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54 Cards in this Set
- Front
- Back
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When palpating the skin over the clavicle of James, age 84, you notice tenting, which is indicative
A. of dehydration. B. common in thin older adults. C. a sign of edema. D. indicative of scleroderma. |
B. Common in thin older adults
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Thin, spoon-shaped nails are usually seen in
A. trauma. B. a fungal infection. C. anemia. D. psoriasis. |
C. Anemia
Thick nails seen in trauma, fungal infection, psoriasis, & decreased peripheral vascular blood supply |
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Which lesion results in scales or shedding flakes of greasy, keratinized skin tissue?
A. Eczema B. Impetigo C. Psoriasis D. Herpes |
C. Psoriasis
Can be white, gray, or silver color. Vary in thickness |
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A client with a nutritional deficiency of vitamin C may have
A. dry skin and loss of skin color. B. thickened skin that is dry or rough. C. flaky skin, sores in the mouth, and cracks at the corners of the mouth. D. bleeding gums and delayed wound healing. |
D. Bleeding of gums & delayed wound healing
protein def = dry skin & loss of skin color; Vit A = thick skin that is rough or dry; B6 = flaky skin, sores in mouth, cracks in corner of mouth |
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Sandra, age 69, is complaining of dry skin. What do you advise her to do?
A. Bathe every day. B. Use tepid water and a mild cleansing cream. C. Use a dehumidifier. D. Decrease the oral intake of fluids. |
Answer B
If a client is complaining of dry skin, the client should use tepid water and a mild cleansing cream or soap, use a humidifier to humidify the air, and increase the oral intake of fluids to assist in replacing some of the fluids lost from the skin. Advise the client that it is not necessary to take a bath every day because soaps and hot water are drying. |
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Why is ultraviolet light therapy used to treat psoriasis?
A. To dry the lesions B. To kill the bacteria C. To decrease the growth rate of epidermal cells D. To kill the fungi |
Answer C
Ultraviolet light therapy is used to treat psoriasis to decrease the growth rate of epidermal cells. This assists in decreasing the hyperkeratosis. Treatments are given daily and last only for seconds. |
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You’re teaching Mitch, age 18, about his tinea pedis. You know he doesn’t understand your directions when he tells you which of the following?
A. “I should dry between my toes every day.” B. “I should wash my socks with bleach.” C. “I should use an antifungal powder twice a day.” D. “I should wear rubber shoes in the shower to prevent transmission to others.” |
Answer D
If a client has tinea pedis, tell the client to dry between the toes every day, wash socks with bleach, and use an antifungal powder twice per day. Rubber-or plastic-soled shoes can harbor the fungus and therefore should not be worn. The shower should be washed with bleach to kill the fungi. |
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Abe, age 57, has just been given a diagnosis of herpes zoster. He asks you about exposure to others. You tell him that
A. once he has been on the medication for a full 24 hours, he is no longer contagious. B. he should stay away from children and pregnant women who have not had chickenpox. C. he should wait until the rash is completely gone before going out in crowds. D. he should be isolated from all persons except his wife. |
Answer B
If a client has just been given a diagnosis of herpes zoster, advise the client to stay away from children and pregnant women who have not had chickenpox until crusts have formed over the blistered areas. Herpes zoster is contagious to people who have not had chickenpox. |
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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? A. Acne vulgaris B. Acne rosacea C. Acne conglobata D. Nodulocystic acne |
Answer B
Acne rosacea is a chronic type of facial acne that occurs in middle-aged to older adults. Over time, the skin changes in color to dark red, pores become enlarged, and the soft tissue of the nose may exhibit rhinophyma, an irregular bullous thickening. Acne vulgaris is the form of acne common in adolescents and young to middle-aged adults. Acne conglobata begins in middle adulthood and causes serious skin lesions such as comedones, papules, pustules, nodules, cysts, and scars, primarily on the back, buttocks, and chest. Severe (nodulocystic) acne consists mostly of nodules and cysts and always results in scar formation. |
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What is an excessive amount of collagen that develops during scar formation called?
