to 5 weeks after infestation. The burrows,
papules, and vesicular lesions cause severe itching that worsens at night.

Question 19

Which contagious disease creates a primary skin lesion that is a pinpointed macule,
papule, or wheal with hemorrhagic puncture site?
a. Pediculosis c. Scabies
b. Tinea capitis d. Rubeola

Answer 19

ANS: A
Of the options available, only the primary lesion of the body louse (pediculosis) exhibits a
pinpoint red macule, papule, or wheal with a hemorrhagic puncture site.

Question 20

Which contagious disease is caused by the itch mite?

a. Miliaria c. Pediculosis
b. Tinea corporis d. Scabies

Answer 20

ANS: D

Scabies is the only contagious disease caused by the itch mite, Sarcoptes scabiei.

Question 21

Which vascular anomaly is associated with a congenital malformation of dermal
capillaries that does not fade with age?
a. Cutaneous hemangioma 
b. Port-wine (nevus flammeus) stain
c. Strawberry hemangioma 
d. Cavernous hemangioma

Answer 21

ANS: B
A port-wine stain is the only option that is present at birth or within a few days after birth
and does not fade with age.

Question 22

Which skin disorder is characterized by a vesicular eruption after prolonged exposure to
perspiration, with subsequent obstruction of the eccrine ducts?
a. Scabies c. Pediculosis
b. Tinea corporis d. Miliaria

Answer 22

ANS: D
Of the available options, only miliaria is characterized by a vesicular eruption after
prolonged exposure to perspiration, with subsequent obstruction of the eccrine ducts.

Question 23

What is the treatment plan for a strawberry hemangioma?

a. Cosmetic surgical removal
b. Topical steroid therapy
c. Oral antibiotics
d. Support of its involution

Answer 23

ANS: D
Approximately 90% of strawberry hemangiomas involute by 5 to 6 years of age, usually
without scarring; therefore self resolution is the usual treatment plan.