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DERMATOLOGY EXAM QUESTIONS AND ANSWERS, Exams of Nursing

DERMATOLOGY EXAM QUESTIONS AND ANSWERS

Typology: Exams

2024/2025

Available from 01/14/2025

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DERMATOLOGY EXAM QUESTIONS AND

ANSWERS

Dermatology Assessment: History - ANSWER Onset—A/W heat, cold, exercise, exposures, travel, drugs, season, change in environment Where initially; has it spread or changed? Itch or hurt? Treatment and response Previous similar lesions, recurrent? Other family members/contacts affected (sexual contact) ROS—constitutional or prodromal symptoms FH—skin conditions Social history—hobbies, exposures Types of Skin lesions - ANSWER Dermatology Assessment: Physical Exam - ANSWER General appearance & VS: sick or toxic Skin: Type of lesion—macule, papule, plaque, wheal, nodule, pustule, vesicle, crust, scaling, ulcer Color Margins Palpation—indurated, fluctuant Shape—round, annular, serpiginous Arrangement—grouped, scattered Distribution—characteristic, pattern General PE—hair, nails, mucous membranes, lymph nodes, spleen, joints Laboratory Tests in Dermatology - ANSWER Dermatopathology Direct microscopic examination (scale, skin, parasites) Culture (bacterial, fungal, viral) Blood CBC Chemistry profile

Serology Wood's lamp Green if tinea Coral if erythrasma Other tests: imaging; stool and urine evaluation; patch testing; biopsy Topipcal Treatments - ANSWER Ointments: most potent, best for hairless areas, lubricating, occlusive Creams: 2nd most potent, hairless areas, easier to wash off Lotions: 3rd most potent, good for moist & hairy areas, cooling effect Solutions: drying to exudative lesions, hairy areas Gel: oil-in-water with alcohol base, as therapeutic as ointment but with cosmetic advantage Corticosteroids: low, medium, high, & ultra potency Antifungals Topical antibiotics Compresses and soaks: Burow's solution, Aveeno Rosacea - ANSWER 30-50 yr olds, female Rhynophema in men Episodic erythema in response to increase skin temp (sun, alcohol, foods) Cheeks, chin, forehead; occurs in stages of erythema, pustules, telangiectases. No comedomes Can involve eyes Rosacea Treatment - ANSWER Prevention by avoidance of offending factors (hot foods & liquids, etoh, emotional stress, sun) Topical Metronidazole cream 0.75% or gel BID; or 1% cream daily Systemic antibiotics for unremitting or severe: TCN 1-1.5 g/day initially then taper or Minocycline/Doxycyclin50-100mg BID Accutane for severe disease. Requires Dermatologist referral for Rx due to toxicity

Acne Vulgaris - ANSWER Increased sebum prod., Propionibacterium acnes Abnormal keratinization and desquamation Inflammatory response Comedomes (open & closed), pustules, papules Nodules & cysts Acne, hirsuitism, obesity & amenorrhea PCOD Assessment of Acne - ANSWER History: OTC treatments, Skin care—soaps, moisturizers, cosmetics Medications—OCP's, corticosteroids, Lithium Diet Effect on their life Mechanical factors—helmets, collars, phone, hands Assessment Mild acne: several papules/pustules, no nodules Moderate: few to several nodules Severe: generalized nodules, cysts; can scar Therapy for Acne - ANSWER Benzoyl peroxide: OTC in 2%, 5%, & 10%; prevents proliferation of P. acnes Topical antibiotic: Clindamycin(Cleocin-T), Erythromycin (A/T/S). Can be combined with BP (Benzamycin) Topical retinoids: Comedolytic. Retin-A, Tazorac. Start low and increase if tolerated. + sun sensitivity Differin: Retinoid activity. Less irritation than Retin-A. Benzoyl peroxide: OTC in 2%, 5%, & 10%; prevents proliferation of P. acnes Topical antibiotic: Clindamycin(Cleocin-T), Erythromycin (A/T/S). Can be combined with BP (Benzamycin) Topical retinoids: Comedolytic. Retin-A, Tazorac. Start low and increase if tolerated. + sun sensitivity Differin: Retinoid activity. Less irritation than Retin-A. Azelaic acid (Azelex): keratolytic and antibacterial. Apply cream BID. Hypopigmentation possible

