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a microscopic examination o
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NR602 Dermatology Question Bank
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NR602 Dermatology Question Bank
A microscopic examination of the sample taken from a skin lesion indicates hyphae. What type of
infection might this indicate? ( Fungal )
Under microscopic exam, hyphae are long, thin and branching and indicate dermatophytic infections.
Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis.
A child with a sandpaper-textured rash probably has: ( Strep infection )
Streptococcal infections can present as a sandpaper-textured rash that initially is felt on the trunk.
Rubeola, measles, produces a blanching erythematous “brick-red” maculopapular rash that begins on
the back of the neck and spreads around the trunk and then extremities. Varicella infection produces the
classic crops of eruptions on the trunk that spread to the face. The rash is maculopapular initially and
then crusts. Roseola produces a generalized maculopapular rash preceded by 3 days of high fever.
A 40-year-old female patient presents to the clinic with multiple, painful reddened nodules on the
anterior surface of both legs. She is concerned. These are probably associated with her history of:
( ulcerative colitis )
These nodules describe erythema nodosum. These are most common in women aged 15-40 years old.
They are typically found in pretibial locations and can be associated with infectious agents, drugs, or
systemic inflammatory disease like ulcerative colitis. They probably occur as a result of a delayed
hypersensitivity reaction to antigens. It is not unusual to find polyarthralgia, fever, and/or malaise that
precede or accompany the skin nodules.
A patient is diagnosed with tinea pedis. A microscopic examination of the sample taken from the
infected area would likely demonstrate: ( hyphae )
Under microscopic exam, hyphae are long, thin and branching, and indicate dermatophytic infections.
Hyphae are typical in tinea pedis, tinea cruris, and tinea corporis. Yeasts are usually seen in candidal
infections. Cocci and rods are specific to bacterial infections.
When can a child with chickenpox return to daycare? ( After all lesions have crusted )
Chickenpox is highly contagious and can be spread via respiratory secretions from an infected person or
by direct contact from the vesicle fluid from lesions on the skin or mucus membranes. The usual
incubation period is about 2 weeks but can be as long as 21 days or as short as 10 days. The greatest
period of infectivity is 48 hours prior to the onset of the rash and until all the skin lesions have crusted
over.
A patient with a primary case of scabies was probably infected: (3-4 weeks ago )
,The incubation period for scabies is about 3-4 weeks after primary infection. Patients with subsequent
infections with scabies will develop symptoms in 1-3 days. The classic symptom is itching that is worse at
night, coupled with a rash that appears in new areas over time.
The nurse practitioner examines a patient who has had poison ivy for 3 days. She asks if she can
spread it to her family members. The nurse practitioner replies: (“No, transmission does not occur
from the blister’s contents”)
The skin reaction seen after exposure to poison ivy (or any other skin irritant), takes place because of
contact with the offending substance. In the case of poison ivy, the harmful exposure occurs from
contact with oil from the plant. The eruptions seen are NOT able to transmit the reaction to other
people unless oil from the plant remains on the skin and someone touches the oil. The fluid found in the
blisters is NOT able to transmit poison ivy to anyone; only the oil from the plant can do that. After oil has
touched the skin, some time must pass for the reaction to occur. Therefore, reaction times vary
depending on skin thickness and quantity of oil contacting the skin.
Which chronic skin disorder primarily affects hairy areas of the body? (Seborrheic dermatitis)
Seborrheic dermatitis causes flaking of the skin, usually the scalp. In adolescents and adults, when it
affects the scalp, it is termed dandruff. When this occurs in young children or infants, it is termed “cradle
cap”. The exact cause is unknown; however it has a propensity for hairy areas of the body such as the
scalp, face, chest, and legs. It appears greasy and flaky. This may be seen in patients with Parkinson’s
disease.
A patient with diabetes has right anterior shin edema, erythema, warmth, and tenderness to touch.
This developed over the past 3 days. There is no visible pus. What is the most likely diagnosis to
consider? ( Cellulitis )
This description is one of cellulitis. Cellulitis involves an infection of the subcutaneous layers of the skin.
