Skin, Hair, and Nails Review Questions

A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office.

A) Reassure him that there is nothing to worry about.

Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely? A) An enlarged lymph node B) A sebaceous cyst C) An actinic keratosis D) A malignant lesion

B) A sebaceous cyst

filled with fluid, > 1cm

bulla

You are beginning the examination of the skin of a 25-year-old teacher. you have previously elicited that she came to the office for evaluation of fatigue, weight loss, and hair loss. you strongly suspect that she has hypothyroidism. what is the expected moisture and texture of the skin of a patient with hypothyroidism?

dry and rough

tinea versicolor

fine scales of hypopigmentation

tinea cruris

groin

lesion is flat, < 1cm

macule

tinea incognito

mutation of initial lesions localized skin infection caused by fungus It is a skin infectious process that looks very different from other fungal infections, both the shape and the degree of involvement.

tinea unguinum

nails

lesion is elevated, <1cm, and not fluid filled

papule

flat, > 1cm

patch

lesion is elevated, > 1cm, no fluid

plaque

silvery, scaly rash

psoriasis

lesion is raised, < 1cm, and fluid filled

vesicle

A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma

A) Actinic keratosis

You have recently returned from a medical missions trip to sub-Saharan Africa, where you learned a great deal about malaria. You decide to use some of the same questions and maneuvers in your "routine" when examining patients in the midwestern United States. You are disappointed to find that despite getting some positive answers and findings, on further workup, none of your patients has malaria except one, who recently emigrated from Ghana. How should you next approach these questions and maneuvers? A) Continue asking these questions in a more selective way. B) Stop asking these questions, because they are low yield. C) Question the validity of the questions. D) Ask these questions of all your patients.

A) Continue asking these questions in a more selective way.

A 28 year old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso. The lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) pityriasis rosea B) tinea versicolor C) psoriasis D) atopic eczema

A) pityriasis rosea Pityriasis rosea is a common skin disease that causes a skin rash that sometimes begins as a large spot on the chest, belly, or back followed by a pattern of smaller lesions. This rash usually disappears on its own without treatment. The rash typically lasts for about 6 to 8 weeks, but sometimes the rash lasts much longer.

Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Urticaria, or hives C) Psoriasis D) Purpura

B) Urticaria, or hives Urticaria, or hives, is a common skin rash of round, red welts on the skin that itch intensely, sometimes with dangerous swelling, caused/triggered by an allergic reaction, typically to specific foods, medications, or stress. Symptoms include itchy, raised, red, or skin-colored welts on the skin's surface. Hives usually go away without treatment, but antihistamine medications are often helpful in improving symptoms.

A patient with a recent diagnosis of hypothyroidism presents to the clinic. During the skin assessment, you may expect the following skin finding: A) oily skin on face and trunk B) generalized areas of dry skin C) generalized areas of warmth over the skin D) skin that is a velvety texture

B) generalized areas of dry skin Associated findings of hypothyroidism include dry, rough, and pale skin; coarse and brittle hair; myxedema; alopecia (lateral third of the eyebrows to diffuse); skin cool to touch; thin and brittle nails

Jane is an NP who observes a raised rash on the backs of her patient's knees covering an area greater than 1 cm. She charts these solid bumps as: A) macules B) papules C) plaques D) vesicles

B) papules

A patient comes to you for the appearance of red patches on his forearms that have been present for several months. They remain for several weeks. He denies a history of trauma. Which of the following is likely? A) Actinic keratoses B) Pseudoscars C) Actinic purpura D) Cherry angiomas

C) Actinic purpura Actinic purpura is a benign clinical entity resulting from sun-induced damage to the connective tissue of the dermis. Actinic purpura is characterized by ecchymoses on the extensor surfaces of the forearms and the dorsa of the hands that usually last 1-3 weeks.

An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia

A) Alopecia areata

Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems.

A) It is likely to be related to her lupus.

