Dermatology

22. 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 9:00 a.m. to 1:00 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: Avoiding sunlight is not the best prevention. Avoiding tanning beds and using cover-ups, hats, sunglasses, and sunscreen are the best prevention.

71. While examining 7-year-old S. R.'s scalp, you note three small patches of hair loss. Broken hair is present, as is erythema and scaling. On the basis of this information, which of the following diagnoses is most likely? a. Tinea capitis b. Traction alopecia c. Trichotillomania d. Alopecia areata

A: Erythema, scaling, and broken hair are characteristic findings associated with tinea capitis. Traction alopecia may have associated erythema, but not scaling. Whereas neither trichotillomania nor alopecia areata are associated with erythema or scaling, only alopecia areata is noted for total hair loss

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

A: Folliculitis most commonly occurs on localized areas of erythema and edema with papular or pustular lesions on face, scalp, neck, buttocks, and other areas

30. 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 for severe cases d. Oral steroids for severe cases

A: For infants, shampoo and wash affected areas with a nonperfumed baby shampoo or baby wash and use mineral oil with brushing to loosen crusts prior to washing

6. W. R.'s 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 an appropriate management or treatment consideration for W. R.? a. Application of topical steroids to the affected area to prevent pruritus b. Camouflage of affected area with cosmetics c. Pulsed laser treatment of affected area d. Counseling for psychological concerns

A: Management consists of referral for dermatologist evaluation for consideration of pulsed dye laser treatment, which is recommended to start as early as possible in infancy and definitely before 1 year of age. The area may be camouflaged later in childhood with water-resistant cosmetics. Using a steroid cream is not indicated.

25. What would you not advise regarding the management or treatment of M. N.'s condition? a. Excise lesions b. Apply topical steroids c. Apply mineral oil and moisturizers d. Expose to monitored short periods of sunlight

A: Management does not consist of excising the lesions. The use of topical steroids, mineral oil, and moisturizers may help with lesions. Decreasing exposure to direct sunlight also is part of the management.

The mother of 4-month-old TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note popular lesions on his feet and erythematous papules over his back. 62. Having confirmed the diagnosis of scabies in TW, the treatment of choice would be: a Permethrin 5% b. Lindane 1% c. Sulfur ointment 6% d. Crotamiton 10%

A: 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

38. 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: Proven factors that may contribute to acne development are increased androgenic hormonal influence, positive family history, and stress. Unproven factors with questionable and unsubstantiated contribution are food—nuts, eggs, cheese, chocolate, milk—and poor hygiene

24. M. N.'s 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

A: Psoriasis is more common in light-skinned than in dark-skinned populations. It also occurs in those with a positive family history: approximately one third of cases is strongly suggestive of a genetic connection.

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

A: Scabies is characterized by intense pruritus—especially at night in older children and adolescents—red bumps, blisters, pustules, and small burrow marks that may be obliterated by scratch marks. The burrows are superficial, 2 to 8 mm long, linear, and curved with small papules at the proximal end; burrows may be obliterated by scratch and excoriation marks resulting from scratching

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

69. 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. he infant most likely has: a. Erythema toxicum b. Transient neonatal pustular melanosis c. Molluscum contagiosum d. Milia

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

9. What symptom is commonly experienced in J. R.'s condition? a. Pruritus b. Pain at site of lesions c. Nausea d. Headache

A: The most common symptom is periodic pruritus of varying degrees of severity especially at onset.

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

60. D.M., 7 months old, presents with a beefy red macular- popular rash in the diaper are with satellite lesions on the abdomen. The appropriate treatment would be: a. Clotrimazole b. A&D ontment c. Gentian violet 1% to 2% d. Cornstarch

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

18. A. F. was diagnosed with pityriasis alba. Which of the following is proper management of A. F.'s condition? 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: The treatment for pityriasis alba is the use of bland moisturizer to reduce overdrying.

