NPs BH Derm Mod 2 N6221

A 9-year-old girl is burned by hot oil after an unintentional spill from a deep fryer. She has superficial burns over her entire anterior left upper extremity and partial-thickness burns of her entire anterior trunk and entire anterior right upper extremity. What approximate percent of her body surface area is involved?

22.5%

Which of the following children would necessitate further evaluation by a specialist prior to starting medication for attention-deficit/hyperactivity disorder?

5-year-old boy with moderate attention-deficit/hyperactivity disorder who has parental support for starting medication

A mother presents with her 3-year-old son. He was recently diagnosed with autism spectrum disorder. Which of the following abnormalities is most associated with his disorder during childhood?

Accelerated head growth during infancy

A 16-year-old girl has experienced multiple stressors over the past 6 months, including the incarceration of her father, a diagnosis of leukemia in her younger sister, and starting two jobs to help her mom pay for rent and her sister's medical bills. Over the past 4 months, she has felt anxious, had trouble sleeping, frequently caught colds, and gained several pounds unintentionally. Which of the following terms refers to adverse physiologic changes that result from psychosocial stressors?

Allostasis

A 5-year-old boy presents to the office for evaluation of atypical behaviors. He becomes upset, clingy, or throws a tantrum when he sees a dog outside, even when it is far away or on a leash. He refuses to have playdates with friends who have dogs. His family does not own a dog, and his parents say he has never been bitten. He reports no specific traumatic event but notes that he has watched some movies with "bad dogs." Increased activity in which of the following areas of the brain would be most likely when he is actively exposed to dogs?

Amygdala

A 27-year-old woman presents to her provider with a rash over her entire torso, and some on her arms and legs. Her vital signs are normal. She reports mild itchiness that improves with taking diphenhydramine, however, she is anxious about why she has the rash and how to make it go away. She denies any recent changes to her hygiene, cosmetic products, or laundry products. She is healthy overall but did complete a 10-day course of sulfamethoxazole-trimethoprim for a urinary tract infection two days ago. On exam, she has a morbilliform rash and there are no hives, pustules, or petechiae. Her mucous membranes are not involved, and her face, palms, and soles are spared. Based on her history and exam, a reaction to the antibiotic is suspected as the cause of the rash, and she is given reassurance the rash should self-resolve in the next one to two weeks. Which of the following mechanisms is likely responsible for her reaction and rash?

Antigen exposure, sensitizing T cells, which then mediate tissue injury

A 29-year-old woman presents with complaints of an ongoing pruritic rash to both arms, wrists, and lower legs. She reports the rash has been present in varying severity for the past 4 years. Her only significant past medical history is intermittent asthma. She uses inhaled albuterol as needed. She reports no recent exposure to new cosmetics, lotions, animals, or plants. On physical examination, there are excoriated, dry papules noted to the antecubital fossa of both arms, volar wrists, and lower legs. There is lichenification and mild erythema noted to each area. What is the most likely diagnosis?

Atopic dermatitis

A 28-year-old woman presents with concerns for skin changes to her hands, and now a new spot on her face. The spots are not itchy or painful. She recently gave birth to her first child and there were no complications with the pregnancy or delivery. She denies any recent illnesses. On exam she has several well-demarcated pale macules between 1-4 cm in diameter on both of her hands and one near her lips, concerning for vitiligo. Which of the following mechanisms is most likely responsible for pathogenesis of this disease?

Autoimmune

A 9-year-old girl with type 1 diabetes mellitus presents to the clinic with a new rash. On exam, she has symmetrical hypopigmented macules and patches on her hands, elbows, knees, and ankles. What is the most likely cause of this patient's rash?

Autoimmune destruction of melanocytes

Which of the following classes of medications is recommended as first-line therapy in the treatment of moderate to severe alcohol withdrawal?

Benzodiazapines

A 25-year-old man presents to the clinic at the behest of his wife. According to his wife, he has not slept more than two hours in the past two weeks and believes that he is on the verge of making a discovery that would change humanity forever. He recently spent his savings on fancy cars and flamboyant clothing, because he believes he is a superstar and needs to look the part. During history taking and physical assessment, his speech is noted to be pressured and he often jumps from one topic to another, making it difficult to understand him. Laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Bipolar I disorder

A 27-year-old man is being seen by his family practice provider for a skin survey based on having more than fifty nevi on his arms and trunk. Which of the following findings should make the provider concerned about malignant melanoma?

