Skin Disorders continued - Fitzgerald
114. 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.
114. D. consultation with a skin cancer expert to direct next best action.
118. Type I hypersensitivity reaction is mediated through: A. TNF-a binding to T cells. B. IgG antibodies binding to T cells. C. IgE antibiotics binding to mast cells. D. IL-10 binding to basophils.
118. C. IgE antibiotics binding to mast cells.
119. Which of the following do you expect to find in the assessment of the person with urticaria? A. eosinophilia B. low erythrocyte sedimentation rate C. elevated thyroid-stimulating hormone level D. leukopenia
119. A. eosinophilia
120. Common clinical conditions included in the atopy subgroup of type I hypersensitivity reactions include all of the following except: A. allergic rhinitis. B. rosacea. C. atopic dermatitis. D. allergic gastroenteropathy.
120. B. rosacea.
121. 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 presents: A. dermographism. B. contact dermatitis. C. angioedema D. allergic reaction
121. A. dermographism.
122. An urticarial lesion is usually described as a: A. wheal. B. plaque C. patch D. papule
122. A. wheal.
123. 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. hypertension.
123. D. hypertension.
124. Common triggers for anaphylaxis include exposure to certain types of all of the following except: A. medications. B. food. C. pet dander. D. insect bites.
124. C. pet dander.
125. 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.
125. B. injectable epinephrine.
126. When counseling a person who has a 2 mm verruccaform 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.
126. B. lesions usually resolve without therapy in 12-24 months.
127. The mechanism of action of imiquimod is as a/an: A. immunomodulator. B. antimitotic. C. keratolytic. D. irritant.
127. A. immunomodulator.
128. The most common human papillomavirus 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
128. A. 1,2, and 4
129. The human papillomavirus responsible for non genital 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.
129. C. person-to-person contact.
13. 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
13. B. 2
130. A 62 year old woman presents 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.
130. C. cellulitis.
99. 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
99. B. greasy, scaling lesions in the nasolabial folds.
115. 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. a crusting lesion along flexor aspects of the fingers.
115. A. a slightly rough, pink or flesh-colored lesion in a sun-exposed area.
116. Treatment options for actinic keratoses include topical: A. vitamin D derivative cream. B. 5-flourouracil. C. acyclovir D. Mohs micrographic surgery
116. B. 5-flourouracil.
117. Recommended non pharmacological options to treat actinic keratosis include all of the following except: A. chemical peel. B. cryotherapy. C. laser resurfacing. D. Mohs micrographic surgery
117. D. Mohs micrographic surgery
52. You examine a patient with a red, tender thermal burn that has excellent capillary refill involving the entire surface of the anterior right leg. The estimated involved body surface area (BSA) is approximately: A. 5% B. 9% C. 13% D. 18%
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53. A burn that is about twice as large as an adult's palmar surface of the hand including the fingers encompasses a BSA of approximately ______________________%. A. 1 B. 2 C. 3 D. 4
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54. to 56. Match the following 54. First-degree burn 55. Second-degree burn 56. Third -degree burn A. Affected skin blanches with ease. B. Surface is raw and moist. C. Affected area is white leathery.
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100. Among the following, who is at greatest risk of developing seborrheic dermatitis? A. a 15 year old boy residing in a rural setting B. a 34 year old woman who smokes 2 packs per day. (PPD). C. a 48 year old male truck driver. D. a 2 year old man with Parkinson disease
100. D. a 2 year old man with Parkinson disease
101. In counseling a 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 corticosteroid cream three times a week. D. expose the lesions periodically to heat by carefully using a hair dryer.
101. A. use ketoconazole shampoo.
102. A 64 year old man with seborrhea mentions that his skin condition is "better in the summer when I get outside more and much worse in the winter." You respond: A. Sun exposure is a recommended therapy for the treatment of 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 off for the summer months.
102. 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.
103. You see a 6 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.
103. D. high-potency topical corticosteroid.
104. 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.
