Skin Disorders

You see a 52-year-old woman who was bitten by a rat while opening a Dumpster. The examination reveals a wound approximately 1 cm deep that is oozing bright red blood. Treatment of this patient should include standard wound care with the addition of: A. rabies immune globulin B. rabies vaccine C. oral ciprofloxacin D. oral amoxicillin-clavulanate

D. Oral amoxicillin clavulanate

Which of the following is an oral antimicrobial option for the treatment of a community acquired methicillin resistant S. aureus cutaneous infection? A. Amoxicillin B. Dicloxacillin C. Cephalexin D. Trimethorphin-Sulfatmethoxale

D. Trimethorpin-Sulfamethoxale

A skin biopsy results indicate the presence of malignant melanoma for a 53-year-old woman. You recommend: A. excision of the entire lesion B. electrodissection with curettage C. initiating treatment with topical cancer chemotherapy D. consultation with a skin cancer expert to direct next best action

D. consultation with a skin cancer expert to direct next best action

annular

in a ring formation

In an afebrile patient with an abscess less than 5mm than diameter:

incision and drainage and localized care is advised; wound culture and sensitivity

Stage 3 Lyme disease

late persistent infection starts approximately 1 year after initial infection MSK signs/symptoms--range: joint pain with no objective findings frank arthritis with evidence of joint damage memory problems, depression, and neuropathy

ulcer

loss of epidermis and dermis; concave; varies in size

atrophy

loss of skin markings and full skin thickness

Stage I Lyme disease

mild flu like illness singular annular lesion with central clearing (erythema migrans) rarely pruritic or painful signs/symptoms can resolve in 3-4 weeks without treatment

confluent or coalescent

multiple lesions blending together

fissure

narrow linear crack into epidermis, exposing dermis

reticular

net like cluster

When to refer to burn

patients with any burn involving areas of high function such as the hands, feet, and face, or involving the genitalia.

plaque

raised lesion, larger than 1 cm, may be same or different color from the surrounding skin

lichenification

skin thickening usually found over pruritic or friction areas Ex: seen in areas of recurrent scratching

If abscess is greater than or equal to 5mm

start systemic antimicrobial therapy

Second degree burn

surface is raw and moist

pustule

vesicle-like lesion with purulent content

All CA-MRSA strains are capable of causing necrotizing infection. A. True B. False

B. False

CA-MRSA is most commonly spread from one person to another via airborne pathogen transmission. A. True B. False

B. False

The likely causative organisms of nonbullous impetigo in a 6-year-old child include: A. H. influenzae and S. pneumoniae. B. group A streptococcus and S. aureus. C. M. catarrhalis and select viruses. D. P. aeruginosa and select fungi

B. Group A Strep, S. aureus

Oral antimicrobial treatments recommended for rosacea include all of the following except: A. metronidazole B. levofloxacin C. erythromycin D. doxycycline

B. Levofloxacin

Stage 3 Lyme disease, characterized by joint pain and neuropsychiatric symptoms, typically occurs how long after initial infection? A. 1 month B. 4 months C. 1 year D. 5 years

C. 1 year

First line therapy for acne vulgaris with closed comedones includes: A. oral antibiotics B. isotretinoin C. benzoyl peroxide D. hydrocortisone cream

C. Benzoyl peroxide

A common cause of angular chelitis is infection by: A. E. Coli B. Strep pneumo C. Candida species D. Aspergillus species

C. Candida species

You write a prescription for a topical agent and anticipate the greatest rate of absorption when it is applied to the: A. palms of the hands B. soles of the feet C. face D. abdomen

C. Face

Type I hypersensitivity reactions, such as atopic dermatitis, involve the action of which antibodies binding to receptor sites on mast cells? A. IgG B. IgM C. IgE D. IgA

C. IgE

Type I hypersensitivity reaction is mediated through: A. TNF-a binding to T cells B. IgG antibodies binding to T cells C. IgE antibodies binding to mast cells D. IL-10 binding to basophils

C. IgE antibodies binding to mast cells

You see a 28-year-old man who was involved in a fight approximately 1 hour ago with another person. The patient states, "He bit me in the arm." Examination of the left forearm reveals an open wound consistent with this history. Your next best action is to: A. obtain a culture and sensitivity of the wound site B. refer for rabies prophylaxis C. irrigate the wound and débride as needed D. close the wound with adhesive strips

C. Irrigate the wound with adhesive strips

Oral antifungal treatment options for onychomycosis include all of the following except: A. Itraconazole B. Fluconazole C. Metronidazole D. Terbinafine

C. Metronidazole

A 28 year old woman presents to your practice with chief complaint of a cat bite sustained on her right ankle. Her pet cat had bitten her after she inadvertently stepped on its paw while she was at home. Her cat is 3 years old, UTD on immunizations, and does not go outside. PE reveals pinpoint superficial puncture wounds on the right ankle consistent with presenting history. She washed the wound with soap and water immediately and asks whether she needs additional therapy. Treatment for this cat bite wound should include standard wound care with addition of: A. oral Erythromycin B. topical Bacitracin C. oral Amoxicillin Clavulanate D. Parenteral rifampin

