When performing a skin assessment, what is the most vital component of the assessment?
- Assessing skin turgor for hydration status
- Visual examination of the skin surface
- A thorough history
- A biopsy of any unusual looking lesions
3. A thorough history
A thorough history is invaluable in identifying skin disorders. While the other answers are correct and may be considered, they are not as vital to the assessment.
The NP is using the correct terminology to describe the morphology of a lesion. Which of the following is an appropriate description?
- "The lesion has irregular borders."
- "The lesion is a macule."
- "The lesion is erythematous."
- "The lesion is scaly."
2. "The lesion is a macule."
Morphology is the term used to describe the shape of a lesion such as a macule, papule, or patch.
A patch can be differentiated from a macule by observing that:
- A patch is less than 1 cm in diameter.
- A patch is elevated, firm, and circumscribed and less than 1 cm in diameter.
- A patch is an elevated, firm, rough lesion with a flat top surface and greater than 1 cm in diameter.
- A patch is a flat, non-palpable, irregular-shaped macule greater than 1 cm in diameter.
4. A patch is a flat, non-palpable, irregular-shaped macule greater than 1 cm in diameter.
The primary difference between a macule and a patch is that the patch is > 1 cm in size.
Vitiligo can be described as what?
- Distinct raised areas of the skin that are pruritic
- Hypo-pigmented macular lesions ranging in size from 5 mm to 5 cm or greater
- A loss of skin pigment and hair due to injury at the base of the hair follicle
- A progressive thickening and hardening of the epidermis
2. Hypo-pigmented macular lesions ranging in size from 5 mm to 5 cm or greater
By definition, vitiligo consists of hypopigmented lesions of varying size.
Treatment for vitiligo may include which of the following?
- Topical steroids
- Lamisil cream
3. Topical steroids
Although the etiology remains unknown, vitiligo may have an autoimmune component and, therefore, may respond to corticosteroid therapy.
A patient presents to the office with concerns about sudden losses of patches of hair from her scalp. She denies any recent changes in use of hair products. She does not pull or tug at her hair. The NP diagnoses the patient with alopecia areata. Which of the following statements made by the NP would provide the most reassurance to the patient?
- "There is no treatment but it is always a benign condition."
- "If we can identify the causative agent, we may be able to prevent further hair loss."
- "A 1% topical naftifine cream (Naftin) applied bid for 2–4 weeks may help prevent further hair loss."
- "Eighty percent of all people with this condition will have spontaneous re-growth of hair within one year."
4. "Eighty percent of all people with this condition will have spontaneous re-growth of hair within one year."
This is the best choice since it is the only answer that provides reassurance to the patient by providing information that hair growth is likely to reoccur spontaneously.
A 35-year-old female patient is seen in the primary care office with concerns about multiple small, oval, pink, scaling macules that have appeared on her trunk. There is no associated pain or pruritus. There is one significantly larger scaly patch observed on the abdomen. The NP diagnoses the patient as having what?
- Pityriasis rosea
- Contact dermatitis
2. Pityriasis rosea
The significantly larger scaly patch that is seen on the patient’s abdomen is known as a "herald patch" and is a classic sign seen with pityriasis rosea.
An 8-year-old male child is seen in the clinic with a superficial pustule along his inner forearm that started as a mosquito bite. There is a characteristic honey-colored crust covering the entire lesion. The NP diagnoses the patient with which of the following?
- Staph aureus or Group A beta hemolytic streptococcus infection
- Group B: Beta hemolytic streptococcus infection
- Community-acquired Methicillin-resistant staph aureus
- Tinea corporis
1. Staph aureus or Group A beta hemolytic streptococcus infection
The patient is showing classic signs of impetigo which is consistent with a history of scratching a pruritic lesion such as a mosquito bite.
A patient presents to the clinic with complaints of itching and flaking to bilateral feet. The NP observes that there is a characteristic macerated appearance between the toes. The NP diagnoses the patient with which of the following?
- Tinea pedis
- Tinea versicolor
- Seborrheic dermatitis
1. Tinea pedis
The macerated appearance between the toes is consistent with a tinea infection and is commonly called "athlete’s foot."
A patient is seen in the primary care office. The patient has a maculo-papular rash with distinct vesicles on the lateral left trunk that follows along a dermatome. The patient states that the rash has been there for three days. Which of the following is important educational information that should be provided to the patient?
- The patient is experiencing a reactivation of the chicken pox virus and is not contagious.
- The patient is contagious and must avoid pregnant woman, immunocompromised individuals, and non-immunized children.
- The patient is only contagious for the first 48–72 hours that the rash is present.
- The patient is not contagious. The rash may remain for many months and there is no treatment.
2. The patient is contagious and must avoid pregnant woman, immunocompromised individuals, and non-immunized children.
This is a reactivation of the chicken pox virus and the patient is contagious. Precautions should be taken to avoid exposure to non-immune individuals.