104. D. variable pigmentation.
105. 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
105. D. variable pigmentation.
106. A 2 year old woman presents with a newly formed, painless, pearly, ulcerated nodule with an overlying telangiectasis on the upper lip. This most likely represents: A. an actinic keratosis. B. a basal cell carcinoma. C. a squamous cell carcinoma. D. molluscum contagiosum.
106. B. a basal cell carcinoma.
107. Which of the following represents the most effective method of cancer screening? A. skin examination B. stool for occult blood C. pelvic examination D. chest radiography
107. A. skin examination
108. When examining a ole for malignant melanoma, all of the following characteristics can indicate a melanoma except: A. asymmetry with nonmatching sides. B. color is not uniform. C. a recently formed lesion. D. a lesion that has been present for at least years.
108. D. a lesion that has been present for at least years.
109. The most common sites for squamous and basal cell carcinoma including: A. palms of hands and soles of feet. B. pelvic and lumbar regions. C. the abdomen. D. the face and scalp.
109. D. the face and scalp.
110. a 56 year old truck driver presents with a new nodular, opaque lesion with non distinct borders on his left forearm. The most likely represents a(n): A. actinic keratosis. B. squamous cell carcinoma. C. basal cell carcinoma. D. malignant melanoma.
110. B. squamous cell carcinoma.
111. 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.
111. B. history of blistering sunburn.
112. Definitive diagnosis of skin cancer requires: A. skin examination B. CT scan C. biopsy. D. serum antigen testing.
112. C. biopsy.
113. 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.
113. D. oral hydroxyurea.
17. You prescribe a topical medication and you want it to have maximum absorption, so you choose the following vehicle. A. gel B. lotion C. cream D. ointment
17. D. ointment
18. 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
18. C. a vasoconstrictor.
35. In the treatment of acne vulgaris, which lesions respond best to topical antibiotic therapy? A. open comedones B. cysts C. inflammatory lesions D. superficial lesions
35. C. inflammatory lesions
76. The zoster vaccine (Zostavax) is a(n): A. inactivated killed virus vaccine. B. conjugated vaccine containing a virus-like particle (VIP). C. live, attenuated vaccine. D. inactivated toxin vaccine.
76. C. live, attenuated vaccine.
77. 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.
77. A. it is readily diagnosed by clinical examination.
78. Oral antifungal treatment options for onychomycosis include all of the following except: A. itraconazole. B. fluconazole. C. metronidazole. D. terbinafine.
78. C. metronidazole.
49. A patient presents with a painful, blistering thermal burn involving the first, second, and third 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 care. D. wrap the burn loosely with a nonadherent dressing and prescribe an analgesic agent.
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50. Gram-negative bacteria that commonly cause burn wound infections include all of the following except: A. P. aeruginosa B. E. coli. C. K. pneumonia. D. H. influenzae.
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51. 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
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131. Which of the following statements is 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 wound.
131. A. Insect bites, abrasion, or other skin trauma can be the origin of cellulitis.
132. The most common causative organisms in cellulitis are: A. Escherichia coli and Haemophilus influenzae. B. Bacteroides species and other anaerobes. C. group A beta-hemolytic streptococci and S. aureus. D. pathogenic viruses.
132. C. group A beta-hemolytic streptococci and S. aureus.
133. 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. trimethoprim-sulfamethoxazole
133. A. dicloxacillin
134. 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.
134. A. Incision and drainage of the lesion.
135. 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.
135. B. oral trimethoprim-sulfamethoxazole.
136. to 142. answer the following questions true or false. _____________136. Skin lesions infected by community-acquired MRSA (CA-MRSA) often occur spontaneously on intact skin.
