Ch. 8 Integumentary Problems

Harry uses a high-potency corticosteroid cream for his dermatoses. You tell him the following?

"It may exacerbate your concurrent condition of tinea corporis."

Client teaching is an integral part of successfully treating pediculosis. Which of the following statements would you incorporate in your teaching plan?

"Itching may continue after successful treatment for up to a week."

Silas, age 82, comes to your office with a fairly new colostomy. Around the stoma he has a papular rash with satellite lesions. What does this indicate?

A fungal infection, usually Candida albicans

Which treatment would you order for anogenital pruritus?

A high-fiber diet for constipation.

What is an excessive amount of collagen that develops during scar formation called?

A keloid

What is the connection between the surface of the skin and underlying structure called?

A sinus

What is a safe and effective treatment for mild psoriasis?

Coal tar preparations

Which of the following warts (HPV) looks like a cauliflower and is usually found in the anogential region?

Condyloma acuminata

What is a non-invasive method of treating skin cancer (other than melanoma) that uses liquid nitrogen?

Cryosurgery

Steve, age 29, has a carbuncle on his neck. After an incision and draindage, an antibiotic is ordered. What is the most common organism involved?

Staphylococcus aureus

A Wood's light is especially useful in diagnosing which of the following?

Tinea versicolor

Janice states that her son is allergic to eggs, and she heard that he should not receive the flu vaccine. How do you respond?

"Although measles, mumps, rubella, and influenza vaccines contain a minute amount of egg, most egg allergic individuals can tolerate these vaccines without any problem."

Suzanne has a 7 year old daughter who has had two recent infections of lice. She asks you what she can do to prevent this. You respond, ?

"Don't let her share hats, combs, or brushes with anyone."

Amy, age 36, is planning to go skiing with her fiance. He has warned her about frostbite, and she is wondering what to do if frostbite should occur. You know she's misunderstood the directions when she tells you which of the following?

"I should rub the area with snow."

You're teaching Mitch, age 18, about his tinea pedis. You know he doesn't understand your teaching when he tells you which of the following?

"I should wear rubber shoes in the shower to prevent transmission to others."

Jamie, age 6, was bitten by a dog. Her mother asks you if the child needs antirabies treatment. You tell her?

"If the dog was a domestic pet that had been vaccinated, the wound should be cleaned and irrigated."

Your 24 yr old client, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?

"Once all the vesicles are crusted over."

Marie asks what she can do for Sarah, her 90 year old mother, who has extremely dry skin. You respond?

"Your mother does not need a bath every day."

Your client had a colostomy several weeks ago and is having difficulty finding a permanent appliance that fits. How long do you tell him to wait for the stoma to shrink before buying a permanent appliance?

6-8 weeks

Which form of acne is more common in the middle-aged to older adult and causes changes in skin color, enlarged pores, and thickening of the soft tissues of the nose?

Acne rosacea

Which skin lesion is morphologically classified as pustular?

Acne rosacea

Which skin lesions are directly related to chronic sun exposure and photodamage?

Actinic keratoses

Tanisha, a 24 year old African American mother of four young children, presents in the clinic today with varicella. She states that three of her children also have it and that her eruption started less than 24 hours ago. Which action may shorten the course of the disease in Tanisha?

Acyclovir (Zoviax)

A Gram stain of which lesion reveals large, square-ended, gram-positive rods that grow easily on blood agar?

Anthrax

The morphology of which lesion begins as an inflammatory papule that develops within several days into a painless, hemorrhagic, and necrotic abscess, eventually with a dense, black, necrotic eschar forming over the initial lesion?

Anthrax

Janine, age 29, has numerous transient lesions that come and go and is diagnosed with urticaria. What do you order?

Antihistamines

The ABCEDs of melanoma identification include which of the following?

Asymmetry: One half does not match the other half.

What is the most important thing a woman can do to have youthful, attractive skin?

Avoid smoking

What is the most effective treatment for urticaria?

Avoidance of the offending agent

A differential diagnosis of scarring alopecia may be?

Bacterial infection of the scalp

Candidiasis may occur in many parts of the body. James, age 29, has it in the glans of his penis. What is your diagnosis?

Balanitis

Which assessment system for a malignant melanoma is used to determine the thickness of a lesion and help in determing prognosis?

Breslow's

Shelly has a blister filled with clear fluid on her arm. It is the result of contact with a hot iron How do you document this?

Bulla

Balanitis is associated with?

Candida infection of the penis.

Justin, an obese 42-year old, cut his right leg 3 days ago while climbing a ladder. Today his right lower leg is warm, reddened, and painful without a sharply demarcated border. What do you suspect?

