Chapter 8

D. J. is a 4-year-old African American child with 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

a. 1% hydrocortisone

Parents are concerned about their newborn's appearance and the psychological effect on their daughter as she becomes aware of the port-wine stain. In educating the parents, you tell them about several options. Which of the following is not an appropriate management or treatment consideration? a. Application of topical steroids to the affected area to prevent pruritus b. Camouflage treatment of affected area c. Pulsed laser treatment of affected area d. Counseling for psychological concerns

a. Application of topical steroids to the affected area to prevent pruritus

Patient education regarding prevention of malignant melanoma is essential. Which of the following is not considered best prevention education? a. Avoid sunlight, especially during hours of 10:00 A. M. to 4:00 P. M. b. Avoid sun tanning lamps c. Use cover-up clothing, hats, and sunglasses d. Use sunblocks that protect against ultraviolet exposure with SPF>30

a. Avoid sunlight, especially during hours of 10:00 A. M. to 4:00 P. M.

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, applying cool compresses to the site of injury is the usual management c. Insect stings occur more often during the spring and summer months d. Most stings occur in self-defense when the nonaggressive insect feels threatened or irritated

a. Greater reaction of hypersensitivity occurs most often with the initial exposure than with subsequent exposures

Jerry has a condition (folliculitis) that most commonly occurs on which body surface? a. Neck & scalp b. Upper arms c. Chest & abdomen d. Legs

a. Neck & scalp

The condition of psoriasis is common in approximately 33% 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

a. Occurs more commonly in dark-skinned ethnic individuals

Judy, age 15 years, has been diagnosed as having acne. Which of the following is not true of this condition? a. Poor hygiene is the primary cause of acne b. Acne is associated with increased androgenic hormonal activity c. Females can have a "cyclic" component to their acne d. Severe acne having a later onset in puberty is more common among males

a. Poor hygiene is the primary cause of acne

What would you not recommend as management and treatment of contact dermatitis? a. Skin testing during the acute episode to determine whether the patient has an allergy b. Cool compresses of Burrow's solution to affected areas c. Topical steroids to affected area for 5 days d. Oral antihistamines

a. Skin testing during the acute episode to determine whether the patient has an allergy

Which of the following is not characteristic of scabies? a. The patient has several erythematous papular, pustular, and crusted lesions on his face b. The several excoriated scratched areas around the umbilicus and waist area c. The patient has several curved lines approximately 4 mm in length with a papule at the proximal end d. The patient complains of severe pruritus that is worse at night

a. The patient has several erythematous papular, pustular, and crusted lesions on his face

Which of the following is proper management for pityriasis alba? a. bland moisturizers to reduce overdrying b. topical steroids to the affected areas c. exposure of affected areas to short periods of sunlight each day d. Burrow's wet compresses to affected areas

a. bland moisturizers to reduce overdrying

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

a. cheeks and forehead

D. M., 7 months old, 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 1-2% d. cornstarch

a. clotrimazole

H. B. is 2 days old. Her mother calls and reports a rash consisting of redness with yellow-white "bumps" all over her body except for the palms and soles. The infant most likely has: a. erythema toxicum b. transient neonatal pustular melanosis c. molluscum contagiosum d. milia

a. erythema toxicum

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 short, monitored periods of sunlight

a. excise lesions

What is the best treatment for 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 antibiotic for severe cases d. oral steroid for severe cases