136. False
____________137. CA-MRSA is most commonly spread from one person to another via airborne pathogen transmission.
137. False
_____________138. All CA-MRSA strains are capable of causing necrotizing infection.
138. False
_____________139. The mechanism of resistance of MRSA is via the production of beta-lactamase.
139. False
14. How many grams of a topical cream or ointment are needed for a single application to an arm? A. 1 B. 2 C. 3 D. 4
14. C. 3
____________140. 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.
140. False
___________141. Most acute-onset necrotic skin lesions reported in North America are caused by spider bites.
141. False
__________142. 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.
142. True
143. An 8 year old, community-dwelling man who lives alone has limited mobility because of osteoarthritis. Since his last office visit months ago, he has lost 5% of his body weight and has developed angular cheilitis. You expect to find the following on examination: 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 buccal mucosa D. raised, painless lesions on the gingival
143. A. fissuring and cracking at the corners of the mouth.
144. A common cause of angular cheilitis is infection by: A. Escherichia coli. B. Streptococcus pneumonia. C. Candida species. D. Aspergillus species.
144. C. Candida species.
145. Risk factors for angular cheilitis in adults include all of the following except: A. advanced age. B. HIV infection. C. alteration of facial vertical dimension due to loss of teeth. D. obesity.
145. D. obesity.
146. First-line therapy for angular cheilitis therapy includes the use of: A. metronidazole gel. B. hydrocortisone cream. C. topical nystatin. D. oral ketoconazole.
146. C. topical nystatin.
147. A 29 year old woman has a sudden onset of right-sided facial asymmetry. She is unable to close her right eyelid tightly or frown or smile on the affected side. Her examination is otherwise unremarkable. This likely represents paralysis of cranial nerve: A. III. B. IV. C. VII D. VIII
147. C. VII
148. Which of the following represents the most important diagnostic test for the patient in the previous question? A. complete blood cell count with white blood cell differential B. serum testing for Borrelia burgdorferi infection C. computed tomography (CT) scan of the head with contrast enhancement D. serum protein electrophoresis
148. B. serum testing for Borrelia burgdorferi infection
149. 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.
149. D. 24 hours.
15. How many grams of a topical cream or ointment are needed for a single application to the entire body? A. 10 to 30 B. 30 to 60 C. 60 to 90 D. 90 to 120
15. B. 30 to 60
150. Lyme disease is caused by the bacterium: A. Borrelia burgdorferi. B. Bacillus anthracis C. Corynebacterium striatum. D. Treponema pallidum
150. A. Borrelia burgdorferi.
151. Which of the following findings is often found in a person with stage 1 Lyme disease? A. peripheral neuropathic symptoms B. high-grade atrioventricular heart block C. Bell's palsy D. single painless annular lesion
151. D. single painless annular lesion
152. Which of the following findings is often found in a person with stage 2 Lyme disease? A. peripheral neuropathic symptoms B. atrioventricular heart block C. conductive hearing loss D. macrocytic anemia
152. B. atrioventricular heart block
153. State 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.
153. C. 1 year
154. Preferred antimicrobials for the treatment of adults with Lyme disease when visiting a Lyme endemic area? A. tetracycline. B. an aminoglycoside. C. a cephalosporin. D. a penicillin.
154. B. an aminoglycoside.
155. Which of the following would not be recommended to prevent Lyme disease when visiting a Lyme endemic area? A. Wear long pants and long-sleeved shirts. B. Use insect repellent. C. If a tick bite occurs, wait until after consulting a healthcare provider before removing the insect. D. If a tick bite occurs and the tick is engorged, administer a single 200 mg dose of doxycycline.
155. C. If a tick bite occurs, wait until after consulting a healthcare provider before removing the insect.
156. 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.
156. D. they prefer to harbor unsanitary environments.
157. 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 bugs bites. B. skin reactions can typically involve papules, macules, or wheals. C. allergic reactions can be treated with topical corticosteroids. D. systemic skin reactions frequently occur following an initial exposure to bed bug bites.
157. D. systemic skin reactions frequently occur following an initial exposure to bed bug bites.
158. 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 1-2 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.
158. B. the reaction is usually self-limiting and should resolve in 1-2 weeks.
159. Signs that bed bugs are present in a home include all of the following except: A. small drops of fresh blood and floorboards. B. blood smears on bed sheets. C. presence of light brown exoskeletons. D. dark specks found along mattress seams.