C. Oral Amoxicillin Clavulanate

A patient presents with a painful, blistering thermal burn involving the first, second and third digits of his digits of his right hand. The most appropriate plan of care is to: A. apply an anesthetic cream to the area and open the blisters B. apply silver sulfadiazine cream (Silvadene) to the area followed by a bulky dressing C. refer the patient to burn specialty D. wrap the burn loosely with a non adherent dressing and prescribe an analgesic

C. Refer the patient to burn speciality care

Biological agents to treat psoriasis, such as infliximab and etanercept, work by blocking the action of: A. IL-9 B. CD4 C. TNF-a D. IgG

C. TNF-a

A 29 year old woman has a sudden onset of right sided facial asymmetry. She is unable to close her right eye lid tightly or frown or smile on the affected side. Her exam is otherwise unremarkable: A. III B. IV C. VII D. VIII

C. VII

To transmit the bacterium that causes Lyme disease, an infected tick must feed on a human host for at least: A. 5 minutes B. 30 minutes C. 2 hours D. 24 hours

D. 24 hours

Among the following, who is at greatest risk of developing seborrheic dermatitis? A. 15 year old boy in rural setting B. 34 year old woman who smokes 2 PPD C. 48 year old male truck driver D. 72 year old male with Parkinson's

D. 72 year old male with Parkinson's

Gram-negative bacteria that commonly cause burn wound infections include all of the following except: A. P. aeruginosa B. E. Coli C. K. pneumoniae D. H. influenzae

D. H. Influenzae

Common clinical manifestations of anaphylaxis can include all of the following except: A. upper airway edema B. itch without rash C. dizziness with syncope D. HTN

D. HTN

Leonard is an 18-year-old man who has been taking isotretinoin (Accutane) for the treatment of acne for the past 2 months. Which of the following is the most important question for the clinician to ask at his follow-up office visit? A. Are you having any problems remembering to take your medication? B. Have you noticed any dry skin around your mouth since you started using Accutane? C. Do you notice any improvement in your skin? D. Have you noticed any recent changes in your mood?

D. Have you noticed any recent changes in your mood?

Recommended non pharmacological options to treat actinic keratosis include all of the following except: A. a chemical peel B. cryotherapy C. laser resurfacing D. Mohs micrographic surgery

D. Mohs micrographic surgery

First line treatment of impetigo with fewer than five lesions of 1-2 cm in diameter on the legs of a 9 year old girl is: A. topical mupirocin B. topical neomycin C. oral cefixime D. oral doxycycline

A. Topical mupirocin

Characteristics of onychomycosis include all of the following except: A. it is readily diagnosed by clinical examination B. nail hypertrophy C. brittle nails D. fingernails respond more readily to therapy than toenails

A. it is readily diagnosed by clinical examination

Which of the following is not a potential adverse effect with long-term high potency topical corticosteroid use? A. lichenification B. telangiectasis C. skin atrophy D. adrenal suppression

A. lichenification

The use of which of the following medications contributes to the development of acne vulgaris? A. lithium B. propanolol C. sertraline D. clonidine

A. lithium

Which of the following represents the most effective method of cancer screening? A. skin exam B. stool exam for occult blood C. pelvic exam D. chest X ray

A. skin exam

Signs that bed bugs are present in a home include all of the following except: A. small drops of fresh blood on floorboards. B. blood smears on bed sheets. C. presence of light brown exoskeletons. D. dark specks found along mattress seams.

A. small drops of fresh blood on floorboards

Patients with rosacea are recommended to use daily: A. sunscreen B. astringents C. an exfoliant D. an antimicrobial cream

A. sunscreen

Which of the following is recommended for preventing a burn wound infection? A. Topical corticosteroid B. topical silver sulfadiazine C. Oral erythromycin D> Oral moxifloxacin

B. Topical silver sulfadiazine

How many grams of a topical cream or ointment are needed for a single application to an arm?

3 grams

How many grams of a topical cream or ointment are needed for a single application to the entire body?

30-60 grams

Skin lesions associated with actinic keratosis can be described as: A. a slightly rough, pink, or flesh colored lesion in a sun exposed area B. a well defined, slightly raised, red, scaly plaque in a skinfold C. a blistering lesion along a dermatome D. crusting lesion along the flexor aspects of the finger

A. slightly rough, pink, or flesh colored lesion in a sun exposed area

The most common HPV types associated with cutaneous non genital warts include: A. 1, 2, and 4 B. 6 and 11 C. 16 and 18 D. 32 and 36

A. 1, 2, and 4

You see a 33-year-old male with a minor dog bite on his hand. The examination reveals a superficial wound on the left palm. The dog is up-to-date on immunizations. In deciding whether to initiate antimicrobial therapy, you consider that ______ of dog bites become bacterially infected. A. 5% B. 20% C. 50% D. 75%

A. 5%

An oral antimicrobial option for the treatment of methicillin-sensitive S. aureus includes all of the following except: A. amoxicillin. B. dicloxacillin. C. cephalexin. D. cefadroxil.