Which of the following is the preferred treatment for herpes zoster (shingles)?
- Ketoconazole 200 mg tablet po daily × 10–14 days
- Lotrisome topical cream 0.5%; apply to affected area for two weeks
- Diflucan 150 mg one tablet po daily for 14 days
- Valcyclovir 1 gm tid × 7 days
4. Valcyclovir 1 gm tid × 7 days
Herpes zoster is a virus and therefore would respond best to antiviral treatment. The treatment should be started as early as possible to shorten the duration and intensity of the outbreak.
- Caused by a viral infection.
- Caused by a fungal infection.
- Caused by a bacterial infection.
- There is no known etiology.
2. Caused by a fungal infection.
Onychomycosis, by definition, is a fungal infection of the nails. It is more commonly seen in the toenails but may be seen in the fingernails as well.
The preferred therapy for onychomycosis is topical agents. If the NP uses oral agents, the NP should first obtain lab work to determine what?
- The patient’s renal function
- The patient’s hepatic function
- The patient’s coagulation factors
- The patient’s immune-competency
2. The patient’s hepatic function
If an oral antifungal agent is used, the patient’s hepatic function needs to be assessed first because the medication is metabolized extensively within the liver.
Verruca vulgaris is more commonly known as warts. They are cutaneous neoplasms caused by which of the following?
- A fungal infection
- A bacterial infection
- HPV virus
- A dermatophyte
3. HPV virus
There are more than 50 different types of herpes virus responsible for the growth of warts.
A patient is requesting more information about several warts that have appeared along his fingers on both hands. Which of the following is appropriate educational information for this patient?
- There is no known treatment, but generally most warts will resolve in 1–2 years.
- They are not spread through casual contact but rather through contact with an open area.
- They are usually confined to the hands or the feet.
- They are more common in women than in men.
1. There is no known treatment, but generally most warts will resolve in 1–2 years.
There is no cure for warts, but most warts will resolve without any intervention. They are spread through contact and do not need to be in contact with an open skin area.
Lichenification is a term used to describe which of the following?
- Scar tissue formation that is out of proportion to the healing process
- Thick fibrous tissue that replaces normal skin tissue
- A linear crack in the epidermis that has a scaly appearance
- A cutaneous thickening and hardening of the epidermis
4. A cutaneous thickening and hardening of the epidermis
Lichenification can occur anywhere on the body. It is a thickening of the skin related to persistent rubbing or itching of an area that occurs over an extended period of time.
The term bulla is used to describe a lesion that is:
- Elevated, firm, and circumscribed.
- A vesicle or large fluid-filled blister.
- An elevated firm rough lesion with a flat top surface.
- A large grouping of keritanized cells with thick oily walls.
2. A vesicle or large fluid-filled blister.
A bulla is a large fluid-filled blister. It is commonly seen in patients who have a severe allergy to poison ivy, poison oak, or poison sumac. Bullae can appear in response to any injury or allergic reaction.
The patient presents to the office with an apparent allergic reaction to an unknown antigen. The patient has pruritic hives on his arms, legs, trunk, and face. The patient has no difficulty breathing or swallowing, his lungs are clear, and there is no swelling of the lips or tongue. With this information, the NP should choose which of the following options for treatment?
- One-time dose of epinephrine via EpiPen stat in office
- Oral antihistamines, cool compresses, and oral corticosteroids
- Topical steroid cream to be applied to all affected areas × 1 week or until lesions disappear
- Using second-generation antihistamines and warm compresses to affected areas for 20 minutes tid
2. Oral antihistamines, cool compresses, and oral corticosteroids
The patient is having an allergic reaction but does not exhibit any signs or symptoms of impending anaphylaxis. For this reason, it is reasonable to treat the patient with oral antihistamines and corticosteroids. The patient should be prescribed an EpiPen because subsequent exposure to the antigen may cause a more severe reaction.
A patient presents to the office with complaints of skin inflammation, intense itching, and flaky skin on the elbows and knees. The NP diagnoses the patient with eczema. What would the NP expect to find when conducting the personal and family history?
- Mother has a history of asthma and COPD.
- Father had an MI at age 52.
- Sister has type 2 diabetes mellitus.
- The patient had a tonsillectomy at age 5.
1. Mother has a history of asthma and COPD.
Patients with eczema often have a personal or family history of allergies, such as those commonly seen with patients who have asthma.
A patient comes to the clinic concerned about non-pruritic lesions that are present on both of his elbows. The lesions are pink, sharply demarcated papular plaques covered with silvery scale. The NP diagnoses the patient with which of the following?
The patient has a classic presentation of psoriasis. The location and appearance are enough to diagnose the patient.