159. A. small drops of fresh blood and floorboards.
16. You write a prescription for a topical agent and anticipate the greatest rate of absorption when it is applied to the: A. palms and hands. B. soles of the feet. C. face. D. abdomen.
16. C. face.
160. 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 weeks. D. running bedding and other items in a dryer on high heat for 20 minutes.
160. C. isolating the infested area from any hosts for at least weeks.
161. All of the following organisms have been implicated in the development of rosacea except: A. viruses. B. bacteria. C. yeast. D. mites.
161. A. viruses.
162. Patients with rosacea are recommended to use daily: A. sunscreen B. astringents. C. exfoliant. D. antimicrobial cream.
162. A. sunscreen
163. 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. benzoyle peroxide.
163. C. medium-potency corticosteroid cream.
164. Oral antimicrobial treatments recommended for rosacea include all of the following except: A. metronidazole. B. levofloxacin. C. erythromycin. D. doxycycline.
164. B. levofloxacin.
165. 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.
165. B. ablative laser surgery
19. 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.
19. B. and cover with an occlusive dressing.
20. Which of the following is the least potent topical corticosteroid? A. betamethasone dipropionate 0.1% (Diprosone) B. clobetasol proprionate 0.05% (Cormax) C. hydrocortisone 2.5% D. fluocinonide 0.05% (Lidex)
20. C. hydrocortisone 2.5%
21. 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.
21. C. blocking activity at histamine receptor sites.
22. A possible adverse effect with the use of a first generation antihistamine such as diphenhydramine is an 80 year old man is: A. urinary retention B. hypertension C. tachycardia. D. urticaria
22. A. urinary retention
23. Which of the following medications is likely to cause the most sedation A. chlorpheniramine B. certrizine C. fexofenadine D. loratadine
23. A. chlorpheniramine
24. Clinical features of bullous impetigo include: A. intense itch. B. vesicular lesions. C. dermatomal pattern. D. systematic symptoms such as fever and chills.
24. B. vesicular lesions.
25. The likely causative organisms of nonbullous impetigo in a 6 year old child include: A. H. influenzae and S. pneumonia B. group A streptococcus and S. aureus C. M. catarrhalis and select viruses. D. P. aeruginosa and select fungi
25. B. group A streptococcus and S. aureus
26. 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.
26. B. select gram-positive organisms.
27. An impetigo lesion that becomes deeply ulcerated is known as: A. cellulitis. B. erythema C. ecthyma D. empyema.
27. C. ecthyma
28. First-line treatment of impetigo with less than 5 lessons of 1-2 centimeters in diameter on the legs in a 9 year old girl is: A. topical mupirocin B. topical neomycin C. oral cefixime D. oral doxycycline
28. A. topical mupirocin
29. 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
29. A. amoxicillin.
30. 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. trimethoprim-sulfamethoxazole
30. D. trimethoprim-sulfamethoxazole
31.You see a kindergartner with impetigo and advise that she can return________ hours after initiating effective antimicrobial therapy. A. 24 B. 48 C. 72 D. 96
31. A. 24
32. The use of which of the following medications contribute to the development of acne vulgaris? A. lithium B. propranolol C. sertraline D. clonidine
32. A. lithium
33. First-line therapy for acne vulgaris with closed comedones includes: A. oral antibiotics B. isotretinoin C. benzoyl peroxide. D. hydrocortisone cream.
33. C. benzoyl peroxide.
34. When prescribing tretinoin (Retin-A), the NP advises the patient to: A. use it with benzoyl peroxide to minimize irritating effects. B. use the sunscreen because the drug is photosensitizing. C. add a sulfa-based cream to enhance antiacne effects. D. expect a significant improvement in acne lesions after approximately 1 week of use.
34. B. use the sunscreen because the drug is photosensitizing.
36. 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". You 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.