A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema

A) Pityriasis rosea

A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story

A) Reassure her that this is normal

You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E = evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution

B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution

A 22-year-old advertising copywriter presents for evaluation of joint pain. The pain is new, located in the wrists and fingers bilaterally, with some subjective fever. The patient denies a rash; she also denies recent travel or camping activities. She has a family history significant for rheumatoid arthritis. Based on this information, which of the following pathologic processes would be the most correct? A) Infectious B) Inflammatory C) Hematologic D) Traumatic

B) Inflammatory

A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma

B) Seborrheic keratosis Seborrheic keratosis: ■ Often have a verrucous texture ■ Appear like a "stuck-on" or flattened ball of wax ■ May crumble or bleed if picked ■ Specific features on dermoscopy such as milia-like cysts or comedone-like openings are reassuring, if present ■ May be erythematous if inflamed

A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema

B) Tinea versicolor

Joel is a nurse practitioner in a busy family practice clinic. He is charting on his patient, Deborah, who appears to have a skin rash on her face. He charts the following: no fevers, no new lotions or soaps, no new medications, no recent sun exposure, no itching. His documentation is an example of charting: A) too much detail about the chief complaint B) pertinent negatives C) in a succinct writing style D) objective data

B) pertinent negatives

Alexander is a 16 year old athlete who came to the clinic with a rash on his neck. while taking his history, he states he started a new exercise called hot yoga, where the room is very warm and he sweats a great deal. Then he has a long drive home while wearing wet, sweaty clothing. when you examine his back, you note several discrete, round lesions with a raised edge along the outside and a central clearing. What might you suspect? A) impetigo B) tinea C) psoriasis D) versicolor

B) tinea A highly contagious, fungal infection of the skin or scalp. Types of tinea include ringworm, athlete's foot and jock itch. These infections are usually not serious, but they can be uncomfortable. You can get them by touching an infected person, from damp surfaces such as shower floors, or even from a pet.

Ms. Whiting is a 68 year old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient.

C) Ask how she acquired them.

A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Female D) Heavy sun exposure

C) Female

You are examining an unconscious patient from another region and notice Beau's lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next? A) Conclude this is caused by a cultural practice. B) Conclude this finding is most likely secondary to trauma. C) Look for information from family and records regarding any problems which occurred 3 months ago. D) Ask about dietary intake.

C) Look for information from family and records regarding any problems which occurred 3 months ago. Beau's lines are transverse linear depressions of the nail plates, usually bilateral, resulting from temporary disruption of proximal nail growth from systemic illness. Timing of the illness may be estimated by measuring the distance from the line to the nail bed (nails grow approximately 1 mm every 6 to 10 days). Seen in severe illness, trauma, and cold exposure if Raynaud disease is present.

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection

C) Psoriasis

A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection

C) Psoriasis Psoriasis is an immune-mediated disease that causes raised, dry, red, scaly patches to appear on the skin. Psoriasis typically affects the outside of the elbows, knees or scalp, though it can appear on any location. Some people report that psoriasis is itchy, burns and stings

A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum, there is a full-thickness skin loss that is 5cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4

C) Stage 3 Stage 1: Presence of a reddened area that fails to blanch with pressure, and changes in temperature (warmth or coolness), consistency (firm or boggy), sensation (pain or itching), or color (red, blue, or purple on darker skin; red on lighter skin) Stage 2: The skin forms a blister or sore. Partial-thickness skin loss or ulceration involving the epidermis, dermis, or both Stage 3: A crater appears in the skin, with full-thickness skin loss and damage to or necrosis of subcutaneous tissue that may extend to, but not through, underlying muscle Stage 4: The pressure ulcer deepens. There is full-thickness skin loss, with destruction, tissue necrosis, or damage to underlying muscle, bone, and sometimes tendons and joints

A deeper loss of epidermis and dermis which may bleed and scar is: A) erosion B) fissure C) ulcer D) excoriation

C) ulcer

Rhonda is seeing a patient that just came back from the beach for spring break and has a rash on her thighs that started after the last day while she was laying in the sun. A cursory exam of her thigh and the rash looks like a hand print. All of the following are important questions to ask, EXCEPT: A) Did you wear sunscreen? B) Did you shower after being in the sun? C) What were you drinking while you were laying out? D) Did you see any sand fleas?

D) Did you see any sand fleas?