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

During a patient's 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 antihistamine for pruritus c. topical steroids to affected areas to reduce the immune response d. cool compresses to affected areas

a. oral antibiotics to prevent secondary infection

Treatment of choice for scabies for a 4-month old? a. permethrin 5% b. lindane 1% c. sulfur ointment 6% d. crotamiton 10%

a. permethrin 5%

In order to confirm your diagnosis of JD (erythema toxicum neonatorum), 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

a. presence of eosinophils

What symptom is commonly experience with pityriasis rosea? a. pruritus b. pain at site of lesions c. nausea d. headache

a. pruritus

While examining 7-year-old S. R.'s scalp, you not three small patches of hair loss. Broken hair is present, as are erythema and scaling. On the basis of this information, with of the following diagnoses is most likely? a. tinea capitis b. traction alopecia c. trichotillomania d. alopecia areata

a. tinea capitis

You order a culture and the results confirm that Jerry's condition (folliculitis) is caused by the most common organism for this condition. What treatment do you prescribe? a. Oral penicillin b. Dicloxacillin c. Tinactin d. Tretinoin

b. Dicloxacillin

Which of the following is not a characteristic of contact dermatitis? a. Having hypersensitivity to a substance within their environment when direct contact is made b. Experiencing a delayed reaction of several days with reexposure to an allergen c. Dermatitis may be caused by direct contact with topical medications, soaps, cosmetics, fabrics, and plants d. The typical response is redness and edema at the site of contact, which may progress to papules and vesicles

b. Experiencing a delayed reaction of several days with reexposure to an allergen

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

b. Facial scrubs are recommended before applying topical antibiotics

Sandra, age 12 years, has several vesicles and honey-colored crusted lesions on her face above the right nares. She has a history of having had a scratch in the same area several days ago. What condition do you suspect? a. Acne b. Impetigo c. Herpes simplex d. Eczema

b. Impetigo

Which of the following is not characteristic of a capillary hemangioma? a. It was not present at birth; however his mother noticed the site was blanched b. It will continue to grow for the first 9-12 months of the child's life c. It will begin to gradually resolve when the child is between 12 and 15 months of age d. It is expected to completely resolve by the time the child is 10 years old

b. It will continue to grow for the first 9-12 months of the child's life

K. C., age 13 years, has several firm, small (2-mm), 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. Ance b. Molluscum contagiosum c. Warts d. Cellulitis

b. Molluscum contagiosum

Which of the following statements regarding the 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 bag for 2-4 weeks c. Hair must be trimmed close to the scalp to ensure elimination of nits d. Frequent shampooing with permethrin 1% will prevent reinfestation

b. Nonwashable items that have come into contact with an infected person should be sealed in plastic bag for 2-4 weeks

Judy has a history of remission and exacerbation of acne that has followed the pattern of menses for 2 years. However, the condition over the last 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 erythromycin c. Oral minocycline d. Oral tetracycline

b. Oral erythromycin

What is the cause of molluscum contagiosum? a. M. canis tinea b. Poxvirus c. S. aureus d. Streptococcus group A

b. Poxvirus

Which of the following is not recommended as management and treatment strategy for scabies? a. Put nonwashable items in a plastic bag and store for 1 week b. Prescribe topical antifungal applications c. Prescribe topical antiparasitics d. Prescribe topical steroids and/or oral antihistamines for pruritus

b. Prescribe topical antifungal applications

Mrs. Franklin is concerned about a light pink lesion on the back of 2-month-old Aaron's neck that darkens with crying. This description is consistent with: a. Sturge-Weber disease b. Salmon patch c. Port-wine stain d. Hemangioma

b. Salmon patch

Which of the following secondary skin changes is not associated with atopic dermatitis? a. Lichenification b. Striae c. pigment changes d. excoriations

b. Striae

What would you teach a patient and family regarding the progress and prognosis of pityriasis alba? a. The patient will continue to develop lesions for the rest of their life b. The patient's condition should fade appreciably in 3-4 months c. The patient's condition is permanent, and affected areas will not repigment d. The patient's condition will resolve completely; however, the affected areas can become slightly reddened when exposed to sunlight

b. The patient's condition should fade appreciably in 3-4 months

You see Paul after 8 weeks of treatment with a topical antifungal preparation. The original lesions have almost resolved; however, the condition has worsened, with the development of several other larger 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. Continuing with the topical antifungal application d. Educating again regarding not sharing personal items