A. Amoxicillin

Lyme disease is caused by the bacterium: A. Borrelia burgdorferi B. Bacillus anthracis C. Corynebacterium striatum D. Treponema

A. Borrelia burgdorferi

When prescribing pulse dosing with itraconazole for the treatment of fingernail fungus, the clinician realizes that: A. a transient increase in hepatic enzymes is commonly seen with its use B. drug-induced leukopenia is a common problem C. the patient needs to be warned about excessive bleeding because of the drug's antiplatelet effect D. its use is contraindicated in the presence of iron deficiency anemia

A. a transient increase in hepatic enzymes is commonly seen with its use

In a 13 year old female patient with mild acne and who experiences an inadequate response to benzoyl peroxide treatment, an appropriate treatment option would be to: A. add a topical retinoid B. add a oral antibiotic C. consider isotretinoin D. consider hormonal therapy

A. add a topical retinoid

The mechanism of action of pimecrolimus (Elidel) in the treatment of atopic dermatitis is as: A. an immunomodulator B. an antimitotic C. a mast cell activator D. an exfoliant

A. an immunomodulator

Anthralin (Drithocreme) is helpful in treating psoriasis because it has what type of activity? a. antimitotic b. exfoliative c. vasoconstrictor d. humectant

A. anitmitotic

Which of the following medications is likely to cause the most sedation? A. Chlorpheniramine B. Cetirizine C. Fexofenadine D. Loratadine

A. chlorpheniramine

You have initiated therapy for an 18-year-old man with acne vulgaris and have prescribed doxycycline. He returns in 3 weeks, complaining that his skin is "no better." Your next action is to: A. counsel him that 6 to 8 weeks of treatment is often needed before significant improvement is achieved. B. discontinue the doxycycline and initiate minocycline therapy. C. advise him that antibiotics are likely not an effective treatment for him and should not be continued. D. add a second antimicrobial agent such trimethoprim-sulfamethoxazole.

A. counsel him that 6 to 8 weeks of treatment is often needed before significant improvement is achieved

A 24-year-old woman presents with hive-form linear lesions that develop over areas where she has scratched. These resolve within a few minutes. This most likely represents: A. dermographism B. contact dermatitis C. angioedema D. allergic reaction

A. dermographism

Which of the following is the best treatment option for cellulitis when risk of infection with a methicillin-resistant pathogen is considered low? A. dicloxacillin B. amoxicillin C. metronidazole D. Bactrim

A. dicloxacillin

Which of the following do you expect to find in the assessment of the person with urticaria? A. eosinophilia B. low ESR C. elevated TSH D. leukopenia

A. eosonophilia

A 78 year old resident of a long term care facility complains of generalized itchiness at night that disturbs her sleep. Her examination is consistent with scabies. Which of the following do you expect to find on exam? A. excoriated papules on the interdigital area B. annular lesions over buttocks C. vesicular lesions in a linear pattern D. honey colored crusted lesions that began as vesicles

A. excoriated papules on the interdigital area

One of the most common trigger agents for contact dermatitis is: A. exposure to nickel B. use of fabric softener C. bathing with liquid body wash D. eating spicy foods

A. exposure to nickel

An 88 year old community dwelling man who lives alone has limited mobility because of OA. Since his last office visit 2 months ago, he has lost 5% of his body weight and has developed angular chelitis. You expect to find the following on exam: A. fissuring and cracking at the corners of the mouth B. marked erythema of the hard and soft palates C. white plaques on the lateral borders of the oral mucosa D. raised, painless lesions on the gingiva

A. fissuring and cracking at the corners of the mouth

A 38 year old woman with advanced human immunodeficiency virus (HIV) presents with a chief complaint of a painful, itchy rash over her trunk. Examination reveals linear vesicular lesions that do not cross the midline and are distributed over the posterior thorax. This presentation is most consistent with: A. herpes zoster B. dermatitis herpetiformis C. molluscum contagiosum D. impetigo

A. herpes zoster

A Tzanck smear that is positive for giant multinucleated cells was taken from a lesion caused by: A. herpesvirus B. S. aureus C. streptococci D. allergic reaction

A. herpesvirus

A significant rabies risk is associate with a bite from all of the following except: A. humans B. foxes C. bats D. skunks

A. humans

The mechanism of action of imiquimod is as: A. an immunomodulator B. an antimitotic C. keratolytic D. an irritant

A. immunomodulator

You see a 36-year old man with no chronic health problems who presents with two furuncles, each around 4 cm in diameter, on the right anterior thigh. These lesions have been present for 3 days, slightly increasing in size during this time. He has no fever or other systemic symptoms. You advise the following: a. incision and drainage of the lesion b. a systemic antibiotic empirically c. a topical antibiotic d. aspiration of the lesion contents and prescription of a systemic antibiotic based on culture results

A. incision and drainage of the lesions

Treatment options in postherpetic neuralgia include all of the following except: A. injectable methylprednisolone B. oral pregabalin C. oral norttriptyline D. topical lidocaine