A 35-year-old female with a past medical history that includes psoriasis presents to the office for an annual physical. While obtaining a detailed history, the NP recognizes that it would be important to inquire about any personal history of:
- Sexually transmitted diseases.
- Autoimmune disorders.
- Joint pains.
- Migraine headaches.
3. Joint pains.
Psoriatic arthritis is commonly found in patients who have psoriasis. It is important to assess this early in the patient’s history.
While performing a complete physical exam, the NP notes that the patient has very dry, scaly skin on all of the patient’s extremities. The NP inquires about the use of moisturizers and fragrances and asks if there is a personal or family history of:
Many patients with dry scaly skin are found to have hypothyroidism. A patient with no other personal history that would explain the dry, scaly skin appearance should have a TSH level done.
What is the most common lesion seen in dermatology?
- Basal cell skin cancer
- Squamous cell skin cancer
- Actinic keratosis
- NMSC (non-melanoma skin cancer)
3. Actinic keratosis
Actinic keratosis is a pre-cancerous lesion and is the most common lesion seen in dermatology.
What is the most common type of skin cancer?
- Basal cell carcinoma
- Squamous cell carcinoma
- Seborrheic keratosis
1. Basal cell carcinoma
Basal cell carcinoma is the most common form of skin cancer. Squamous cell carcinoma is the second most common form.
An 18-year-old female patient presents to the office with complaints of papulopustular, cystic acne to her forehead, chin, and upper back areas. The NP is concerned with psychosocial effects as well as physiological long-term scarring. The NP decides to initiate therapy with which of the following?
- Exfoliation therapy
- Topical clindamycin
- Isotretinoin (Accutane)
3. Isotretinoin (Accutane)
Isotretinoin is the most effective of the treatments listed. It is a known teratogen and therefore is only used in severe cases of acne that interfere with the patient’s quality of life.
The NP prescribes Isotretinoin for an 18-year-old female patient with severe cystic acne. The pharmacist receives the prescription but refuses to fill it. What is the most likely reason for the pharmacist’s refusal?
- The NP is not registered with the IPLEDGE program.
- The patient must first show a negative pregnancy test to the pharmacist.
- The pharmacist feels it is an inappropriate medication for an 18-year-old female patient.
- Female patients that are potentially fertile are not allowed to have Isotretinoin therapy due to its severe teratogenic effects.
1. The NP is not registered with the IPLEDGE program.
The IPLEDGE program is designed to increase the awareness and accountability of both the health care provider (prescriber) and the pharmacist. These professionals are required to complete a program and be certified in the prescribing and dispensing of medications that are highly teratogenic.
A patient is diagnosed with alopecia areata. The nurse practitioner reassures the patient that there is no permanent scarring or damage to the hair follicle and that hair growth will likely return within one year. To prevent further episodes, the NP suggests that the patient do which of the following?
- Take 2000 international units of Vitamin D once daily.
- Use baby shampoo or shampoo that contains no perfumes or dyes.
- Consider practicing daily meditation, yoga, or guided imagery to reduce stress.
- Avoid tight hats and restrictive headbands.
3. Consider practicing daily meditation, yoga, or guided imagery to reduce stress.
Although there is no known etiology of alopecia areata, it is believed that stress may be a trigger. Practicing daily stress-relieving activities may decrease the chance of a reoccurrence.
The term dermatographism refers to what?
- Skin welts or redness that appears when the skin is scratched or stroked firmly
- The ability to correctly identify an item that is placed in the hand when the eyes are closed
- The visible burrows left by chiggers burrowing under the skin
- Areas of hypopigmentation that are the result of the presence of dermatophytes
1. Skin welts or redness that appears when the skin is scratched or stroked firmly
Dermatographism is, by definition, the development of skin welts when the skin is scratched or stroked firmly.
A patient complains of a pruritic red rash that appeared on his body several days ago. The NP obtains a skin scraping, applies KOH, and visualizes multiple hyphae under the microscope. The nurse practitioner diagnoses the patient with which of the following?
- Herpes zoster
- Seborrheic dermatitis
- Tinea corporis
3. Tinea corporis
The appearance of hyphae under the microscope is an indicator that yeast is present. Yeast is a fungus. Overgrowth of yeast on the skin is a common occurrence.
A 19-year-old female college student is seen in the health center complaining of several pustules that have appeared in her groin area after shaving. The NP diagnoses the patient with folliculitis. The NP obtains a pregnancy test and then prescribes which of the following?
- Topical clindamycin and oral doxycycline
- Topical imiquimod lotion
- Azithromycin 250 mg; take 2 tabs on day one and then one tab for four days thereafter
- Medrol dosepak × 5 days
1. Topical clindamycin and oral doxycycline
Folliculitis is treated with both topical and oral antibiotics. A pregnancy test should always be done first on a young female to avoid the risk of exposure to a known teratogen.