A. A keloid B. A skin tag C. An angioma D. A keratosis |
Answer A
A keloid is an elevated, irregularly shaped, and progressively enlarging scar that arises from excessive amounts of collagen during scar formation. A skin tag is a soft papule on a pedicle. An angioma is a benign vascular tumor. A keratosis is any skin condition in which there is a benign overgrowth and thickening of the cornified epithelium. |
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11 The morphology of which lesion begins as an inflammatory papule that develops within several days into a pain less,hemorrhagic, and necrotic abscess, eventually with a dense, black, necrotic eschar forming over the initial lesion?
A. Furuncle-carbuncle B. Hidradenitis suppurativa C. Anthrax D. Cellulitis |
Answer C
Although cellulitis, furuncle-carbuncles, and hidradenitis suppurativa are all distinctive abscesses, only anthrax has the morphology described. It results in a dense, black, necrotic eschar gradually forming over the initial lesion. A furuncle-carbuncle is a pustular lesion surrounding one or several hair follicles, and a hidradenitis suppurativa lesion results in scarring and fibrotic bands. Cellulitis begins as a tender, warm, erythematous area of the skin and then takes on multiple presentations but not with a dense black necrotic eschar as described here. |
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What is the initial emergency measure to limit burn severity?
A. Stabilize the client’s condition. B. Identify the type of burn. C. Prevent heat loss. D. Eliminate the heat source. |
Answer D
The first intervention is to eliminate the heat source. Then, stabilize the client’s condition, identify the type of burn, prevent heat loss, reduce wound contamination, and prepare for emergency transportation. |
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In a burn trauma, which blood measurement rises as a secondary result of hemoconcentration when fluid shifts from the
intravascular compartment? A. Hemoglobin B. Sodium C. Hematocrit D. Blood urea nitrogen (BUN) |
Answer C
In burn trauma, the hematocrit rises as fluid, not blood, shifts from the intravascular compartment. The hemoglobin level decreases secondary to hemolysis; the sodium level decreases secondary to massive fluid shifts into the interstitium; and the blood urea nitrogen level increases secondary to dehydration. |
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In burn trauma, silver sulfadiazine (Silvadene), a sulfonamide, is the most commonly used topical agent. What is its mechanism of action?
A. It is a synthetic antibiotic that appears to interfere with the metabolism of bacterial cells. B. It is a bacteriostatic agent that inhibits a wide variety of gram-positive and gram-negative organisms by altering the microbial cell wall and membrane. C. It is a bactericidal agent that acts on the cell membrane and cell wall of susceptible bacteria and binds to cellular DNA. D. It is a protective covering that prevents light, air, and invading organisms from penetrating its surface. |
Answer C
Silver sulfadiazine (Silvadene), the most commonly used topical agent for burn trauma, is a bactericidal agent that acts on the cell membrane and cell wall of susceptible bacteria and binds to cellular DNA. It is effective against a wide variety of both gramnegative and gram-positive organisms. Mafenide acetate (Sulfamylon) is a synthetic antibiotic that interferes with the metabolism of bacterial cells. Approximately 3%–5% of clients develop a hypersensitivity to mafenide. Silver nitrate is a bacteriostatic agent that alters the microbial cell wall and membrane. It has limited penetrating ability and is ineffective if used more than 72 hours after a burn injury. |
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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?
A. Calamine lotion B. Cool baths C. Acyclovir (Zovirax) D. Corticosteroids |
Answer C
In adolescents and young adults, acyclovir (Zovirax), if started within the first 24–48 hours after the rash appears, may shorten the course of varicella (chickenpox). Acyclovir is not, however, recommended for children. In children, treatment of varicella consists of cool baths with Aveeno for pruritus and calamine lotion to dry the lesions. |
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Your 24-year-old client, whose varicella rash just erupted yesterday, asks you when she can go back to work. What do you tell her?