A. injectable methylprednisolone

Which of the following statements is the most accurate regarding cellulitis? A. insect bites, abrasion, or other skin trauma can be the origin of cellulitis B. cellulitis most often occurs on the chest and abdomen C. necrosis is a common complication of cellulitis D. cellulitis often occurs spontaneously without any identifiable skin wounds

A. insect bites, abrasion, or other skin trauma can be the origin of cellulitis

You see a 34-year-old man with atopic dermatitis localized primarily on the arms who complains of severe itching. The condition becomes worse at night and interferes with his sleep. You recommend: A. taking a bedtime dose of antihistamine B. taking a bedtime dose of acetaminophen C. taking a hot shower prior to bedtime D. applying a warm compress to the affected areas 30 minutes prior to bedtime

A. take a bedtime dose of antihistamine

When prescribing itraconazole (Sporanox), the NP considers that: A. the drug is a cytochrome P450 3A4 inhibitor B. one pulse cycle is recommended for fingernail treatment, and two cycles are needed for toenail therapy C. continuous therapy is preferred in the presence of hepatic disease D. taking the drug on an empty stomach enhances the efficacy of the product

A. the drug is a cytochrome P450 3A4 inhibitor

In an adult with BMI greater than 40kg/m who is being treated with TMP-SMX for CA-MRSA, the recommended dose is two tablets BID. A. True B. False

A. true

A possible adverse effect with the use of a first generation antihistamine such as diphenhydramine in an 80 year old man is: A. urinary retention B. hypertension C. tachycardia D. urticaria

A. urinary retention

In counseling patient with seborrheic dermatitis on the scalp about efforts to clear lesions, you advise her to: A. use ketoconazole shampoo B. apply petroleum jelly nightly to the affected area C. coat the area with high-potency steroid cream three times/week D. expose the lesions periodically to heat by carefully using a hair dryer

A. use Ketoconazole shampoo

All of the following organisms have been implicated in the development of rosacea except: A. viruses B. bacteria C. yeast D. mites

A. viruses

An urticarial lesion is usually described as a: A. wheal B. plaque C. patch D. papule

A. wheal

A burn that is about twice as large as an adult's palmar surface of the hand including the fingers encompasses aBSA of approximately ____%. A. 1 B. 2 C. 3 D. 4term-1873

B. 2

Who is the best candidate for isotretinoin (Accutane) therapy? A. a 17-year-old patient with pustular lesions and poor response to benzoyl peroxide B. a 20-year-old patient with cystic lesions who has tried various therapies with minimal effect C. a 14-year-old patient with open and closed comedones and a family history of "ice pick" scars D. an 18-year-old patient with inflammatory lesions and improvement with tretinoin (Retin-A)

B. 20 year old patient with cystic lesions who has tried various therapies with minimal effect

When prescribing fluconazole, the NP considers that it is a Cytochrome P450: A. 3A4 inhibitor B. 2C9 inhibitor C. 2D6 inhibitor D. 1A2 inhibitor

B. 2C9

Treatment options for actinic keratosis include topical: A. vitamin D derivate cream B. 5-fluoruoracil C. acyclovir D. doxepin

B. 5-fluoruracil

You examine a patient with a red, tender thermal burn that has excellent capillary refill involving the entire surface of the anterior right thigh. The estimated involved body surface area (BSA) is approximately: A. 5% B. 9% C. 13% D. 18%

B. 9%

Which of the following findings is often found in a person with stage 2 Lyme disease? A. peripheral neuropathic symptoms B. AV block C. conductive hearing loss D. macrocytic anemia

B. AV heart block

Which of the following is not a recommended option to make cosmetic improvements for phymatous rosacea? A. laser peel B. ablative laser surgery C. surgical shave technique D. mechanical dermabrasion

B. ablative laser surgery

A 64 year old man with seborrhea mentions that his skin condition is "better in the summer when he gets outside more and much worse in the winter." You respond: A. sun exposure is a recommended therapy for this condition B. although sun exposure is noted to improve the skin lesions associated with seborrhea, its use as a therapy is potentially associated with an increased rate of skin cancer C. the lower humidity in the summer months noted in many areas of North America contributes to the improvement in seborrheic lesions D. use high potency topical corticosteroids during the winter months, tapering these of for the summer months

B. although sun exposure is noted to improve the skin lesions associated with seborrhea, its use as a therapy is potentially associated with an increased rate of skin cancer

Preferred antimicrobials for the treatment of adults with Lyme disease include all of the following except: A. a tetracycline. B. an aminoglycoside. C. a cephalosporin. D. a penicillin.