Oral antibiotic: Minocycline, Tetracycline, Doxycycline. Decreases P. acnes concentration and inflammation. Taper once improvement noted. Continue 1- 6 mo. Not first line or single therapy. Oral retinoid: Accutane. Severe, resistant nodulocystic acne. Requires Rx by Derm. Many adverse systemic effects. Must be on OCP's. OCP: Ortho Tri-Cylen FDA approved Management of Acne - ANSWER Mild or comedonal acne: Start with keratolytic agent (Retin-A, Differin, Azelaic acid) and benzoyl peroxide 5% (applied separately) Mild papulopustular: Add topical antibiotic; increase strength of BP Moderate papulopustular: Add oral antibiotic and/or OCP Severe: Refer to dermatology Remember it takes 8-12 weeks to see response Psoriasis - ANSWER Chronic, recurrent, papulosquamous eruption. Itchy. Well-defined erythematous plaques with silvery white scale; characteristic distribution Affects 2% of pop. Factors: genetic, stress, illness, trauma 4 types: Vulgaris Guttate Erythrodermic Pustular Nail and joint involvement Psoriasis Differential - ANSWER Differential: Contact dermatitis Atopic dermatitis Seborrhea Fungal (onychomycosis)

Pityriasis rosea Rheumatoid arthritis Treatment of Psoriasis - ANSWER Consider age, site and extent of lesions, other medical conditions Dermatology referral if initial diagnosis or severe Topical corticosteroids ointment (super to high potency) applied after removing scale. Cover with plastic wrap overnight. Scalp—salicylic acid in oil base, tar shampoo Avoid systemic corticosteroids Dovonex (Vit D) ung/cream/sol for scalp bid (< 100 gm/wk) Tazorac (Tazarotene)Vit. A gel r/t Retin A .05% or .1 % concentration applied at hs. Pulse therapy (weekends): Diprolene/Temovate with something else (less potent) the rest of week If > 10% skin involvement phototherapy; Methotrexate per Dermatologies Topical Steroidal Strengths: Ultra high: Diprolene 0.05% oint, gel, Temovate High: Lidex 0.05%, Kenalog 0.5% cream Intermediate: Synalar 0.025% cream, ointment, Kenalog 0.1% cream Low: Hydrocortisone cream 1%, Kenalog 0.025% Seborrheic Dermatitis - ANSWER Greasy, erythematous scaling involving sebaceous glands Associated with Pityrosporon ovale May be worse in winter (dry environment) Sun may improve or worsen +/- itchiness, worse with perspiration Affects face, scalp, presternal area, body folds Chronic disorder unless onset as child Treatment of Seborrheic Derm - ANSWER Shampoo: Nizoral, Selsun, Head & Shoulders 5-10 mins. qd x 10-14 days, then prn May use emollient (white petroleum) to soften X 20 mins or overnight Scales removed with fingers or brush, followed by non-medicated shampoo UV radiation Cautious use of topical steroids

Watch for secondary infections Refer if unresponsive Atopic Dermatitis - ANSWER Acute or chronic, relapsing dermatitis— "Eczema" "The itch that rashes" Onset in childhood A/W asthma, allergies Aggravated by dry skin sweating, heat, stress, topicals, wool, season Erythematous, dry patches with scale Lichenification Atopic Dermatitis Asssessment - ANSWER Hx of childhood symptoms Asthma, allergies Distribution on flexor surfaces, neck, eyelids, forehead, wrists, trunk Erythema papules serous discharge crusts Chronic remitting, relapsing Atopic Dermatitis Treatment - ANSWER Stop the itch-scratch cycle: antihistamines (diphenhydramine, hydralazine, nonsedating) Hydrate the skin: Aveeno baths, petroleum, avoid harsh soaps Topical corticosteroids very sparingly Oral corticosteroids only in severe disease Treat secondary bacterial or fungal infections Avoid aggravating factors Referral to allergist? Dyshidrotic Eczema - ANSWER Confluent "tapioca" vesicles on hand & feet that scale then desquamate Chronic, acute, recurring Idiopathic Treat with emollients, & topical steroid Nummular Eczema - ANSWER Chronic, inflammatory, pruritic