36. A. counsel him that 6 to 8 weeks of treatment is often needed before significant improvement is achieved.
37. 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)
37. B. a 20 year old patient with cystic lesions who has tried various therapies with minimal effect.
38. In a 22 year old woman using isotretinoin (Accutane) therapy, the NP ensures follow-up to monitor for all of the following tests except: A. hepatic enzymes B. triglyceride measurements C. pregnancy test D. platelet count
38. D. platelet count
39. Leonard is an 18 year old man who has been taking isotretinoin (Accutane) for the treatment of acne for the past months. Which of the following is the most important question for the clinician to ask at his follow up 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?
39. D. Have you noticed any recent changes in your mood?
40. 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
40. B. moderate acne
41. In a 13 year old female patient with mild acne and who experience an inadequate response to benzoyl peroxide treatment, an appropriate treatment option would be to: A. add a topical retinoid. B. add an oral antibiotic C. consider isotretinoin. D. consider hormonal therapy.
41. A. add a topical retinoid.
42. A common infective agent in domestic pet cat bites is A. viridans streptococcus species. B. Pasteurella multocida C. Bacteroides species. D. Haemophylus influenzae.
42. B. Pasteurella multocida
43. A 2 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 in her home. Her cat is 3 years old, is up-to-date on immunizations, and does not go outside. Physical examination reveals pinpoint superficial puncture wounds on the right ankle consistent with the presenting history. She washed the wound with soap and water immediately and asks if she needs additional therapy. Treatment for this patient's cat bite wound should include standard wound care with the addition of: A. oral erythromycin. B. topical bacitracin. C. oral amoxicillin-clavulanate. D. parenteral rifampin.
43. C. oral amoxicillin-clavulanate.
44. A 24 year old man arrives at the walk-in center. He reports that he was bitten in the thigh by a raccoon while walking in the woods. The examination reveals a wound that is 1 cm deep on his right 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.
44. C. Give rabies immune globulin and rabies vaccine.
45. A significant rabies risk is associated with a bite from all of the following except: A. humans. B. foxes. C. bats. D. skunks.
45. A. humans.
46. You see a 33 year old male with minor dog bite on his hand. The examination reveals a superficial wound on the 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%
46. A. 5%
47. 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
47. D. oral amoxicillin-clavulanate
48. 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 debride as needed. D. close the wound with adhesive strips.
48. C. irrigate the wound and debride as needed.
57. A mother brings to the clinic her 3 year old daughter, who presents with dry red patches on her face around the eyes. The mother has observed 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 clinical assessment alone.
57. D. Is usually made by clinical assessment alone.
58. 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
58. C. IgE
59. During type I hypersensitivity reactions, histamine released from degraded mast cells causes all of the following except: A. vasodilation. B. mucous gland stimulation. C. enhanced sebum production. D. tissue swelling.
59. C. enhanced sebum production.
60. 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.
60. C. application of lubricants.
61. 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.
61. A. exposure to nickel.
62. A common site for atopic dermatitis in an adult is on the: A. dorsum of the hand. B. face. C. neck. D. flexor surfaces.
62. D. flexor surfaces.
63. A common site for atopic dermatitis in an infant is: A. the diaper area. B. the face. C. the neck. D. the posterior trunk.
63. B. the face.
64. 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 of topical corticosteroids. D. applying cool wet dressings made from a clean cloth and water to the affected area.
64. B. applying a heating pad on the affected region for 30 minutes.
65. The mechanism of action of pimecrolimus (Elidel) in the treatment of atopic dermatitis is a/an: A. immunomodulator B. antimitotic C. mast cell activator. D. exfoliant.
65. A. immunomodulator
66. When counseling a patient about the use of tactolimus (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 a potent antihistamine.
66. B. there is a possibility of increased cancer risk with its use.
67. 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.
67. A. taking a bedtime dose of antihistamine.
68. A 38 year old woman with advanced human immunodeficiency virus (HIV) disease 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.
68. A. herpes zoster.
69. A Tzanck smear that is positive for giant multinucleated cells was take from a lesion caused by: A. herpesvirus. B. S. aureus. C. streptococci. D. allergic reaction
69. A. herpesvirus.
70. 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
70. C. receipt of varicella-zoster immunization
71. Shingles most commonly involve the dermatomes of the: A. legs and pubic area. B. face C. upper arms and shoulders D. thorax.