B. an aminoglycoside

To enhance the potency of a topical corticosteroid, the prescriber recommends that the patient apply the preparation: A. to dry skin by gentle rubbing B. and cover with an occlusive dressing C. before bathing D. with an emollient

B. and cover with an occlusive dressing

In counseling a patient with atopic dermatitis, you suggest all of the following can be used to alleviate symptoms of a flare except: A. the use of oral antihistamines B. applying a heating pad on the affected region for 30 minutes C. the use to topical corticosteroids D. applying cool wet dressings made from clean cloth and water to the affected area

B. applying a heating pad on the affected region for 30 minutes

A 72 year old woman presents with a newly formed painless, pearly, ulcerated nodule with overlying telangiectasis on the upper lip. This most likely represents: A. an actinic keratosis B. basal cell carcinoma C. squamous cell carcinoma D. molloscum contagiosum

B. basal cell carcinoma

When advising the patient about scabies contagion, you inform her that: A. mites can live for many weeks away from the host B. close personal contact with an infected person is usually needed to contract this disease C. casual contact with an infected person is likely to result in an infestation D. bedding used by an infected person must be destroyed

B. close personal contact with an infected person is usually needed to contract this disease

When caring for an adult with an outbreak of shingles, you advise that: A. there is no known treatment for this condition B. during outbreaks, the chickenpox (varicella) virus is shed C. although they are acutely painful, the lesions heal well without scarring or lingering discomfort D. this condition commonly strikes the young and the old alike

B. during outbreaks, the chickenpox (varicella) virus is shed

If a skin and soft tissue infection does not improve in 48 to 72 hours with antimicrobial therapy, infection with a resistant pathogen is virtually the only cause. A. True B. False

B. false

Most acute-onset necrotic skin lesions reported in North America are caused by spider bites. A. True B. False

B. false

Skin lesions infected by community-acquired MRSA (CA-MRSA) often occur spontaneously on intact skin. A. True B. False

B. false

The mechanism of resistance of the MRSA is via the production of beta-lactamase. A. True B. False

B. false

Which of the following best describes seborrheic dermatitis lesions? A. flaking lesions in the antecubital and popliteal spaces B. greasy, scaling lesions in the nasolabial folds C. intensely itchy lesions in the groin folds D. silvery lesions on the elbows and knees

B. greasy, scaling lesions in the nasolabial folds

Risk factors for malignant melanoma include: A. asian ancestry B. history of blistering sunburn C. family history of psoriasis vulgaris D. presence of atopic dermatitis

B. history of blistering sunburn

You see a 28-year-old man who is having an anaphylactic reaction following a bee sting and is experiencing trouble breathing. Your initial response is to administer: A. oral antihistamine B. injectable epinephrine C. supplemental oxygen D. vasopressor therapy

B. injectable epinephrine

When counseling a person who has a 2mm verruca form lesion on the hand, you advise that: A. bacteria are the most common cause of these lesions B. lesions usually resolve without therapy in 12-24 months C. there is a significant risk for future dermatologic malignancy D. surgical excision is the treatment of choice

B. lesions usually resolve without therapy in 12-24 months

A 14 year old male presents with acne consisting of 25 comedones and 20 inflammatory lesions with no nodules. This patient can be classified as having: A. mild acne B. moderate acne C. severe acne D. very severe acne

B. moderate acne

The use of lindane (Kwell) to treat scabies is discouraged because of its potential for: A. hepatotoxicity B. neurotoxicity C. nephrotoxicity D. pancreatitis

B. neurotoxicity

A woman was treated as an inpatient for a serious soft tissue infection with parenteral linezolid and now is being seen on day 3 of her illness and is being discharged to home. She is feeling better and appears by examination to be clinically improved. Culture results reveal MRSA, sensitive to trimethoprim-sulfamethoxazole, linezolid, daptomycin, vancomycin,and clindamycin and resistant to cephalothin and erythromycin. Her antimicrobial therapy should be completed with: A. oral cephalexin. B. oral trimethoprim-sulfamethoxazole. C. parenteral vancomycin. D. oral linezolid

B. oral Trimethoprim-Sulfamethoxazole

A common infective agent in domestic cat bites is: A. viridans streptococcus species B. Pasteurella multocida C. bacteroides species D. H. Influenzae

B. pasteurella multocida

Psoriatic lesions arise from: A. decreased skin exfoliation B. rapid skin cell turnover, leading to decreased maturation and keratinization C. inflammatory changes in the dermis D. lichenification

B. rapid skin cell turnover, leading to decreased maturation and keratinization

Common clinical conditions included in the atopy subgroup of the type I hypersensitivity reactions include all of the following except: A. allergic rhinitis B. rosacea C. atopic dermatitis D. allergic gastroenteropathy

B. rosacea

The spectrum of antimicrobial activity of mupirocin (Bactroban) includes: A. primarily gram negative organisms B. select gram positive organisms C. Pseudomonas species and anaerobic organisms D. Only organisms that do not produce beta-lactamase

B. select gram positive organisms

Which of the following represents the most important diagnostic test for the patient in the previous question? A. CBC with WBC diff. B. serum testing for Borrrelia burgdorferi infection C. CT scan of head with contrast D. serum protein electrophoresis

B. serum testing for Borrelia burgdorferi

Risk factors for the development of post herpetic neuralgia include: A. age younger than 50 B. severe prodromal symptoms C. lumbar location of lesions D. low volume of lesions

B. severe prodromal symptoms

A 56 year old truck driver presents with new nodular, opaque lesion with nondistinct borders on his left forearm. This most likely represents: A. an actinic keratosis B. squamous cell carcinoma C. basal cell carcinoma D. malignant melanoma