b. Topical antibiotic preparation

You note 10 tan macular lesions of varying sizes on a patient and refer him for a medical evaluation to rule out neurofibromatosis or Albright syndrome. What kind of lesion does the patient have? a. malignant melanoma b. cafe' au lait spots c. mongolian spots d. vitiligo

b. cafe' au lait spots

J. D. is a postterm infant with lesions of varying morphology, including wheals, vesicles, and pustules, on her trunk. You suspect J. D. has: a. cutis marmorata b. erythema toxicuma neonatorum c. milia d. contact dermatitis

b. erythema toxicuma neonatorum

To confirm the suspicion of scabies, you would order a: a. Wood's lamp examination b. microscopic skin scraping c. KOH preparation of skin scraping d. skin culture

b. microscopic skin scraping

In addition to having atopic dermatitis, you have diagnosed a child with a secondary bacterial infection at the site of several lesions. What is the best management of the infection? a. topical antibiotics to affected areas b. oral antibiotics c. hot compresses to affected areas d. monitored and controlled daily sunlight exposure

b. oral antibiotics

What is the treatment for Molluscum Contagiosum? a. curettage lesions b. oral antibiotics c. observations d. topical imiquimod

b. oral antibiotics

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

b. raised, with distinct, symmetrical borders

Mrs. J brings her 6-year-old son in because of "hives" that she describes as a red raised rash. Which of the following below 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 pruritis

c. Lesions that are present for more than 24 hours

Pediculosis is highly communicable, common condition in children. Which of the following is not correct of P. humanus? a. An insect that does not fly or jump b. Gravid females lay ova in seams of clothing c. Likes hairy areas of the body better than the nonhairy body surfaces d. Same medication used for scabies may be used to effectively eradicate this species

c. Likes hairy areas of the body better than the nonhairy body surfaces

During 15-year-old NM's routine physical examination, she 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. NM's clinical presentation is consistent with: a. Comedonal acne b. Mild acne c. Moderate acne d. Severe acne

c. Moderate acne

Jerry has been diagnosed as having folliculitis, an inflammatory condition involving the pilosebaceous follicle. What is the most common cause of this condition? a. Microsporum canis tinea b. Poxvirus c. Staphlycoccus aureus d. Streptococcus group a

c. Staphylococcus aureus

You have a child diagnosed with acute atopic dermatitis. Which of the following is not correct regarding the incidence of this condition? a. The child is most likely an infant b. The child has a greater chance of developing asthma later in childhood than the average individual c. The child has a greater chance of developing malignant melanoma in adulthood than the average individual d. The child has a condition associated with familial predisposition

c. The child has a greater chance of developing malignant melanoma in adulthood than the average individual

Paul has four superficial lesions on his anterior lower abdomen of 1 week's duration. The lesions are 4 cm in diameter, scaly, irregular-shaped plaques with skin-colored centers and erythematous borders. The affected areas are slightly pruritic. What condition do you suspect Paul has? a. Psoriasis b. Eczema c. Tinea corporis d. Pityriasis rosea

c. Tinea corporis

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 he has? a. malignant melanoma b. port-wine stain c. capillary hemangioma d. burn

c. capillary hemangioma

You suspect your patient has chronic psoriasis. Which of the following is characteristic of her lesions is she has psoriasis vulgaris? a. scaly erythematous patches and plaques 3-10 mm in diameter b. round or oval in shape c. large, scaly, silver-white plaques 5-10 cm in diameter d. located mainly on her trunk

c. large, scaly, silver-white plaques 5-10 cm in diameter

What is the characteristic of cafe' au lait spots? a. they are more common in Caucasians than in dark-skinned individuals b. they are more common in males than in 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