Cellulitis

Lance, age 50, is complaining of an itchy rash that ocurred about a half hour after putting on his leather jacket. He recalls a slightly similar rash last year when he wore his jacket. The annular lesions are on his neck and both arms. They are erythematous, sharply circumscribed, and both flat and elevated. His voice seems a little raspy although he states his breathing is normal. What is your first action?

Determine the need for 0.5ml 1:1,000 epinephrine subcutaneously

Which of the following is a predisposing condition for furunculosis?

Diabetes mellitus

What is the initial emergency measure to limit burn severity?

Eliminate the heat source.

What is the drug of choice for acute anaphylaxis?

Epinephrine 1:1,000 subcutaneously (0.3-0.5ml) for adults.

Which disease usually starts on the cheeks and spreads to the arms and trunk?

Erythema infectiosum (fifth disease)

Which type of wart has fingerlike, flesh-colored projections emanationg from a narrow or broad base?

Filiform warts

In a burn trauma, which blood measurement rises as a secondary result of hemoconcentration when fluid shifts from the intravascular compartment?

Hematocrit

Elizabeth, age 83, presents with a 3 day history of pain and burning in the left forehead. This morning she noticed a rash with erythematous papules in that site. What do you suspect?

Herpes zoster.

Large, flaccid bullae with honey-colored crusts around the mouth and nose are characteristic of?

Impetigo.

Where is the epitrochlear lymph node located?

In the inner condyle of the humerus

Susan states that her fiance has been frostbitten on the nose while skiing and is fearful that it will happen again. What do you tell her?

Infarction and necrosis of the affected tissue can happen with repeated frostbite.

In burn trauma, silver sulfadiazine (Silvadene), a sulfonamide, is the most commonly used topical agent. What is its mechanism of action?

It is a bactericidal agent that acts on the cell membrane and cell wall of susceptible bacteria and binds to cellular DNA.

Susie, age 6 months, has a Candida infection in the diaper region. What do you suggest to the mother?

Keep the area as dry as possible

Which of the following secondary skin lesions usually results from chronic scratching or rubbing?

Lichenification

Jerry, age 52, has gout. What do you suggest?

Limiting consumption of purine-rich foods.

Which treatment is considered the gold standard in tissue-conservative skin cancer removal?

Mohs' micrographic surgery

Psoriasis may occur after months of using?

NSAIDs

Which of the following types of cellulitis is referred to as "flesh eating bacteria" ?

Necrotizing fascitis

What is the treatment for thrush?

Nystatin oral suspension for 2 weeks, 2-3ml in each side of the mouth, held as long as possible.

Tinea unguium is also known as?

Onchomycosis

A 70 year old client with herpes zoster has a vesicle on the tip of the nose. This may indicate?

Ophthalmic zoster

Which is the drug of choice for tinea capitis?

Oral griseofulvin (Grisactin)

Jim, age 59, presents with recurrent, sharply circumscribed, red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect?

Psoriais

Which lesion results in scales or shedding flakes of greasy, keratinized skin tissue?

Psoriasis

Persons with which skin phototype (SPT) sunburn easily after 30 minutes in the sun but never tan?

SPT I

Permethrin (Elimite) applied over the body overnight from the neck down is the preferred treatment for?

Scabies

Pastia lines are present in which disease?

Scarlet fever

Which of the following is a secondary skin lesion?

Seborheic dermatitis

Sophie brings in her husband, Nathan, age 72, who is in a wheelchair. On his sacral area he has a deep crater with full- thickness skin loss involving necrosis of subcutaneous tissue that extends down to the underlying fascia. Which pressure ulcer stage is this?

Stage III

Johnny, age 12, just started taking amoxicillin for otitis media. His mother said that he woke up this morning with a rash on his trunk. What is your first action?

Stop the amoxicillin.

Which type of hemangioma in a newborn occurs on the nape of the neck and is usually not noticeable when it becomes covered by the hair?

Stork's beak mark

What is the most common rosacea trigger?

Sun exposure

Sidney, age 72, has just been diagnosed with temporal arteritis. What do you prescribe?

Systemic corticosteriods

Which of the following statements about malignant melanomas is true?

The prognosis is directly related to the thickness of the lesions.

Buddy, age 12, presents with annular lesions with a scaly border and central clearing on his trunk. What do you suspect?

Tinea corporis

Stephen, age 18, presents with a pruritic rash on his upper trunk and shoulders. You observe flat to slightly elevated brown papules and plaques that scale when they are rubbed. You also note areas of hypopigmentation. What is your initial diagnosis?

Tinea versicolor

Why is ultraviolet light therapy used to treat psoriasis?

To decrease the growth rate of epidermal cells

Which agent is ineffective against psoriasis?

Topical antifungals

Jennifer, age 32, is pregnant and has genital warts (condylomata) and would like to have them treated. What should you order?