B. squamous cell carcinoma

A common site for atopic dermatitis in an infant is: A. the diaper area B. the face C. the neck D. the posterior trunk

B. the face

You see a 42-year-old woman with a cluster of red,itchy spots on her left arm. She informs you that she recently stayed at a hotel that she later discovered was infested with bed bugs. You advise her that: A. she should immediately begin a regimen of oral antibiotics. B. the reaction is usually self-limiting and should resolve in 1 to 2 weeks. C. given that bed bug bites are usually not itchy, an alternative diagnosis should be considered. D. she should wash all of her clothes in cold water

B. the reaction is usually self limiting and should resolve in 1-2 weeks

When counseling a patient about the use of Tacrolimus (Protopic) or pimecrolimus (Elidel), you mention that: A. this is the preferred atopic dermatitis treatment in infants B. there is a possibility of increased cancer risk with its use C. the product is used interchangeably with topical corticosteroids D. the product is potent antihistamine

B. there is a possibility of increased cancer risk with its use

For severe, recalcitrant psoriasis that affects more than 30% of the body, all of the following treatments are recommended except: A. methotrexate B. topical anthralin (Drithocreme) C. tumor necrosis factor (TNF) modulators D. cyclosporine

B. topical anthralin

When prescribing tretinion (Retin-A) the NP advises the patient to: A. use with benzoyl peroxide to minimize irritating effects B. use a sunscreen because the medication is photosensitizing C. add a sulfa based cream to enhance anti acne effects D. expect a significant improvement in acne lesions after approximately 1 week of use

B. use a sunscreen because the medication is photosensitizing

Clinical features of bullous impetigo include: A. intense itch B. vesicular lesions C. dermatomal pattern D. systemic symptoms such as fever and chills

B. vesicular lesions

You examine a patient with psoriasis vulgaris and expect to find the following lesions: A. lichenified areas in flexor areas B. well-demarcated plaques on the knees C. greasy lesions throughout the scalp D. vesicular lesions over the upper thorax

B. well demarcated plaques on the knees

How many grams of a topical cream or ointment are needed for a single application to the hands? A. 1 B. 2 C. 3 D. 4

B.2

midrange potency topical corticosteroids

Betamethasone dipropionate, augmented, 0.05% (Diprolene AF cream) Mometasone furoate 0.1% (Elocon ointment)

Which of the following would not be recommended to prevent Lyme disease when visiting a Lyme endemic area? A. wear long pants and long sleeve shorts B. use insect repellant C. if a tick bite occurs, wait until after consulting a HCP before removing the insect D. if a tick bite occurs and the tick is engorged, administer a single 200-mg dose of doxycycline

C. Wait until after consulting an HCP to remove tick

The zoster vaccine (Zostavax) is: A. an inactivated/killed virus B. a conjugate vaccine containing a virus like particle (VLP) C. live, attenuated vaccine D. an inactivated toxin vaccine

C. a live attenuated vaccine

Psoriasis vulgaris is a chronic skin condition caused by: A. baceterial colonization B. absence of melanin C. accelerated mitosis D. type I hypersensitivity reaction

C. accelerated mitosis

The most important aspect of skin care for individuals with atopic dermatitis is: A. frequent bathing with antibacterial soap B. consistent use of medium potency to high potency topical steroids C. application of lubricants D. treatment of dermatophytes

C. application of lubricants

Definitive diagnosis of skin cancer requires: A. skin exam B. Ct scan C. biopsy D. serum antigen testing

C. biopsy

Antihistamines exhibit therapeutic effect by: A. inactivating circulating histamine B. preventing the production of histamine C. blocking activity at histamine receptor sites D. acting as a procholinergic agent

C. blocking activity at histamine receptor sites

a 62 year old woman presents 2 days after noticing a "bug bite" on her left forearm. Examination reveals a warm, red, edematous area with sharply demarcated borders. The patient is otherwise healthy with no fever. This most likely represents: A. contact dermatitis B. an allergic reaction C. cellulitis D. erysipelas

C. cellulitis

An impetigo lesion that becomes deeply ulcerated is known as: A. cellulitis. B. erythema. C. ecthyma. D. empyema.

C. ecythema

During type I hypersensitivity reactions, histamine re-leased from degraded mast cells causes all of the following except: A. vasodilation B. mucous gland stimulation C. enhanced sebum production D. tissue swelling

C. enhanced sebum production

The most common causative organisms in cellulitis are: A. E. Coli and H. Influenzae B. Bacteroides species and other anaerobes C. group A beta-hemolytic strep and S. aureus D. pathogenic viruses

C. group A beta hemolytic strep and Staph aureus

Which of the following is the least potent topical corticosteroid? A. betamethasone dipropionate 0.1% B. Clobetasol propionate 0.05% C. Hydrocortisone 2.5% D. Fluocinonide 0.05%

C. hydrocortisone 2.5%

In the treat of acne vulgaris, which lesions respond best to topical antibiotic therapy? A. open comedones B. cysts C. inflammatory lesions D. superficial lesions