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

Which of the following management measures or treatments would you not recommend for a child with acute atopic dermatitis? a. apply topical steroids to affected areas b. apply wet compresses to affected skin areas c. maintain a dry, warm environment d. eliminate all substances that dry the skin

c. maintain a dry, warm environment

Which medication is the appropriate choice for moderate acne? a. antiandrogens b. isotretinoin c. minocycline d. corticosteroids

c. minocycline

What management would you not recommend for a child with pityriasis rosea? a. cool bath or compresses to lesions b. topical steroids to lesions c. oral antibiotics d. monitored and controlled daily sunlight exposure

c. oral antibiotics

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

c. pityriasis alba

You have diagnosed Jale as having contact dermatitis. Which symptom is most characteristic of his condition? a. HA b. difficulty breathing c. pruritus at site of affected areas d. pain at site of affected areas

c. pruritus at site of affected areas

What is the treatment of erythema multiforme major? a. prescribe topical antibiotics because of secondary infection b. prescribe topical steroids applied to lesions for pruritus c. refer for medical evaluation d. no treatment is indicated because the condition will resolve spontaneously in 1 week

c. refer for medical evaluation

A 7-year-old African American 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

c. verruca vulgaris

Dale, age 7 years, is complaining of pain and burning on his right leg, where you observe two small red puncture marks surrounded by a blanched area with an erythematous border. He had been playing with his dog all morning outside 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. Brown recluse spider d. Black widow spider

d. Black widow spider

Malignant melanoma is a form of much-dreaded skin cancer. Which of the following is not characteristic of this condition/ a. It occurs in all ethnic groups but more commonly in light-skinned individuals b. Severe sunburn or excessive exposure to sunlight before the age of 10 years predisposes developing melanoma later in childhood or in adult life c. It spreads through the lymphatic system and invades other distant skin surfaces and organs d. It spreads primarily by invading skin surfaces that surround the major lesions

d. It spreads primarily by invading skin surfaces that surround the major lesions

Hypersensitivity may occur to a variety of substances, causing a variety of reactions. It is important to determine whether the body's hypersensitivity reaction will cause an 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 caviity

d. Lesions that all have the same morphology on the trunk

In addition to monitoring the skin for any changes, what is the best management for JD (toxicum neonatorum)? a. topical antibiotics on lesions b. topical steroids on lesions c. a moisturizer on lesions d. No treatment is necessary since JD's condition will resolve spontaneously in 5-7 days

d. No treatment is necessary since JD's condition will resolve spontaneously in 5-7 days

You examine a newborn and observe numerous white papular lesions on the cheek, forehead, and nose. Which physical finding helps to 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, bluish area with erythematous mottling d. Papular lesions, yellow in color, are observed on the hard palate

d. Papular lesions, yellow in color, are observed on the hard palate

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 spot d. Port-wine stain (nevus flammeus)

d. Port-wine stain (nevus flammeus)

Seborrhea dermatitis is common in both infants and adolescents. Which of the following is not correct of this condition? a. Can cause irritation 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 comedones, papular and pustular lesions

d. The condition in adolescents is known as acne with comedones, papular and pustular lesions

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

d. cutis marmorata

A major first-and second- degree burn should appear: a. dry, with mild edema and erythema b. as dry, whitish areas that blanch with pressure c. as dry, whitish to brownish areas with edema d. moist with edema, erythema, and a few vesicles

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

When examining 7-month-old R. V. 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

d. nystatin

You see a child in your clinic and suspect she 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

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

An 8-year-old 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

d. pityriasis rosea

What is the best treatment for a major first-and second- degree burn? a. warm compresses to affected areas and mild analgesic for discomfort b. topical emollients to affected areas c. topical steroids to affected areas d. referral for urgent treatment in an emergency department

d. referral for urgent treatment in an emergency department

You are evaluating a 3-year-old, who sustained an acute burn when she pulled a pan of boiling water onto herself within the past hour. Because 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 in 5% of her body surface is burned and the burned area involves the epidermis and upper part of the dermis? a. she has minor first- and second- degree burns 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

d. she has major first-and second- degree burns

Urticaria is an allergic hypersensitivity reaction to a variety of substances and agents. You suspect a pt has urticaria because of the typical morphology of lesions on her trunk and arms, which are: a. erythematous papules b. vesicles c. pustules d. wheals

d. wheals