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

A: Treatment for contact dermatitis consists of cool compresses with Burrow's solution, oral antihistamines, and topical steroids. Skin testing during an acute episode is not recommended

54. During W. P.'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 antihistamines for pruritus c. Topical steroids to affected areas to reduce the immune response d. Cool compresses to affected areas

A: Treatment for urticaria consists of oral antihistamines, topical steroids, and cool compresses. Oral antibiotics are not indicated for the treatment of urticaria

46. 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: With insect stings, hypersensitivity to venom develops after initial exposure, with more severe reactions upon subsequent exposures

2. In order to confirm your diagnosis of J. D., 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: Wright's stained smear of pustules identifies predominance on 90% eosinophils rather than neutrophils, which rules out neonatal pustular melanosis

59. 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: A salmon patch is a flat, light pink to light red mark seen on the eyelid, glabella, or nape of neck that intensifies with crying

16. You notice 10 macular tan lesions of varying sizes on D. D. and refer him for a medical evaluation to rule out neurofibromatosis or Albright syndrome. What kind of lesion does D. D. have? a. Malignant melanoma b. Café au lait spots c. Mongolian spots d. Vitiligo

B: Café au lait spots are light to medium brown pigmented macular lesions of varying sizes and shapes found anywhere on the body; they are the color of coffee with milk, from which the name is derived. If there are six or more lesions, this condition may be associated with neurofibromatosis or Albright syndrome.

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

B: Capillary hemangiomas often are not present at birth; however, the area of eventual lesion is blanched or slightly colored. They grow quickly within 2 to 4 weeks to a red or blue-red, protuberant, rubbery nodule or plaque, with the most growth in the first 6 months. There is a gradual reduction in proliferation usually beginning between 9 and 12 months.

27. Which of the following is not characteristic of Jale's condition? a. He has hypersensitivity to a substance within his environment when direct contact is made. b. He may experience a delayed reaction of several days with reexposure to an allergen. c. His dermatitis may be caused by direct contact with topical medications, soaps, cosmetics, fabrics, and plants. d. Typical response is redness and edema at the site of contact, which may progress to papules and vesicles.

B: Contact dermatitis is caused by hypersensitivity to an allergen with reexposure—allergic response usually occurs within 24 hours due to prior sensitization. However, numerous substances are associated with producing hypersensitivity reactions in sensitive individuals, with the most common including perfumes, soaps, cosmetics, and fabric dyes

During 15-year-old N. M.'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. 68. 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 to 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 not recommended and may exacerbate acne

13. In addition to having atopic dermatitis, you have diagnosed D. L. 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

B: For secondary infections, if present, treat with oral antibiotics, for example, Bactrim, cefadroxil, cephalexin, and clindamycin

37. 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 is caused by a localized bacterial infection of skin often precipitated by insect bites (spider, mosquito, flea) or other trauma that breaks protective skin barrier; it predominately involves face and less commonly other body surfaces, including perineum. Vesicles that erupt result in honey-colored serous crusts with erosion of the epidermis

39. 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: In moderate chronic acne, oral antibiotics may be recommended. The choice of antibiotics is tetracycline, doxycycline, or minocycline

21. 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: Malignant melanoma is not characterized by having raised distinct, symmetrical borders. They can be irregular, asymmetrical, with uneven coloring and may bleed.

The mother of 4-month-old TW states that the infant has been irritable and has not been sleeping well. During the physical exam, you note popular lesions on his feet and erythematous papules over his back. 61. To confirm your 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 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

41. What is the cause of K. C.'s condition? a. Microsporum canis tinea b. Poxvirus c. Staphylococcus aureus d. Streptococcus group A

B: Molluscum contagiosum is caused by a poxvirus

40. 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. Acne b. Molluscum contagiosum c. Warts d. Cellulitis

B: Molluscum contagiosum is characterized by a self-limiting skin condition characterized by waxy, firm papules that may occur on any skin surface but predominately on the face, axillae, abdomen, and arms.

42. Which treatment would you not recommend for K. C.'s condition? a. Curettage lesions b. Oral antibiotics c. Observation d. Topical imiquimod

B: Molluscum contagiosum treatment does not consist of antibiotics but, with observation, at times consists of curettage of the lesions or topical imiquimod

63. 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 to 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: Objects that cannot be washed should be sealed in plastic bags. Since eggs mature in 7 to 10 days, 2 to 4 weeks should be sufficient to prevent reinfestation. Frequent shampooing and close haircuts are unnecessary and may contribute to a feeling of shame and embarrassment. Environmental cleaning includes vacuuming, although sprays are not recommended

19. Patient education is a major part of the PNP's role. What would you teach A. F. and her parent regarding the progress and prognosis of pityriasis alba? a. A. F. will continue to develop lesions for the rest of her life. b. A. F.'s condition should fade appreciably in 3 to 4 months. c. A. F.'s condition is permanent, and affected areas will not repigment. d. A. F.'s condition will resolve completely; however, the affected areas can become slightly reddened when exposed to sunlight.