C. inflammatory lesions

Nonchemical means to eliminate bed bugs can include all of the following except: A. vacuuming crevices B. washing bedding and other items in hot water C. isolating the infested area from any hosts for at least two weeks D. running bedding and other items in a dryer on high heat for 20 minutes

C. isolating the infested area from any hosts for at least two weeks

The use of sunscreen has minimal impact on reducing the risk of which type of skin cancer? A. squamous cell carcinoma B. basal cell carcinoma C. malignant melanoma D. all forms of skin cancer

C. malignant melanoma

Topical therapies for the treatment of rosacea include all of the following except: A. metronidazole cream B. azelaic acid gel C. medium potency corticosteroid cream D. benzoyl peroxide

C. medium potency corticosteroid

In diagnosing onychomycosis, the NP considers that: A. nails often have a single midline groove B. pitting is often seen C. microscopic exam reveals hyphae D. beau lines are present

C. microscopic exam reveals hyphae

The HPV responsible for nongenital warts is mainly passed through: A. contact with infected surfaces B. exposure to saliva from infected person C. person to person contact D. exposure to infected blood

C. person to person contact

Common triggers for anaphylaxis include exposure to certain types of all the following except: A. medications B. food C. pet dander D. insect bites

C. pet dander

A 24 year old man arrives at the walk in center. He reports that while walking in the woods he was bitten in the thigh by raccoon. The examination reveals a wound that is 1 cm deep on his thigh. The wound is oozing bright red blood. Your next best action is to: A. Administer high dose parenteral penicillin B. initiate antibacterial prophylaxis with amoxicillin C. give rabies immune globulin and rabies vaccine D. suture the wound after proper cleansing

C. rabies immune globulin and rabies vaccine

What is the most effective protection against shingles? A. previous episode of chickenpox as a child B. prior episode of shingles C. receipt of varicella zoster immunization D. avoiding children and daycare centers

C. receipt of varicella zoster immunization

In counseling a patient with scabies, the NP recommends all of the following methods to eliminate the mite from bedclothes and other items, except: A. washing items in hot water B. running items through the clothes dryer for a normal cycle C. soaking items in cold water for at least 1 hour D. placing items in a plastic storage bag for at least 1 week

C. soaking items in cold water for at least 1 hour

Which of the following represents the most accurate patient information when using Permethrin (Elimite) for treating scabies? A. to avoid systemic absorption, the medication should be applied over the body and rinsed off within 1 hour B. the patient should notice marked reduction in pruritis within 48 hours of using the product C. Itch often persists for a few weeks after successful treatment. D. It is a second line product in the treatment of scabies

C. the itch often persists for a few weeks after successful treatment

first line therapy for angular chelitis therapy includes the use of: A. metronidazole gel B. hydrocortisone cream C. topical nystatin D. oral Ketoconazole

C. topical Nystatin

In counseling a patient on the use of topical products to treat nail fungal infections, the NP considers that: A. nail lacquers such as Ciclopirox 8% solution (Penlac) offer similar effectiveness to oral antifungals B. some herbal products, such as tea tree oil, can be an effective alternative to oral agents C. topical products have limited penetration through the nail matrix to reach the site of infection D. cream-based products are more effective than gel-based products in treating nail fungal infections

C. topical products have limited penetration through the nail matrix to reach the site of infection

One of the mechanisms of action of a topical corticosteroid preparation is as: A. an antimitotic. B. an exfoliant. C. a vasoconstrictor. D. a humectant.

C. vasoconstrictor

Super high potency corticosteroids

Clobetasol propionate 0.05% Halobetasol propionate 0.05%

Analgesia for a patient with singles can include all of the following except: A. topical lidocaine gel 5% with oral acetaminophen B. Burrow's solution with a high potency oral NSAID C. Burrow's solution with an oral opioid D. fentanyl transdermal patch and a topical medium-potency corticosteroid on the affected area

D. fentanyl transdermal patch and a topical medium potency corticosteroid on the affected area

A common site for atopic dermatitis in an adult is on the: A. dorsum of the hand B. face C. neck D. flexor surfaces

D. flexor surfaces

You see a 67-year-old man with seborrheic dermatitis that has failed to respond to treatment with ketoconazole shampoo. An appropriate second-line treatment option can include all of the following except: A. oral fluconazole. B. a topical immune modulator. C. topical propylene glycol. D. high-potency topical corticosteroid

D. high potency topical corticosteroid

A mother brings her 3 year old daughter who presents with dry red patches on her face around the eyes. The mother has observed her daughter constantly rubbing the area, which has caused swelling around the eyes. Physical examination is consistent with atopic dermatitis. The NP considers that this is a diagnosis that: A. requires a skin culture to confirm contributing bacterial organisms B. should be supported by a biopsy of the affected area C. necessitates obtaining peripheral blood eosinophil level D. is usually made by a clinical assessment alone

D. is usually made by clinical assessment alone

When examining a mole for malignant melanoma, all of the following characteristics can indicate a melanoma except: A. asymmetry with nonmatching sides B. color that is not uniform C. recently formed lesion D. lesion that has been present for at least 2 years

