Week 3 - Dermatology

Question 1

You are teaching self-skin examination to your patient. You explain to you patient the “D” of ABCDE technique stands for: (Bates, p 179; Pearls & Pitfalls lecture)

a. Duration
b. Diameter
c. Depth
d. Dimpling

Answer 1

B Diameter

Question 2

You see a notation that the patient’s rash is plaque. An example of a plaque would be: (Bates, p. 192)

a. Fifth’s disease
b. Erythema migrans
c. Varicella zoster
d. Herald patch of pityriasis rosea

*Extra: describe findings of each with appropriate terminology

Answer 2

D - Herald patch of pityriasis rosea

fifth’s disease (erythema infectious) -

erythema migrans -

varicella zoster - vesicle

Question 3

Common, benign newborn skin findings include all except: (Bates, p. 819)

a. Hair tufts at mid lumbar spine
b. Jaundice
c. Acrocyanosis
d. Erythema toxicum

*Extra: describe each condition and it’s etiology

Answer 3

A. Hair tufts at mid lumbar spine - suggest possible spinal cord defect

Jaundice - during days 2 to 5 of life progress from head to toes as it peaks. extreme jaundice = hemolytic process or biliary or liver disease

acrocyanosis - bluish discoloration, usually in palms and soles

erythema toxicum - rash consists of erythematous macule with central pinpoint vesicles scattered diffusely over the entire body

Question 4

You see blanching on exam. You understand this to mean: (Bates, p 183)

a. Inflammation
b. Vascular lesion
c. Contact dermatitis
d. Umbilicated lesion

Answer 4

A inflammation

Question 5

Which dermatological issue may present with a herald patch? (Bates, p 912)

a. Rosacea
b. Pityriasis Rosea
c. Pityriasis versicolor
d. Vitiligo

*Extra: describe each condition and it’s etiology

Answer 5

B pityriasis rosea

rosacea -

pityriasis versicolor -

vitiligo - large confluent completely depigmented patches on dorsal hands and distal forearms

Question 6

You find circumscribed, superficial elevations of the skin formed by free fluid with the skin layers that measures 0.6 cm. You know that this is: (Bates, p 183)

a. Vesicle
b. Wheal
c. Papule
d. Bulla

*Describe each term

Answer 6

A vesicle (clear fluid blisters)

wheal - area of localized dermal edema that evanesces (comes and goes) within a period of 1-2 days (primary lesion of urticaria). variably sized.

papule - <1cm, not fluid filled (broad raised area)

bulla - >1cm, fluid filled (larger vesicle)

Question 7

Your 14-mo-old patient presents today with moist, bright-red maculopapular lesions with sharp borders & satellite lesions in the intertriginous folds. You suspect: (Bates, p 911; Pearls & Pitfalls lecture)

a. Tinea cruris
b. Candidiasis
c. Tinea versicolor
d. Thrush

Answer 7

B candidiasis (diaper rash)

intertriginous - areas where two skin areas touch/rub. the axilla or the arms, the anogenital region, skin folds of the breast etc..

Question 8

8. You see this on exam. You describe this as a: (Bates, 195)
   - –red presentation of urticaria all over neck and chest

a. Vesicle
b. Wheal
c. Burrow
d. Patch

Answer 8

B - wheal

Question 9

This is a dense layer of interconnecting collage & elastic fibers that contain sebaceous & sweat glands, hair follicles & terminals of the cutaneous nerves: (Bates, p. 174)

a. Epidermis
b. Subcutaneous tissue
c. Dermis
d. Adipose layer

Answer 9

C dermis

epidermis - thin avascular keratinized epithelium consisting of two layers where both melanin and keratin are formed

Question 10

The FNP assesses honey-crusted lesion on 4 y.o. Billy’s face. The FNP suspects this common, contagious bacterial superficial skin infection: (Bates, p 911; Pearls & Pitfalls lecture)

a. Acne vulgaris
b. Cellulitis
c. Folliculitis
d. Impetigo

Answer 10

D Impetigo

Question 11

You are performing a newborn exam & observe the following on inspection. You inform the caregiver that this is a benign condition known as: (Bates, p 820)