A. “Once all the vesicles are crusted over” B. “When the rash is entirely gone” C. “Once you have been on medication for at least 48 hours” D. “Now, as long as you stay away from children and pregnant women” |
Answer A
A client who has a varicella rash can return to work once all the vesicles are crusted. Varicella is contagious from 48 hours before the onset of the vesicular rash, during the rash formation (usually 4–5 days), and during the several days while the vesicles dry up. The characteristic rash appears 2–3 weeks after exposure. Treatment is effective only if started within the first few days, and then only to shorten the course of the disease. Clients should avoid contact with pregnant women and children who have not been exposed to varicella. |
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Jack, age 59, has a nevus on his shoulder that has recently changed from brown to bluish black. You advise him to
A. have an excisional biopsy. B. monitor the nevus for a change at the end of 1 month. C. apply benzoyl peroxide solution. D. apply hydrocortisone 1% cream. |
Answer A
The ABCDEs (asymmetry, border irregularity, color changes, diameter, evolving/elevation) of melanomas should be taught to all clients. A change in the color variation may indicate a melanoma, and an excisional biopsy should be done. Monitoring for a month may enable a melanoma to extend extensively, resulting in death. Benzoyl peroxide and hydrocortisone may be used with folliculitis. |
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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 A. sheep and goats. B. horses. C. metals. D. tile. |
Answer A
An orf skin ulcer results from a parapoxvirus infection, which causes a common skin disease of sheep and goats. It is occasionally transmitted to humans. |
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All of the following are treatments for psoriasis except
A. topical antifungals. B. systemic medications. C. phototherapy. D. topical corticosteroids. |
Answer A
Antifungal agents are ineffective against psoriasis. The most common form of treatment is corticosteroids applied topically. Systemic treatments are used in more severe cases, and phototherapy, from either natural or artificial light, may also be helpful. |
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20 What is the most common rosacea trigger?
A. Alcohol B. Cold weather C. Skin care products D. Sun exposure |
20 Answer D
Clients with rosacea usually have a long history of flushing in response to sun exposure. Alcohol, cold weather, and skin care products may also be triggers, but not nearly as often. Other triggers may include emotional stress, spicy foods, exercise, wind, hot baths, and hot drinks. |
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21 The ABCDEs of melanoma identification include which of the following?
A. Asymmetry: one half does not match the other half B. Border: the borders are regular; they are not ragged, notched, or blurred C. Color (pigmentation) is uniform D. Diameter: the diameter is greater than 10 mm |
21 Answer A
One of the warning signs of cancer is a lesion that does not heal or one that changes in appearance. The ABCDEs of melanoma identification should be taught to all clients. The A is for asymmetry: one half does not match the other half. B is for border irregularity: the edges of a melanoma are ragged, notched, or blurred. The C is for color: pigmentation is not uniform; there may be shades of tan, brown, and black, as well as red, white, and blue. The D is for diameter: greater than 6 mm. E is for an evolving lesion, as well as for elevation. |
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22 What is the connection between the surface of the skin and an underlying structure called?
A. An ulcer B. A sinus C. An erosion D. An abscess |
22 Answer B
The connection between the surface of the skin and an underlying structure is called a sinus. An ulcer is a depressed lesion in which the epidermis and part of the dermis have been lost. An erosion is a moist, red, shiny, circumscribed lesion that lacks the upper layer of the skin. An abscess is a circumscribed collection of pus that involves the deeper layers of the skin. |
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23 A Wood’s light is especially useful in diagnosing which of the following?
A. Tinea versicolor B. Herpes zoster C. A decubitus ulcer D. A melanoma |
23 Answer A
A Wood’s light is especially useful in diagnosing tinea versicolor or other fungal infections. A Wood’s light produces a “black light” through long-wave ultraviolet rays. It accentuates minor losses of melanin, which makes it useful in diagnosing tinea versicolor and vitiligo, in which there is hypopigmentation. |
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24 A darkfield microscopic examination is used to diagnose
A. scabies. B. leprosy. C. syphilis. D. Candida infections. |
24 Answer C
A darkfield microscopic examination is used to diagnose syphilis. A darkfield examination, with its special condenser, causes an oblique beam of light to refract off objects too small to be seen by conventional microscopes, such as the narrow organism Treponema pallidum that causes syphilis. Application of a special tetracycline solution followed by shining a Wood’s light on the skin may accentuate the burrow of scabietic mites, thus helping to diagnose scabies. A direct acid-fast stain is used to diagnose leprosy, and a potassium hydroxide (KOH) stain helps diagnose candida infections. |
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26 Which of the following statements about malignant melanomas is true?
1. They usually occur in older adult males. 2. The client has no family history of melanoma. 3. They are common in blacks. 4. The prognosis is directly related to the thickness of the lesions. |
26 Answer D
Prognosis is directly related to the thickness of the lesion. Malignant melanomas usually occur in middle-aged adults of both sexes. The client usually has a family history of melanoma. Melanomas occur rarely in blacks; when they do, the lesions usually develop on the palms and soles and under the nails. |
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27 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?