It must be treated with an oral antibiotic. In a patient with diabetes, it is particularly important to
identify, and aggressively treat cellulitis early, because elevated blood sugar levels will make eradication
more difficult. Buerger’s disease involves inflammation of the medium-sized arteries and does not
present on the anterior shin only. DVT seldom presents on the anterior shin, so this is not likely. Venous
disease does not present acutely, as in this situation.
The agent commonly used to treat patients with scabies is permethrin. How often should it be applied
to eradicate scabies? ( Once )
A single whole-body application of permethrin is usually successful in eradicating infection with scabies.
It is applied over the entire body from the neck down. The lotion is left on and then showered off 8-12
hours later. All contacts must be treated at the same time and all potential fomites (bed linen,
mattresses, cloth furniture, etc.) must be treated as well. Permethrin can be sprayed on cloth fomites, or
the fomite can be bagged for several days, washed and dried in a washing machine and dryer. Ironing
clothes after washing them is acceptable.
Impetigo is characterized by: ( honey-colored crusts )
, Impetigo is a superficial bacterial infection of the skin characterized by honey-colored crusts. Another
form of impetigo is characterized by the presence of bullae. These infections are treated with topical
antibiotics, good hygiene, and frequent hand washing. It is usually caused by Staphylococcus or Group A
Streptococcus.
A 60-year-old patient is noted to have rounding of the distal phalanx of the fingers. What might have
caused this? ( Hepatic cirrhosis )
Rounding of the distal phalanx describes clubbing. Clubbing of fingers is most often associated with
chronic hypoxia as seen in cigarette smokers and patients with COPD or lung cancer. Other causes are
cirrhosis, cystic fibrosis, pulmonary fibrosis and cyanotic heart disease.
A patient has suspected scarlet fever. He likely has a sandpaper rash and: ( a positive rapid Strep test )
A patient with scarlet fever (scarlatina) has a common childhood disease that is characterized by sore
throat, fever, and a scarlet “sandpaper” rash. The causative organism is Group A beta hemolytic
Streptococcus pyogenes. The patient’s rapid Strep test will likely be positive. Diarrhea with abdominal
cramps is not specific to scarlet fever. Petechiae represent an extravasation of blood under the skin and
are not present with scarlet fever unless some other disease process is present. Petechiae should be
considered to be a serious finding.
A patient with a positive history of a tick bite about 2 weeks ago and erythema migrans has a positive
ELISA for Borrelia burgdorferi. The Western blot is positive. How should he be managed? (He should
receive doxycycline for Lyme disease)
The first serologic test for Lyme disease is the ELISA. If this is positive, it should be confirmed. In this
case, it was confirmed by a Western blot and it is positive. This patient can be diagnosed with Lyme
disease. The appropriate treatment for erythema migrans is doxycycline, amoxicillin, or cefuroxime for
21 days. All three medications were found to be of equal efficacy.
A patient will be taking oral terbinafine for fingernail fungus. The NP knows that: (terbinafine is an
inhibitor of the CYP 2D6 enzymes)
Many oral antifungal agents inhibit the 3A4 or 2D6 enzymes in the cytochrome P450 system. This is why
they must be used with extreme caution (or not used) in patients who consume medications that need
3A4 or 2D6 enzymes for metabolism. And, liver enzymes must be monitored in patients who take oral
antifungal medications and discontinued if elevations are >2.5 times the upper limits of normal. No oral
agent has a 95% cure rate for fingernail fungus (tinea unguium). This can be a difficult infection to clear
even if oral antifungal agents are utilized. A topical antifungal agent typically will not clear the infection
if the nail matrix is involved. There is anecdotal evidence that menthol ointments or bleach may cause
resolution when used topically. Generally, resolution of fingernail fungus occurs more rapidly than
toenail fungus because toenails grow at slower rates than fingernails.
A skin lesion that is a solid mass is described as a: ( papule )
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