–dark blue spots all over the butt cheeks

a. Blue slate patch
b. Café au lait spot
c. Pustular melanosis
d. Miliaria rubra

*Extra: Describe each finding

Answer 11

A blue slate patch

cafe au lait spot - light brown pigmented lesions usually have border and are uniform

pustular melanosis - small vesiculopustules over a brown macular base; these can last for several months. presents at birth and seen more commonly in black infants

milia rubra - scattered vesicles on an erythematous base, usually on the face and trunk, result from obstruction of ht sweat gland ducts; this condition disappears spontaneously within weeks

Question 12

A deep infection involving the base of the follicle & deep dermis is known as folliculitis. (Bates, p 194)

a. True
b. False

Answer 12

B false

foliculitis - erythematous papule and pustules on frontal, temporal, and parietal scalp

furuncle - inflamed hair follicle; multiple furuncles together form a carbuncle

Question 13

A lesion that is < 1 cm, raised & filled with fluid is know as: (Bates, p. 193)

a. Furuncle
b. Pustule
c. Bullae
d. Vesicle

Answer 13

D vesicle

Question 14

An example of a secondary skin lesion is: (Pearls & Pitfalls lecture)

a. Macula
b. Pustule
c. Lichenification
d. Patch

Answer 14

C linchenification

Question 15

You see scattered vesicles on an erythematous base on the face & the trunk. You know this is caused by obstruction of the sweat glands. You provide education to the caregivers explaining this generally disappears spontaneously, and there’s no intervention needed. This is identified as: (Pearls & Pitfalls lecture)

a. Erythema toxicum
b. Miliaria rubra
c. Pustular melanosis
d. Milia

Answer 15

B miliaria rubra

Question 16

Your 9 y.o. patient presents with cc of low-grade fever, headache, malaise, mild rhinitis symptom with initially an intensely red cheeks “slapped cheek” that appeared on days 3-5 & then faded, a lacy maculopapular eruption then appeared on trunk & then the arms, thighs & buttocks. You are most suspicious of: (Pearls & Pitfalls lecture)

a. Erythema infectiosum
b. Erythema multiform
c. Rubella (German measles)
d. Measles

Answer 16

A erythema infectiosum

Question 17

You see lesions that are described as “a dew drop on a rose petal”. You can see the vesicle on an erythematous base. It presents with pruritis, fever, generally unwell symptoms. You suspect (Pearls & Pitfalls lecture).

a. Erythema infectiosum
b. Erythema multiform
c. Varicella
d. Measles

Answer 17

C varicella

Question 18

You would describe the following lesions: (Bates, p 182)

a. Macule: Lesion is flat and <1 cm
b. Papule: Lesion is raised, <1 cm, and not fluid filled
c. Vesicle: Lesion is raised, <1 cm, and filled with fluid
d. Plaque: Lesion is raised, >1 cm, but not fluid filled

Answer 18

A macule

Question 19

You see the following on exam & diagnosis your patient with molluscum contagiosum. You describe the lesion as (Bates, p 192)

—small pink domed pimple looking things where there is hair

a. Macule
b. Vesicle
c. Pustule
d. Papule

*Extra: Describe each term & given an example of each

Answer 19

D papule
ex: basal cell CA, skin tags, guttate psoriasis,

macule - flat <1cm
ex: drug eruption, tinea versicolor, benign melanocytic nevi

vesicle - raised, fluid filled <1cm
ex: herpes simplex, herpes zoster “shingles”, allergic dermatitis/contact dermatitis

putstule - small palpable collection of neutrophils or keratin that appears white
Ex: acne vulgaris, bacterial folliculitis,

Question 20

You diagnose your patient with poison ivy based on the following findings. The primary lesion would be describe as: (Bates, p 193)

—raised fluid filled <1cm erythematous

a. Bullae
b. Pustule
c. Vesicle
d. Plaque

*Extra: Describe each term & given an example of each

Answer 20

C vesicle

bullea - >1cm, fluid filled, larger vesicle

pustule - small palpable collection of neutrophils or keratin that appears white
Ex: acne vulgaris, bacterial folliculitis

plaque - >1cm, not fluid filled, broad raised area
Ex: plaque psoriasis, atopic dermatitis, pityriasis rosea, nummular dermatitis,