Trichloroacetic acid

Which of the following therapeutic modalities is useful for severe uncontrollable atopic dermatitis?

Ultraviolet light

Sandra, age 69, is complaining of dry skin. What do you advise her to do?

Use tepid water and a mild cleansing cream.

What is the name of the acquired disorder characterized by complete loss of pigment of the involved skin?

Vitiligo

You are teaching Harvey about the warts on his hands. What is included in your teaching?

Warts are caused by the human papillomavirus.

A linear arrangement along a nerve distribution is a description of which type of skin lesion?

Zosteriform

Clubbing is defined as?

a thickening or broadening of the ends of the fingers.

Treatment for a stage 1 pressure ulcer may include?

a transparent, semipermeable membrane dressing.

The total loss of hair on all parts of the female body is called?

alopecia universalis

A basal cell carcinoma is?

an epithelial tumor that originates from either the basal layer of the epidermis or cells in the surrounding dermal structures?

Thin, spoon-shaped nails are usually seen in?

anemia

A thinning of skin that appears white or translucent is defined as?

atrophy

Mary just came from visiting her husband, Sam age 82, who recently had an ileostomy resulting in a stoma. She did not think that Sam's stoma looked "right." You tell her that the color of the stoma should be?

beefy red

A client with a nutritional deficiency of vitamin C may have?

bleeding gums and delayed mouth healing

When palpating the skin over the clavicle of James, age 84, you notice tenting, which is?

common in older adults

Susan, a new mother, states that when she pushes her index finger on one of her baby's skull bones, it presses in and then returns to normal when she removes her finger. she is concerned about this. You tell her it is common and is called?

craniotabes

Adverse effects from prolonged or high-potency topical corticosteriod use on an open lesion may include?

easy bruisability

Which structure of the skin is responsible for storing melanin?

epidermis

A mother complains that her newborn infant lying on his or her side may appear red on the dependent side of the body while appearing pale on the upper side. When she picks up the baby, the coloring disappears. You explain to her about?

harlequin sign

Jack, age 59, has a nevus on his shoulder that has recently changed from brown to bluish black. You advise him to?

have an excisional biopsy

Abe, age 57, has just been given a diagnosis of herpes zoster. He asks you about exposure to others. You tell him that?

he should stay away from children and pregnant women that have not had chickenpox.

The five Ps- purple, polygomal, planar, pruritic papules-- are present on?

lichen planus

A biopsy of a small, yellow-orange papulomodule on the eyelid will probably show?

lipid-laden cells

Nevi aris from?

melanocytes

All of the following medications may cause alopecia except?

minoxidil (Rogaine)

Susie asks you about the "blackheads" on her face. You tell her these are referred to as?

open comedones

An eczematous skin reaction may result from?

penicillin

Zinc oxide, magnesium silicate, ferric chloride, and kaolin are examples of?

physical sunscreens

The "herald patch" is present in almost all cases of ?

pityriasis rosea

Gouty pain in the great toe is?

podagra

The purpose of a transparent dressing such as Tegaderm applied over a pressure ulcer is to?

prevent skin breakdown and the entrance of moisture and bacteria but allow permeability of oxygen and moisture vapor.

A client with a platelet abnormality may present with?

red, flat, nonblanchable petechiae.

The viral exanthem of Koplik's spots is present in?

rubeola

John, age 58, is a farmer. He presents with a painful finger ulcer and a palpable olecranal lymph node. Suspecting an orf skin ulcer, you ask him if he works with?

sheep and goats

Samantha, age 52, has an acrochordon on her neck. She refers to it as a ?

skin tag

Which of the following should be used with all acne medications?

sunscreen

The majority of malignant melanomas are?

superficially spreading

A darkfield examination is used to cutaneously diagnose which disease?

syphilis

A darkfield microscopic examination is used to diagnose?

syphilis

Debbie, age 29, has a high fever and red, warm, sharply marginated plaques on the right side of her face that are indurated and painful. You diagnose erysipelas. What treatment do you begin?

systemic antibiotics

Margaret, age 32, comes into the clinic. She has painful joints and a distinct rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect?

systemic lupus erythematous

Dry, itchy skin in older adults results from?

the reduction of sweat and oil glands

Jane is the 26 year old Asian mother of Alysia, age 2 months. She is concerned about the large blue spot covering her infant's entire right lower leg. Jane tells you that Alysia was born with the spot. You tell her that?

this is a mongolian spot. It is common in Asians and blacks, and no treatment is necessary because it will fade with age.

Johnnie, age 52, presents with pruritus with no rash present. He has hypertension, diabetes, and end-stage renal disease (ESRD). One of the differential diagnoses would be?

uremia from chronic renal disease