Border irregularity

A 29-year-old man presents to the clinic and reports he has felt increasingly nervous and agitated. He explains that he was recently promoted at work and now gives frequent oral presentations in front of large groups of people. He becomes nervous and agitated at the podium but is calm after the presentation. He believes the symptoms are affecting his overall work performance and that he may lose his job. Which of the following would be most appropriate to prescribe?

Buspirone

A 30-year-old woman with a known history of anxiety presents to her provider to have her anxiety medications refilled. She has been using more of her medications recently because she has had some new symptoms. In particular, she is experiencing intrusive thoughts and feels compelled to do things to quiet the thoughts, which sometimes drives her to take her anxiety medicine. These unwanted thoughts are starting to interfere with her ability to get to work on time and focus on work while she is there. Which of the following would be most consistent with the suspected diagnosis?

Checking to make sure all appliances and lights are off before leaving a room due to concern for fire

A 24-year-old woman presents to your office with a complaint of severe anxiety. Approximately three times per week she has episodes of sweating, chest pain, heart palpitations, shaking and fear of losing control or dying. The episodes seem to occur and resolve spontaneously. Which of the following is the most appropriate therapy?

Citalopram (Celexa)

A 25-year-old man with refractory schizophrenia who is being treated with multiple medications has developed left-sided chest pain. Laboratory studies show decreased white blood cell count, decreased absolute neutrophil count, and elevated troponin. Which of the following medications is he taking?

Clozapine

A 52-year-old man presents to the office with a rash on both of his arms for 3 days. He reports that he was working in his yard the day before the rash appeared. The rash is red, itchy, and only located on his arms. On exam, there are erythematous linear markings on bilateral ventral forearms, with scattered papules and pustules. What is the most likely diagnosis?

Contact dermatitis

Which of the following genera of bacteria is most commonly associated with the development of acne vulgaris?

Cutibacterium

A 7-year-old boy presents for evaluation. He has been persistently wetting his bed including three times per week and has not had prior times of urinary continence. He has no known medical complications, he is not constipated, and he does not take any medications or substances. Which of the following is most likely to be a cause of his presentation?

Delayed maturation of bladder control

Which of the following findings supports a diagnosis of herpes zoster?

Dermatomal distribution

A 30-year-old woman presents to the ED with agitation and fever. On physical exam, you note lower extremity hyperreflexia and myoclonus. Vital signs are BP 180/110 mm Hg, HR 130 beats per minute, RR 28 breaths per minute, and T 101.8°F. Which of the following combinations likely led to this presentation?

Dextromethorphan and citalopram

A 35-year-old woman has insomnia and is on zolpidem 10 mg. Her husband reports that she started sleep-walking and was eating from the refrigerator in the middle of the night. The patient does not recall this behavior. Which of the following is the best next step in management?

Discontinue zolpidem

Which of the following neurotransmitters is affected most by first-generation antipsychotic medication used to treat patients with schizophrenia?

Dopamine

A 17-year-old girl who is overweight, presents to the clinic with her mother. Her mother is concerned that she has caught her daughter eating large amounts of food in the middle of the night, and she has found receipts for over-the-counter laxatives in the garbage. What physical exam finding is most likely to be seen with the suspected diagnosis?

Enamel erosion

A 23-year-old man presents to the psychiatric emergency room involuntarily. The patient is malodorous and disheveled. His affect is flat, and he is conversing with people who are not present. Which of the following findings are most likely to be observed on brain MRI?

Enlarged ventricles

A 3-year-old boy who has been recently diagnosed with autism spectrum disorder presents to clinic for a well check. He has started speech therapy for his language delay, and his mother would like to know if he is at increased risk for any other problems because of his autism diagnosis. Which of the following is a known comorbidity of autism spectrum disorder?

Epilepsy

A 64-year-old woman with morbid obesity presents with skin changes of the bilateral lower extremities that have been present for the past several months. She reports darkened patches of skin in the ankle areas with associated mild itching. On examination, there are erythematous, hyperpigmented, and eczematous patches with skin breakdown and weeping at the medial ankle areas. Pitting edema is present. Which of the following describes the pathophysiology for the most likely diagnosis?