D. lesion that has been present for at least 2 years

Risk factors for angular chelitis in adults include all of the following except: A. advanced age B. HIV infection C. alteration of facial vertical dimension due to lose of teeth D. obesity

D. obesity

You prescribe a topical medication and want it to have maximum absorption, so you choose the following: A. gel B. lotion C. cream D. ointment

D. ointment

Nonsurgical options for the treatment of squamous and basal cell carcinoma include all of the following except: A. cryotherapy B. electrodissection with curettage C. topical cancer chemotherapy D. oral hydroxyurea

D. oral hydroxyurea

In a 22 year old woman using Accutane therapy, the NP ensures follow up to monitor for all of the following tests except: A. hepatic enzymes B. triglyceride measurements C. pregnancy D. platelet count

D. platelet count

The use of TNF modulators for the treatment of psoriasis is associated with an increased risk for: A. gastrointestinal disorders B. nephrotoxicity C. QTc prolongation D. reactivation of latent tuberculosis

D. reactivation of latent TB

Which of the following findings is often found in a person with stage I Lyme disease? A. peripheral neuropathic symptoms B. high grade AV block C. Bell's palsy D. single painless annular lesion

D. single painless annular lesion

Treatment options in generalized psoriasis vulgaris include all of the following except: A. psoralen with ultraviolet A light (PUVA) therapy B. methotrexate C. cyclosporine D. systemic corticosteroids

D. systemic corticosteroids

All of the following statements are true regarding skin reactions to bed bugs except: A. skin reactions are more common with repeated exposure to bed bug bites B. skin reactions can typically involve papules, macules, or wheals C. allergic reactions can be treated with topical steroids D. systemic skin reactions frequently occur following an initial exposure to bed bug bites

D. systemic skin reactions frequently occur following an initial exposure to bed bug bites

The most common sites for squamous and basal cell carcinoma include: A. palms of hands and soles of feet B. pelvic and lumbar regions C. the abdomen D. face and scalp

D. the face and scalp

All of the following characteristics about bed bugs are true except: A. they can be found in furniture, carpeting, and floorboards B. their peak feeding time is at dawn C. during feeding, they are attracted to body heat and carbon dioxide D. they prefer to harbor unsanitary environments

D. they prefer to harbor unsanitary environments

Shingles most commonly involve the dermatomes of the: A. legs and pubic area. B. face. C. upper arms and shoulders. D. thorax

D. thorax

A 49 year old man presents with a skin lesion suspicious for malignant melanoma. You describe the lesion as having: A. deep black brown coloring throughout B. sharp borders C. a diameter of 3 mm or less D. variable pigmentation

D. variable pigmentation

first generation antihistamines

Diphenhydramine (Benadryl) Chlorpheniramine (Chlor-Trimeton)

High Potency topical steroids

Fluocinolone acetonide 0.2% Desoximetasone 0.25% Fluocinonide 0.05% Betamethasone dipropionate 0.05% augmented

Low Potency Topical Steroids

Hydrocortisone (0.5%, 1%, 2.5%) Fluocinolone acetonide 0.01% Triamcinolone acetonide 0.025% Fluocinolone acetonide 0.025% Hydrocortisone butyrate 0.1% Hydrocortisone valerate 0.2% Triamcinolone acetonide 0.1%

second generation antihistamines

Loratadine (Claritin) Cetirizine (Zyrtec) Fexofenadine (Allegra) Levocetirizine (Xyzal)

squamous cell carcinoma

N=nodular O=opaque S=sun exposed areas U=ulcerating N=non distinct borders

basal cell carcinoma

P=pearly papule U=ulcerating T=telangiectasis O=on the face, scalp, pinnae N=nodules=slow growing

PVL toxin

Panton-Valentina leukocidin (PVL), present in nearly 77% of CA-MRSA strains, and is less common in healthcare MRSA strains promotes lysis of human leukocytes and is associated with severe necrotizing skin infections and hemorrhagic pneumonia

acne inducing medications

Phenytoin Lithium

Accutane

effective in cystic acne that does not respond to conventional therapy complications: pseudotumor cerebri, fetal defects, elevated TGs, elevated hepatic enzymes, cheiltis monitor for depression use two forms of highly effective contraception and have a preg test done monthly during therapy 4-6 month course; d/c when nodule count is reduced by 70%--repeat course only if needed after 6 months off drug

wheal

a circumscribed, slightly elevated lesion of the skin that is paler in the center than its surrounding edges; hives

Third degree burn

affected area is white and leathery

First degree burn

affected skin blanches with ease

Seborrheic dermatitis is likely caused by: a. accelerated mitosis of the cells b. colonization of skin by S. aureus c. inflammatory reaction to Malassezia species on skin d. exposure to excessive UV radiation

c. inflammatory reaction to Malassezia species on skin

Stage 2 Lyme disease

early disseminated infection typically months later--the classic rash may reappear with multiple lesions, usually accompanied by arthralgias, myalgia, headache and fatigue less common cardiac manifestations: heart block, Bell's palsy, aseptic meningitis

patch

flat discoloration greater than 1 cm in diameter

macule

flat discoloration less than 1 cm in diameter