1. Lentigo syndrome 2. Tinea versicolor 3. Localized brown macules 4. Ochronosis |
27 Answer B
If a client presents with a pruritic rash on his upper trunk and shoulders and you observe areas of hypopigmentation and flat to slightly elevated brown papules and plaques that scale when they are rubbed, suspect tinea versicolor. Lentigines are macular tan to black lesions, ranging from 1 mm to 1 cm in size. They do not increase in color with exposure to the sun. One or more lentigines are seen in normal individuals. Multiple ones need to be further assessed. Localized brown macules are freckles. Ochronosis is a condition with poorly circumscribed, blue-black macules. |
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28 A client with a platelet abnormality may present with
1. red to blue macular plaques. 2. multiple frecklelike macular lesions in sun-exposed areas. 3. numerous small, brown, nonscaly macules that become more prominent with sun exposure. 4. red, flat, nonblanchable petechiae. |
28 Answer D
A client with a platelet abnormality may present with red, flat, nonblanchable petechiae. Red to blue macular plaques describe ecchymoses; multiple frecklelike macular lesions in sun-exposed areas indicate xeroderma pigmentosum; and numerous small, brown, nonscaly macules that become more prominent with sun exposure are freckles. |
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30 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?
1. Systemic steroids 2. Topical steroids 3. Systemic antibiotics 4. NSAIDs |
30 Answer C
Erysipelas is caused by Streptococcus hemolyticus and must be treated with appropriate antibiotics. A 7-day course of therapy is recommended: penicillin VK 250 mg, dicloxacillin 250 mg, or a first-generation cephalosporin 250 mg PO qid. In penicillin-allergic clients, either erythromycin 250 mg qid for 7–14 days or clarithromycin 250 mg bid for |
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33 Dry, itchy skin in older adults results from
1. the reduction of sweat and oil glands. 2. loss of subcutaneous tissue. 3. dermal thinning. 4. decreased elasticity. |
33 Answer A
Dry, itchy skin in older adults results from the reduction of sweat and oil glands. Loss of subcutaneous tissue,dermal thinning, and decreased elasticity are normal changes associated with aging, and they may cause wrinkles and sagging of the skin. |
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34 Marie asks what she can do for Sarah, her 90-year-old mother, who has extremely dry skin. You respond,
1. “After bathing every day, use a generous supply of moisturizers.” 2. “Use a special moisturizing soap every day.” 3. “Your mother does not need a bath every day.” 4. “Increase your mother’s intake of fluids.” |
34 Answer C
Although increasing fluids and a moisturizing cream will help the general problem, Sarah does not need a bath every day because that will exacerbate the dryness of her skin. Plain water should be used rather than special soap. |
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36 Where is the epitrochlear lymph node located?
1. In front of the ear 2. Halfway between the angle and the tip of the mandible 3. In the posterior triangle along the edge of the trapezius muscle 4. In the inner condyle of the humerus |
36 Answer D
The epitrochlear lymph node is located in the inner condyle of the humerus. The preauricular lymph node is located in front of the ear; the submaxillary (submandibular) lymph node is halfway between the angle and the tip of the mandible; and the posterior cervical lymph node is in the posterior triangle along the edge of the trapezius muscle. |
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38 Jerry, age 52, has gout. What do you suggest?
1. Using salicylates for an acute attack 2. Limiting consumption of purine-rich foods 3. Testing his uric acid level every 6 months 4. Decreasing fluid intake |
38 Answer B
For the client with gout, the consumption of purine-rich foods, such as organ meats, should be limited to prevent uric acid buildup. Alcohol should also be limited and fluids increased to 2 L per day. Salicylates should be avoided because they block renal excretion of uric acid. An annual testing of the serum uric acid level is sufficient. |
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37 Gouty pain in the great toe is
1. toe gout. 2. hyperuricemia of the toe. 3. podagra. 4. tophus. |
37 Answer C
Podagra is gouty pain in the great toe. Hyperuricemia results in the deposition of uric acid crystals in the joints. |
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39 An eczematous skin reaction may result from
1. penicillin. 2. allopurinol (Zyloprim). 3. an oral contraceptive. 4. phenytoin (Dilantin). |
39 Answer A
Penicillin, neomycin, phenothiazines, and local anesthetics may cause an eczematous type of skin reaction. Allopurinol (Zyloprim) and sulfonamides may cause exfoliative dermatitis, oral contraceptives may cause erythema nodosum, and phenytoin (Dilantin) and procainamide (Pronestyl) may cause drug-related systemic lupus erythematosus. |
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41 Lance, age 50, is complaining of an itchy rash that occurred 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 that his breathing is normal. What is your first action?