Extravasation of plasma proteins and red blood cells into the subcutaneous tissue

A 24-year-old woman presents to the urgent care clinic for evaluation of new welts on her trunk for the past day. Yesterday after returning home from a lunch of seafood pasta at a local restaurant, she noticed several intensely pruritic and raised lesions on her trunk. Overnight, several new lesions formed next to the initial lesions. She has no known food allergies and notes the pasta contained mussels, which she had never consumed in the past. She took cetirizine 10 mg twice yesterday and once again this morning without symptomatic relief. She has no known medical conditions and does not take any regular medications. On review of systems, she has not experienced fever, dyspnea, or other symptoms. On vital signs, she has a T of 98.7°F, HR of 80 bpm, BP of 114/70 mm Hg, RR of 18 breaths per minute, and oxygen saturation of 98%. Physical exam is unremarkable other than the presence of 10 to 12 of the above lesions on her trunk. Which of the following should be prescribed next?

Famotidine

A 23-year-old man presents to your office to request mental health treatment. He has a family history of schizophrenia and is concerned because he has been hearing voices telling him to do things. Which of the following is most likely to be found on the mental status exam?

Flat affect

A 20-year-old woman presents to the clinic for follow-up. She has a three-year history of bulimia nervosa and is currently being managed with cognitive-behavioral therapy and nutritional rehabilitation. The patient is wanting to explore a pharmacotherapy option. Which of the following is recommended first-line?

Fluoxetine

Initial management of adolescents with depression includes patient education, lifestyle modifications, and counseling. If initial management fails or a patient presents with acute symptoms, what is the most common first-line medication that would be prescribed?

Fluoxetine

Which of the following screening tools should be used as part of the comprehensive evaluation for an adult with suspected generalized anxiety disorder?

GAD-7

A 70-year-old woman presents to the primary care clinic for a refill of alprazolam. She reports that she started taking this medication 7 years ago for anxiety, but her psychiatrist retired last month. She takes 1 mg alprazolam three times daily as prescribed. She notes that she has been taking half of her regular dose for the past 3 days to make the prescription last longer but has been having increased anxiety, insomnia, and an agitated mood. On examination, her BP is 150/90 mm Hg, her HR is 104 bpm, and she appears anxious and slightly diaphoretic. Which of the following neurotransmitters does this medication potentiate to exert its anxiolytic effects on the patient

Gamma-aminobutyric acid

A 30-year-old man presents to clinic with pain in the penis and rectum for two days. He had both oral and anal receptive sex with a new partner one week ago without the use of a condom. He denies penile discharge and dysuria, but did have a low-grade fever for one day prior to the onset of pain. Physical examination shows shallow, painful ulcers on the shaft of the penis and a clustered patch of clear vesicles on the right side of the buttocks adjacent to the anus. No inguinal lymphadenopathy is present. Rapid HIV antibody test is negative. Cultures are obtained from both sites. Which of the following is the most likely diagnosis?

Genital herpes

A 25-year-old woman presents to the clinic with concerns about mood swings. She states she gets into bad fights with her boyfriend every month and has almost ended their relationship a few times. Around this time, she is more tearful, anxious, and irritable. Which history question would help to confirm the suspected diagnosis?

How do these fights correlate with your menstrual cycle?

A 14-year-old boy presents to the outpatient family practice office complaining of several small honey-crusted lesions on an erythematous base located on his chin. He denies fever or chills. He has never experienced this before but recently joined the wrestling team and noticed several other wrestlers with the same rash. What is the most likely diagn

Impetigo

A 14-year-old boy presents to the outpatient family practice office complaining of several small honey-crusted lesions on an erythematous base located on his chin. He denies fever or chills. He has never experienced this before but recently joined the wrestling team and noticed several other wrestlers with the same rash. What is the most likely diagnosis?

Impetigo

A 72-year-old woman presents for a routine visit and medication refill. During her visit, she mentions that her right big toe has been bothering her. It is painful for her to wear shoes and cut her nails. On exam, a thickened, yellowed toenail is noted, affecting the distal two-thirds of the nail bed of her right great toe. The surrounding skin otherwise appears normal. A potassium hydroxide preparation is taken immediately, and hyphae are noted. A fungal culture is sent, and oral terbinafine is prescribed. Which of the following is the mechanism of action for this treatment?