B: Pityriasis alba resolves spontaneously in 3 to 4 months. You can also educate the parent regarding characteristics and expected prognoses

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

B: Striae are skin areas that have been stretched, whereas the skin in atopic dermatitis is thickened, crusted, and hyperpigmented

48. Which of the following is not recommended as a management and treatment strategy for W. A.? 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: Topical antifungal applications are not recommended for treatment of scabies. Treatment is using topical antiparasitics, antihistamines, or topical steroids along with storing nonwashables in a plastic bag for a week

1. 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 toxicum neonatorum c. Milia d. Contact dermatitis

B: Transient, benign, self-limited skin rash with lesions of varied morphology; erythematous macules; wheals, vesicles, and pustules in 50-60% of all newborns. Lesions usually arise from erythematous base, with macular erythema fading within 2-3 days. Occurs predominantly on the trunk; however, may occur anywhere on body except soles and palms

44. 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 applications d. Educating again regarding not sharing personal items

B: Treatment consists of topical antifungal medications, clotrimazole, miconazole, econazole, terbinafine, tolnaftate, naftifine, ciclopirox, or ketoconazole. Antibiotics are not indicated

36. You order a culture and the results confirm that Jerry's condition 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: Treatment for folliculitis caused by staph infection is with dicloxacillin

12. Which of the following management measures or treatments would you not recommend for D. L.? a. Topical steroids to affected areas b. Wet compresses to affected skin areas c. Maintain a dry, warm environment d. Eliminate all substances that dry the skin

C: Atopic dermatitis worsens with sweating and temperature extremes, so a dry and warm environment makes symptoms worse

17. What is characteristic of the lesion that D. D. has? 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: Café au lait spots are usually present at birth; however, they may develop at any age. Twenty percent of darker-skinned populations have these lesions.

14. You see B. D. for the first time at age 6 weeks. B. D. has a bright red, raised, rubbery lesion of irregular shape and 2 cm in diameter on the occiput. What condition do you suspect B. D. has? a. Malignant melanoma b. Port-wine stain c. Capillary hemangioma d. Burn

C: Capillary hemangiomas are bright red or blue-red nodular tumors of varying sizes and shapes with a rubbery and rough surface that occur predominately on the head and face

23. You suspect M. N. has 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

C: Chronic psoriasis is characterized by erythematous plaques with silver-gray-white scaly plaques occurring predominately on the elbows and knees.

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

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

C: Infants, children, and adolescents with atopic dermatitis are not more likely to develop malignant melanoma as adults

10. What management would you not recommend for J. R. with his condition? a. Cool bath or cool compresses to lesions b. Topical steroids to lesions c. Oral antibiotics d. Monitored and controlled daily sunlight exposure

C: Management does not consist of antibiotics but rather topical calamine lotion on lesions, oral antipruritic agents for severe pruritus (for example, diphenhydramine), cool bath or compresses on lesions, and low-potency steroid creams.

During 15-year-old N. M.'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. 66. N. M.'s clinical presentation is consistent with: a. Comedonal acne b. Mild acne c. Moderate acne d. Severe acne

C: Mild acne is characterized by open and closed comedones and occasional pustules, whereas comedonal acne is limited to open and closed comedones only. Open and closed comedones, papules, and pustules characterize moderate acne. Severe acne, in addition to the lesions described above, also involves cysts

During 15-year-old N. M.'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. 67. Which medication is the appropriate choice? a. Antiandrogens b. Isotretinoin c. Minocycline d. Corticosteroids

C: Moderate acne includes open and closed comedones, papules, and pustules. Oral antibiotics are used to control moderate papulopustular acne in addition to topical keratolytics. Antiandrogens are not recommended. Corticosteroids may be used for more severe forms or the flare-ups associated with isotretinoin therapy

52. You suspect D. Y. has erythema multiforme major. What treatment or management is most indicated? 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: Patients with erythema multiforme (EM) major need immediate attention at a hospital for a full medical evaluation

49. Pediculosis is a highly communicable, common condition in children. Which of the following is not correct of Pediculus 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 non-hairy body surfaces d. Same medication used for scabies may be used to effectively eradicate this species

C: Pediculus humanus prefers less-hairy body surfaces

7. 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 is more apparent in darker-skinned populations and occurs in warmer months

34. 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. Staphylococcus aureus d. Streptococcus group A

C: The most common cause of folliculitis is Staphylococcus aureus; less commonly it is caused by Streptococcus bacteria