1. Order a short course of systemic corticosteroids. 2. Determine the need for 0.5 mL 1:1000 epinephrine subcutaneously. 3. Start daily antihistamines. 4. Tell Lance to get rid of his leather jacket. |
41 Answer B
Lance has hives. Although all the actions are appropriate, the first step is to determine the need for 0.5 mL 1:1000 epinephrine subcutaneously (SQ). With Lance’s neck involvement, it is most important to determine if respiratory distress is imminent, in which case the epinephrine must be administered. |
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42 Margaret, age 32, comes into the clinic. She has painful joints and a distinctive rash in a butterfly
distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? 1. Lymphocytoma cutis 2. Relapsing polychondritis 3. Systemic lupus erythematosus 4. None of the above |
42 Answer C
If a client comes into the clinic complaining of painful joints and has a distinctive rash in a butterfly distribution on the face that has red papules and plaques with a fine scale, suspect systemic lupus erythematosus. Acute lupus erythematosus occurs most often in young adult women and has a classic presentation of a rash in a butterfly distribution. The lesions are red papules and plaques with a fine scale. In the acute phase, the client is febrile and ill. The presence of these skin lesions in a client with neurological disease, arthritis, renal disease, or neuropsychiatric disturbances also supports the diagnosis. Lymphocytoma cutis is also most common on the face and neck. It occurs in both sexes and has smooth, red to yellow-brown papules up to 5 cm in diameter. Relapsing polychondritis occurs in adults with a history of arthritis. It appears as a macular erythema, tenderness, and swelling over the cartilaginous portions of the ear. |
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43 Jennifer, age 32, has genital warts (condylomata) and would like to have them treated. All of the following could be applied except
1. benzoyl peroxide. 2. podophyllin. 3. trichloroacetic acid. 4. liquid nitrogen. |
43 Answer A
Genital warts (condylomata) may be treated using podophyllin (contraindicated in pregnant clients), trichloroacetic acid, or liquid nitrogen. Benzoyl peroxide is used for acne. |
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45 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?
1. Actinic keratosis 2. Eczema 3. Psoriasis 4. Seborrheic dermatitis |
45 Answer C
If a client presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees, suspect psoriasis. This is a classic presentation of psoriasis. Besides the extensor aspect of the elbows and knees, it occurs frequently in the presacral area and scalp, although lesions may occur anywhere. Actinic keratosis is distributed on sunexposed areas such as the face, head, neck, and dorsum of the hand and appears as poorly circumscribed, pink to red, slightly scaly lesions. Eczema presents as a group of pinpoint pruritic vesicles and papules on a coin-shaped erythematous base that usually worsens in winter. Seborrheic dermatitis has a symmetric appearance of raised, scaly, red, greasy papules and plaques that may be sharply or poorly circumscribed. |
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46 What is a safe and effective treatment for psoriasis?