Inhibits the enzyme squalene epoxidase, preventing synthesis of ergosterol, which is needed to build fungal cell walls

A clinician is performing testing on a patient's skin lesion to verify a diagnosis of tinea corporis. The clinician orders a microscopic potassium hydroxide preparation of the skin scraping sample. Why is this type of preparation used to diagnose tinea corporis?

It dissolves the surrounding keratin, nail, and skin cells to visualize fungal organisms

A 14-year-old girl presents to the emergency department for evaluation after a near-syncopal episode at school. She reports that she became very dizzy when standing up too quickly from her desk after sitting in class for several hours. Vital signs include a heart rate of 62 bpm and a blood pressure of 97/65 mm Hg. Her weight is 36 kg, and her height is 155 cm. On physical examination, she is nontoxic but appears very thin. A review of the patient's chart shows her weight was documented as 45 kg at a visit 8 months ago. Collateral history is requested from her parents, who report that their daughter has been dieting for the past several months and has recently added more workouts to her daily routine. They are concerned about the degree to which she restricts her calories. In the course of her evaluation, which of the following results is most likely?

Large stool burden on abdominal X-ray

A 67-year-old woman presents to the clinic for a skin lesion. Which of the following factors in the patient's risk assessment may lead the clinician to suspect melanoma?

Light skinned with red hair

A 5-year-old girl presents to the urgent care clinic with her father. The father is concerned about an enlarging rash on the patient's arm. He states the patient spent the night in a tent in their backyard last night, and this morning, she woke up with a small lesion on her left arm that was very itchy. Over the last 2 hours, the lesion has progressively enlarged. Physical examination of the left arm reveals an erythematous, raised, circular plaque that is 6 cm in diameter. The rest of her physical examination is normal. The patient is prescribed cetirizine, and a follow-up call the next morning reveals the lesion has resolved entirely. Which of the following best describes the pathophysiology of the patient's condition?

Mast cell release of histamine in the superficial dermis

A 34-year-old woman presents to the clinic with a rosacea exacerbation. Avoiding triggers has not been sufficient to minimize her symptoms. Which of the following medications is contraindicated in the management of this patient?

Medium-potency corticosteroid cream

A patient presents with the lesion seen above on his upper lid. The lesion developed over weeks. It is nontender. This condition is associated with blockage of which gland?

Meibomian

Which of the following opioid analgesic agents has N-methyl-d-aspartate antagonist and norepinephrine reuptake inhibition activity that may assist with managing neuropathic types of pain?

Methadone

Which of the following antidepressants has potent antihistamine properties that results in sedative effects?

Mirtazapine (Remeron)

A 5-year-old boy presents for well-child care and is noted to have a brown lesion on his right arm. What feature characterizes ephelides but not lentigines?

Most commonly effect sun-exposed areas

A 46-year-old man presents for evaluation. He has a medical history of opioid use disorder and is currently on buprenorphine therapy. Of the following, which is one of the mechanisms of action of buprenorphine

Mu-opioid receptor partial agonist

A 46-year-old man presents for evaluation. He has a medical history of opioid use disorder and is currently on buprenorphine therapy. Of the following, which is one of the mechanisms of action of buprenorphine?

Mu-opioid receptor partial agonist

A 23-year-old woman presents to the emergency department for evaluation of new-onset psychosis. She is accompanied by a close friend who has been worried about her. Her friend reports that, for several months, there has been a change in the patient's behavior. The patient has been paranoid that someone has been following her and that someone can see her through her cell phone. The friend found the patient's phone in the garbage disposal. The friend was contacted by the patient's job after she had not shown up to work in several days. Today, the patient walked into oncoming traffic in the middle of a busy intersection. The patient said, "They told me to," and reports hearing commanding, unfamiliar voices. The patient reports no drug use or a family history of schizophrenia, but she does report a family history of major depression. She constantly looks over her shoulder during the exam but otherwise has a flat affect and demonstrates apathy. What in her history is a poor prognostic factor for her suspected condition?