26. You have diagnosed Jale as having 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

C: The most common characteristic of contact dermatitis is pruritus with varying degrees of intensity

43. Paul has four superficial lesions on his anterior lower abdomen of 1 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 pruritic. What condition do you suspect Paul has? a. Psoriasis b. Eczema c. Tinea corporis d. Pityriasis rosea

C: Tinea corporis lesions are characterized as scaly plaques of varying sizes from less than 5 mm to more than 3 cm with mild erythematous active borders. Lesions spread peripherally as they heal centrally and may be singular or several; numerous lesions are uncommon

64. Mrs. J. brings her 6-year-old son in because of "hives" that she describes 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

C: 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 to 3 weeks

31. You are evaluating F. P., age 3 years, 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 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: Burns are classified according to depth of injury to skin layers. First-degree/superficial burns involve the epidermis layer only. Second-degree/partial-thickness burns involve the epidermis and part of the dermis, which may be superficial dermis or deep dermis

32. F. P.'s 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: First- and second-degree burns are red, swollen, moist, and blistered areas with tenderness

33. What is the best treatment for F. P.'s 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. Refer for urgent treatment in an ED

D: For second-degree burns, evaluation at a tertiary care center is the recommendation

4. You examine C. C., a newborn, and observe numerous white papular lesions on the cheeks, forehead, and nose. You suspect either milia or neonatal acne. 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-blue area with erythematous mottling d. Papular lesions, yellow in color, are observed on the hard palate

D: In milia there is an oral counterpart of yellow, papular lesions on hard palate known as Epstein's pearls, which does not occur in neonatal acne

20. 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 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. 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

D: Malignant melanoma is characterized by being more common in females from birth to 40 years of age and in light-skinned individuals. Severe sunburn or excessive exposure to the sun before the age of 10 years predisposes developing melanoma later in childhood or in adult life. Malignant melanoma is spread through the lymphatic system and invades other skin surfaces and organs. It is not spread by invading skin surfaces that surround the major lesion.

58. During your newborn examination of K. L., 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: Mongolian spots and blue nevus have a bluish discoloration. Cutis marmorata is the only condition that is generalized. Harlequin color change is more red than pale

3. In addition to monitoring the skin for any changes, what is the best management for J. D.? a. Topical antibiotics on lesions b. Topical steroids on lesions c. A moisturizer on lesions d. No treatment necessary since J. D.'s condition will resolve spontaneously in 5 to 7 days

D: No treatment is necessary because this is benign and self-limiting

65. 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: Petrolatum/lanolin ointment, petroleum jelly, and zinc oxide are all ointments that act as barriers to irritants such as urine and feces. The presence of satellite lesions indicates a Candida rash requiring an antifungal such as nystatin

8. J. R., 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 is an acquired common mild inflammatory condition characterized by scaly, hypopigmented, and hyperpigmented lesions predominately on the trunk, upper arms, and upper thighs. Also has a "herald" patch of 1 cm to 5 cm on trunk or buttocks

5. Newborn W. R. has a vascular lesion that will not fade as she gets older. What is your diagnosis? a. Salmon patch b. Capillary hemangioma c. Café au lait spot d. Port-wine stain (nevus flammeus)

D: Port-wine stains are irregular dark red or purple macular lesions occurring on any body surface, predominately on face and head, that never fade and become thickened and raised in adulthood

29. 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 comedones and papular and pustular lesions

D: Seborrhea dermatitis in newborns and infants is characterized by areas of underlying erythema with yellow crusts and greasy scaling on scalp and face; in more severe cases lesions may be present on trunk and in diaper area. Adolescent will have white flakes and greasy scaling on scalp, forehead, eyebrows, and face

45. 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: Spider bites are characterized by a dull burning or pain at site of bite with two red puncture marks surrounded by white area with bluish-red border

50. 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 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 that all have the same morphology on the trunk

D: Target or "bull's-eye" lesions may be present, which have three distinct characteristics—a necrotic or vesicular center, a pale middle macular ring, and an outer erythematous peripheral ring. Itching may be present, and pain may occur in the mouth. Lesions are not all the same size and morphology

51. You see D. Y. 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: The key distinction between erythema multiforme (EM) major and EM minor is the occurrence of prodromal systemic symptoms of fever, malaise, sore throat, headache, nausea, and vomiting

53. Urticaria is a hypersensitivity allergic reaction to a variety of substances and agents. You suspect W. P. 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: Urticarial lesions are consistent with wheals as their typical morphology