1. Coal tar preparations 2. Topical steroids 3. Topical antibiotics 4. Systemic antihistamines |
46 Answer A
A safe and effective treatment for psoriasis is the use of coal tar preparations. The concentration is increased every few days from 0.5% to a maximum of 10%. A contact period of several hours is required and the odor is unpleasant. Topical steroids are used in the treatment of atopic dermatitis; topical antibiotics are indicated for acne rosacea; and systemic antihistamines are indicated for pityriasis rosea. Some of the chemicals in coal tar may cause cancer but only in very high concentrations as in coal tar used for industrial paving. Any client using coal tar regularly should be aware of the signs and symptoms and have a skin cancer checkup annually. Ongoing treatment for psoriasis may include topical creams and ointments, such as vitamin D compounds like calcipotriene, corticosteroids, retinoids such as tazarotene, and anthralin. These may be used in combination with sunlight (phototherapy). For severe psoriasis, systemic therapy may be required; this includes the use of such medications as retinoids, methotrexate, and cyclosporine, usually in addition to continued topical treatments and exposure to ultraviolet light. |
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47 A biopsy of a small, yellow-orange papulonodule on the eyelid will probably show
1. fragmented, calcified elastic tissue. 2. mature sebaceous glands. 3. lipid-laden cells. 4. endothelial swelling and an infiltrate rich in plasma cells. |
47 Answer C
A biopsy of a small, yellow-orange papulonodule on the eyelid will probably show lipid-laden cells. This is a description of a noneruptive xanthoma of the eyelid (xanthelasma). Fragmented, calcified elastic tissue is diagnostic of pseudoxanthoma elasticum. A biopsy of sebaceous hyperplasia will show large, mature sebaceous glands. A biopsy revealing endothelial swelling and perivascular round-cell infiltrate that is rich in plasma cells is diagnostic of syphilis. |
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48 Permethrin (Elimite) applied over the body overnight from the neck down is the preferred treatment for
1. scabies. 2. eczema. 3. herpes simplex. 4. psoriasis. |
48 Answer A
Permethrin (Elimite) applied over the body overnight from the neck down is the preferred treatment for scabies. Lindane (Kwell) is also often effective. Topical corticosteroids or systemic antihistamines are indicated for eczema. Acyclovir (Zovirax) is the treatment for herpes simplex, and coal tar preparations are used to treat psoriasis. |
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49 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?
1. Varicella 2. Herpes zoster 3. Syphilis 4. Rubella |
49 Answer B
The rash of herpes zoster is characteristic in that it appears on only one side of the body. Herpes zoster begins in a dermatomal distribution, most commonly in the thoracic, cervical, and lumbosacral areas, although it also occurs on the face. Although herpes zoster is caused by the reactivation of latent varicella virus in the distribution of the affected nerve, varicella (chickenpox) presents with a scattered rash on both sides of the body. A client with syphilis would present with sharply circumscribed, ham-colored papules with a slight scale and lesions over the entire body, especially on the palms and soles. Rubella (German measles) occurs in childhood. It begins on the face and rapidly (in hours) spreads down to the trunk. |
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50 A 70-year-old client with herpes zoster has a vesicle on the tip of the nose. This may indicate
1. ophthalmic zoster. 2. herpes simplex. 3. Kaposi’s sarcoma. 4. orf and milker’s nodules. |
50 Answer A
Ophthalmic zoster (herpes zoster ophthalmica) involves the ciliary body and may appear clinically as vesicles on the tip of the nose. The client with a herpetic lesion on the nose indicating ophthalmic zoster needs to be referred to an ophthalmologist to preserve the eyesight. Herpes simplex primarily occurs on the perioral, labial, and genital areas of the body. Kaposi’s sarcoma in the older adult usually occurs in the lower extremities. Orf and milker’s nodules almost always appear on the hands. |
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51 What is the most effective treatment for urticaria?
1. An oral antihistamine 2. Dietary management 3. Avoidance of the offending agent 4. A glucocorticosteroid |
51 Answer C
The most effective treatment for urticaria (hives) is avoidance of the offending agent. Usually the offending antigen is identifiable and exposure is self-limited. Treatment with oral antihistamines is usually effective for symptomatic relief of itching, swelling, and nasal symptoms. Dietary management may sometimes be helpful if the cause of the problem is a known food, such as shellfish, nuts, fish, eggs, chocolate, or cheese. Glucocorticoids have a minimal role in treating urticaria; a brief trial may be indicated for temporary relief in a difficult case. |
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52 A linear arrangement along a nerve distribution is a description of which type of skin lesion?
1. Annular 2. Zosteriform 3. Keratotic 4. Linear |
52 Answer B
A zosteriform lesion is a linear arrangement along a nerve distribution and typifies herpes zoster. An annular lesion is ring shaped. Linear simply implies that the lesion appears in lines. A keratotic lesion has horny thickenings. |
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54 The viral exanthem of Koplik’s spots is present in
1. rubeola. 2. rubella. 3. fifth disease. 4. varicella. |
54 Answer A
The viral exanthem of Koplik’s spots is present in rubeola (measles). Koplik’s spots are observed on the buccal mucosa before the rash appears. In rubella (German measles), there are variable erythematous macules on the soft palate, and in fifth disease (erythema infectiosum), there is no exanthem. In varicella (chickenpox), there may be sparse lesions on the mucosal surfaces, especially the hard palate. |
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55 A darkfield examination is used to cutaneously diagnose which disease?