Negative symtpoms

A 26-year-old woman presents to the outpatient family practice office with a past medical history significant for schizoaffective disorder. She reports that she is dead already. She also believes that a 7.0 magnitude earthquake is going to occur in seven days. She describes that she was reading a gardening magazine three weeks ago when she was struck with the knowledge that she no longer exists and that a natural disaster is around the corner. She has been unable to focus on anything else. She denies any visual or auditory hallucinations. When presented with the information that she was present in the office and there has never been a recorded earthquake where she lives, she remains undeterred from this thought. How should this information be documented in the history of present illness?

Nihilistic delusions

A 28-year-old man presents to the clinic complaining of a new onset rash that started one week after initiating antiepileptic therapy. He complains of associated fever and joint pain that started with the appearance of his rash. Multiple skin lesions are present on the posterior elbows bilaterally and demonstrate three concentric rings with a dusky, central area surrounded by a pale ring of edema and an erythematous halo. The central maculopapular lesions vary in size from 1 to 3.5 cm in diameter. The patient also has mild mucosal involvement. Which of the following clinical findings indicates a diagnosis of erythema multiforme major versus erythema multiforme minor?

Presence of fever

A 70-year-old man presents to your office accompanied by his wife. His wife states that the patient has progressively started to develop poor memory over the past year. She states that the patient forgets conversations that happened 20 minutes prior and could not find his way back home after going for a walk outside. Your examination is notable for the patient being oriented to person and place, but he is unable to get the month or year correct. His mini-mental status score is 19. Deficits in which one of the following is most likely to be found on neurological examination in this patient?

Recent memory

Which of the following is a feature of neuroleptic malignant syndrome?

Rigidity

Which of the following is consistent with the description of tinea corporis?

Ring-shaped lesion to forearms, scaly borders with clearing center

Which of the following assessments would lead you to diagnose a patient with folliculitis?

Scattered, erythematous papules and pustules located on the patient's buttocks with symptoms of pruritus; no constitutional symptoms present

A 38-year-old woman presents to the office complaining of increased agitation, diaphoresis, and confusion. She was started on sertraline 100 mg po daily one day ago. On exam you note she is flushed, mildly agitated, has ocular clonus with normal tone, hyperreflexia bilaterally in the lower extremities with an eight beat count. A bottle of hypericum perforatum is found in her purse. Which of the following is the most likely diagnosis?

Serotonin syndrome

A 25-year-old man with no significant past medical history presents for his annual physical. He does complain of irritability and fatigue and scored a 10 on the Patient Health Questionnaire-9 (PHQ-9) scale. The nurse practitioner wants to start treatment. Which of the following would be the most appropriate medication to prescribe?

Sertraline

A 24-year-old woman presents to the clinic and is diagnosed with unipolar depression. She is treated with fluoxetine. Which of the following is a common adverse effect of this medication class?

Sexual dysfunction

A 16-year-old girl presents to the clinic with her parents. Her parents report that the girl has been more withdrawn lately and staying out late at night. They are concerned about illicit drug use and are requesting drug testing. The patient does not report any drug use and has been feeling depressed. She does not want to undergo a drug test. Which of the following is the most appropriate response?

Speak to the patient alone and offer to mediate a discussion with the parents

A 55-year-old man who spent the majority of his adult life working outside as a roofer presents to the clinic with complaints of a pruritic raised lesion on his posterior neck. On exam, the nurse practitioner notes a slightly raised, scaly, erythematous plaque. Which of the following may this lesion be a precursor of?

Squamous cell carcinoma

A 61-year-old man is being evaluated at the outpatient family practice for a suspicious lesion he noticed one month ago on his right shoulder. His past medical history is significant for occupational sun exposure for 40 years as the owner of a landscaping business. On exam, a shallow ulcer with elevated margins is noted on the right shoulder. The center of the ulceration appears crusted. There is no discharge from the lesion. Which of the following is the most likely diagnosis?

Squamous cell carcinoma

An 80-year-old man with a history of diabetes mellitus and dementia presents to the emergency department via ambulance from a long-term care facility for a suspected right hip fracture after a fall. The patient is nonverbal and bedridden secondary to dementia and is unable to independently complete all activities of daily living. Vital signs include a HR of 65 bpm, BP of 130/90 mm Hg, RR of 15/min, oxygen saturation of 98% on room air, and T of 98.6°F. On the initial skin assessment, you note a wound on the patient's sacrum shown in the image above. According to the National Pressure Injury Advisory Panel, how would you stage this patient's wound?