71. D. thorax.
72. 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 young and old alike.
72. B. during outbreaks, the chickenpox (varicella) virus is shed.
73. Analgesia options for a patient with shingles 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 topical medium potency corticosteroid on the affected area.
73. D. fentanyl transdermal patch and topical medium potency corticosteroid on the affected area.
74. Risk factors for the development of the postherpetic neuralgia include all of the following except: A. age younger than 50 years at the time of the outbreak B. severe prodromal symptoms C. lumbar location of lesions. D. low volume lesions.
74. B. severe prodromal symptoms
75. Treatment options in postherpetic neuralgia include all of the following except: A. injectable methylprednisolone. B. oral pregabalin. C. oral nortriptyline. D. topical lidocaine.
75. A. injectable methylprednisolone.
79. When prescribing itraconazole (Sporanox), the NP considers that: A. the drug is a cytochrome P-450 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.
79. the drug is a cytochrome P-450 3A4 inhibitor.
80. 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.
80. A. a transient increase in hepatic enzymes is commonly seen with its use.
81. When prescribing fluconazole, the NP considers that it is a cytochrome P-450: A. 3A4 inhibitor B. CP inhibitor C. D6 inducer. D. 1A2 inducer
81. B. CP inhibitor
82. In diagnosing onychomycosis, the NP considers that: A. nails often have a single midline groove. B. pitting is often seen. C. microscopic examination reveals hyphae. D. Beau lines are present.
82. C. microscopic examination reveals hyphae.
83. In counseling a patient on the use of topical products to treat nail fungal infections, the NP considers that: A. nail laquers, such as cyclopirox olamine 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.
83. C. topical products have limited penetration through the nail matrix to reach the site of infection.
84. 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 examination? A. excoriated papules on the interdigital area B. annular lesions over the buttocks C. vesicular lesions in a linear pattern D. honey-colored crusted lesions that began as vesicles.
84. A. excoriated papules on the interdigital area
85. 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. wash items in hot water. B. run items through the clothes dryer for a normal cycle. C. soak items in cold water for at least 1 hour. D. place items in a plastic storage bag for at least 1 week.
85. C. soak items in cold water for at least 1 hour.
86. 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 noticed a 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.
86. C. Itch often persists for a few weeks after successful treatment
87.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 infestation. D. bedding used by an infected person must be destroyed.
87. B. close personal contact with an infected person is usually needed to contract this disease.
88. The use of lindane (Kwell) to treat scabies is discouraged because for its potential for: A. hepatotoxicity. B. neurotoxicity. C. nephrotoxicity. D. pancreatitis
88. B. neurotoxicity.
89. Psoriasis vulgaris is a chronic skin disease caused by: A. bacterial colonization. B. absence of melanin. C. accelerated mitosis. D. type I hypersensitivity reaction.
89. C. accelerated mitosis.
90. 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.
90. B. well-demarcated plaques on the knees
91. 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.
91. B. rapid skin cell turnover, leading to decreased maturation and keratinization.
92. Anthralin (Drithocreme) is helpful in treating psoriasis because it has what kind of activity? A. antimitotic. B. exfoliative C. vasoconstrictor D. humectant
92. A. antimitotic
93. 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.
93. D. systemic corticosteroids.
94. Which of the following is not a potential adverse effective with long-term high-potency topical corticosteroid use? A. lichenification B. telangiectasia C. skin atrophy D. adrenal suppression
94. A. lichenification
95. 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
95. C. TNF-a
96.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.
96. B. topical Anthralin (Drithocreme)
97. 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
97. D. reactivation of latent tuberculosis
98. Seborrheic dermatitis is likely caused by: A. accelerated mitosis of skin cells. B. colonization of skin by Staphylococcus aureus. C. an inflammatory reaction to Malassezia species on skin. D. exposure to excessive UV radiation.
98. C. an inflammatory reaction to Malassezia species on skin.