1. Syphilis 2. Viral blisters 3. Scabies 4. Candidiasis |
55 Answer A
A darkfield examination is used to diagnose syphilis cutaneously. Viral blisters can be diagnosed cutaneously by the Tzanck smear; a scraping can be done to look for scabies; and a potassium hydroxide preparation and culture are used to diagnose candidiasis. |
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56 Which of the following secondary skin lesions usually results from chronic scratching or rubbing?
1. Crusts 2. Scales 3. Lichenification 4. Atrophy |
56 Answer C
Lichenification is a thickening of the skin that usually results from chronic scratching or rubbing. Crusts represent dried serum, blood, pus, or exudate. Scales are yellow, white, or brownish flakes on the surface of the skin that represent desquamation of stratum corneum. Atrophy represents loss of substance of the skin. |
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57 Which skin lesion is morphologically classified as pustular?
1. A wart 2. Impetigo 3. Herpes simplex 4. Acne rosacea |
57 Answer D
Acne rosacea, acne vulgaris, folliculitis, candidiasis, and miliaria are classified as pustular lesions. Papular lesions include warts, corns, Kaposi’s sarcoma, basal cell carcinoma, and scabies. Vesicular lesions include herpes simplex, varicella, and herpes zoster. Erosive lesions include impetigo, lichen planus, and erythema multiforme. |
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58 The “herald patch” is present in almost all cases of
1. pityriasis rosea. 2. psoriasis. 3. impetigo. 4. rubella. |
58 Answer A
The “herald patch” is present in almost all cases of pityriasis rosea. Pityriasis rosea is a common, acute, viral, self-limited eruption that usually begins with a solitary oval, pink, scaly plaque, approximately 3–5 cm in diameter, on the trunk or proximal extremities. It is referred to as the herald patch because it has an elevated red border and a central clearing. |
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59 The five Ps—purple, polygonal, planar, pruritic papules—are present in
1. ichthyosis. 2. lichen planus. 3. atopic dermatitis. 4. seborrheic dermatitis. |
59 Answer B
The five Ps—purple, polygonal, planar, pruritic papules—are present in lichen planus. Lichen planus occurs in clients of all ages but is more common in adults. It has a primary skin lesion with the five Ps that looks like a shiny, violaceous, flat-topped papule that is very pruritic. Ichthyosis vulgaris lesions are fine, small, flaky white scales with minimal underlying erythema that can be found anywhere but are more prominent on the extensor aspects of the extremities. Atopic dermatitis (eczema) presents differently at different ages and in persons of different races, but it usually starts as red, weepy, shiny patches. Seborrheic dermatitis presents as dry scales with underlying erythema. |
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60 Adverse effects from prolonged or high-potency topical corticosteroid use to an open lesion may include
1. epidermal proliferation. 2. striae. 3. vitiligo. 4. easy bruisability. |
60 Answer D
Adverse effects from prolonged or high-potency topical corticosteroid use may include cutaneous atrophy, telangiectases, and easy bruisability, as well as systemic absorption, which may include growth retardation, electrolyte abnormalities, hyperglycemia, hypertension, and increased susceptibility to infection. Vitiligo is caused by loss of melanin. Striae may occur after use of oral corticosteroids or occlusive topical corticosteroid therapy. |
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64 Which of the following is a predisposing condition for furunculosis?
1. Diabetes mellitus 2. Hypertension 3. Peripheral vascular disease 4. Chronic fatigue syndrome |
64 Answer A
Predisposing conditions for furunculosis or carbuncles include diabetes mellitus, human immunodeficiency virus (HIV) disease, and injection drug use. Furunculosis (boils) and carbuncles are very painful inflammatory swellings of a hair follicle that result in an abscess, caused by coagulase positive Staphylococcus aureus. |
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67 Psoriasis may occur after months of using
1. vitamins. 2. hormone replacement therapy. 3. NSAIDs. 4. antihistamine nasal sprays. |
67 Answer C
Psoriasis may occur after extended therapy with many medications, including beta blockers, lithium, NSAIDs, gold, antimalarials, and angiotensinconverting enzyme (ACE) inhibitors, and after heavy alcohol intake. |