Stage 3 pressure injury

A 55-year-old man with PTSD presents to the clinic for a follow-up after 3 months of psychotherapy sessions. His PTSD is still uncontrolled, and you have decided to start him on paroxetine. What are the most common starting dose and titration schedule for paroxetine?

Start dose at the low end of therapeutic range and titrate every 4 weeks

A 27-year-old woman presents to the clinic to discuss the possibility of becoming pregnant. The only medication she is currently prescribed is valproate. Which of the following would be an appropriate response?

Stop taking the medication because it may cause fetal neural tube defects

A 27-year-old woman presents with a tender, slightly raised rash on both of her legs as seen above. What is the most common cause of this condition?

Streptococcus infection

Which oral antifungal agent has the highest cure rate for toenail onychomycosis?

Terbinafine

A 35-year-old man presents to the urgent care with a superficial partial thickness burn. He is treated with bacitracin to prevent infection. Which of the following describes the route of administration and coverage of bacitracin?

Topical administration and gram-positive coverage

A 23-year-old man is transported to the ED by emergency medical services. He was found obtunded in the street, appears intoxicated, and is unable to give a coherent history. He complains loudly of right arm pain, and on exam, the pain seems out of proportion to physical findings, including exquisite pain elicited with passive motion of his right-hand fingers. His right forearm appears pale and feels cool compared to his left forearm. Surgical consult confirms compartment syndrome. Which of the following is the most common underlying cause of this problem?

Trauma

A 14-year-old boy with a past medical history of allergic rhinitis reports to the clinic concerned for itching and skin changes on his elbows and knees. On physical exam, you note plaques on the inside of his elbows and behind his knees, with some mild scaling and excoriations. What is the best treatment for this adolescent's pruritus and dermatologic changes?

Triamcinolone acetonide cream 0.025%

A 24-year-old woman presents with diffuse urticaria throughout her body. She states that she has a urinary tract infection and took her first dose of trimethoprim-sulfamethoxazole 30 minutes ago. What type of drug reaction is most likely causing her rash?

Type I (IgE response to drug allergy)

A 32-year-old woman presents with concern for a new rash on both of her elbows. The lesions are not painful or itchy. She is otherwise well with no other new symptoms or recent illnesses. On exam, well-demarcated erythematous plaques with silvery scales are noted, which are concerning for psoriasis. Which of the following is likely the first step in the pathogenesis of this disease?

Up-regulation of dendritic cells

A 20-year-old woman presents with a painful lower lip lesion. Examination reveals grouped vesicles on an erythematous base, and you make the diagnosis of herpes labialis. Patient reports recurrent episodes several times per year since she was a child. She has no history of immunosuppression. She desires episodic treatment for recurrent lesions. Which of the following is the most appropriate therapy?

Valacyclovir 2 g twice daily for one day, to start at first sign of symptoms

A 9-year-old boy presents to his pediatrician's office with an intensely itchy rash. He states the rash started 2 weeks ago on his ankles and wrists. He reports no lesions on his trunk. No other family members have similar symptoms. Close examination of the ankles and wrists reveals multiple lesions with fine white lines on the surface. No other lesions are observed on the body. Which of the following findings on physical examination is most consistent with the suspected diagnosis

Violaceous lesions at sites of trauma

A 40-year-old man presents to his clinician with concerns about small ulcers on his right hand and arm with swelling in his right axilla that he has had for several days. After further testing, the man is diagnosed with a Sporothrix infection. What further cautionary instructions should the clinician give to the man?

Wear gloves and protective clothing when working outdoors in the soil and with plants

A 32-year-old man with a past medical history of depression and schizophrenia presents to your clinic for a routine follow-up appointment. Six months ago, he was prescribed olanzapine for management of his schizophrenia and has since had a 10 kg increase in weight. He states that he is concerned about the weight gain as his father was "overweight and died of a heart attack in his 40s." Which medication would be most appropriate for this patient?

Ziprasidone