Coin-shaped plaques of small papules & vesicles on erythematous base Atopic people Peaks in winter Legs, trunk, hands Hydrate, topical steroids, Intralesion triamcinolone Contact Dermatitis - ANSWER Inflammatory reaction to allergen or chemical irritant Well-demarcated to site of exposure but can become generalized Erythema, edema, pruritic, oozing, crusty Immediate or delayed Lichenification if chronic Wet dressings Topical or oral steroids Rhus Dermatitis - ANSWER Poison ivy, poison oak Oleoresins urushiol Linear patches of erythematous, edematous papules vesicles erosion crusty Residual oil on clothes, gloves, Animals Not contagious Topical or oral steroids Burow soln, antihistamines Watch for secondary infection Fungal Skin Infections - ANSWER Tinea corporis, pedis cruris, capitis, manuum Direct or indirect dermatophyte infection Onychomycosis (nail) Trichomycosis (hair) Prefers warm, moist, occluded location

Tinea corporis - ANSWER Affects trunk, legs, arms, neck. Excludes hands, feet, groin. Well-marginated, red, annular, peripheral enlargement with central clearing, scaling, pruritic. "Ringworm" Can spread from feet, animals, contacts Tinea Cruris - ANSWER "Jock itch", affects groin & upper thighs, often transferred by towels from feet. Scrotal involvement uncommon. Large, scaling, well-demarcated dull red/tan plaques. +/- central clearing and pruritis. Tight clothes, moisture. Tinea Pedis - ANSWER : "Athletes foot". Vesicles on instep; macerated fissures between toes; scaling of sole (moccasin foot). Hx of sweaty feet, nonbreathable shoes Moccasin type: well-defined erythema of plantar aspect of foot; a/w onychomycosis. Keratolytic agents reduce hyperkeratosis Interdigital tinea pedis: macerated, white, moist. Castellani's paint, aluminum chloride Lab Diagnosis of Tinea - ANSWER Microscopic: Scrape edge of lesion with glass slide onto 2nd slide Two drops KOH and cover slip "Spaghetti"—septated hyphae and spores Fungal culture Woods light greenish Treatment of Tinea - ANSWER Prevention: antifungal powders, shower shoes OTC antifungals: (Imidazoles) Lotrimin (Clotrimazole) or miconazole (Micatin). Use bid up to 4 weeks Rx antifungals: (Allylamines) Lamisil; (Imidazoles) Nizoral, Spectazole Ketoconozole, Griseofulvin Systemic antifungal for severe, extensive, or unresponsive infections, nails and scalp Erythasma - ANSWER Looks like tinea cruris

Chronic bacterial infection, Corynebacteria Intertriginous areas Mild symptoms of burning, Pruritis Sharp margins, scaly, macerated in toes, brownish red Red Neg KOH; red with Woods Light Benzoyl peroxide wash & gel EMycin or TCN topical or po Cutaneous Candidiasis - ANSWER Candida spp. like warm moist environment Intertriginous areas, mucosal surfaces (thrush, vaginal yeast infection) Predisposing factors: antibx, DM, obesity, sweating, heat, steroids Erythematous, confluent macular eruption, satellites Tender, pruritic Treat with topical or systemic antifungals Keep dry Intertrigo - ANSWER Erythema, pruritis, tenderness, pain Diagnosis: Candidiasis - ANSWER Microscopic exam: Budding yeast Pseudohyphae Pityriasis Versicolor - ANSWER Chronic, asymptomatic, scaling dermatosis Overgrowth of Pityrosporum ovale (yeast) AKA tinea versicolor Not contagious, asymp. Heat, humidity and increase sebum production predispose Hyper or hypo pigmented oval macules with scale Trunk, upper arms, neck

groin, thighs Assessment & Treatment of Pityriasis Versicolor. - ANSWER Microscopic examination of scale with KOH "spaghetti & meatballs" Woods light Blue-green fluorescence (may be neg if recently showered) Treatment selenium sulfide 2.5% lotion or shampoo or ketoconazole daily for 15 min. then shower, X 1 week then prophylactically Systemic antifungals (Nizoral, Difflucan) Skin pigment normalizes over time Pityriasis Rosea - ANSWER Self-limiting (6 wks), noncontagious Enlarging oval macules, tawny pink, scaly collarette "Herald" patch Christmas tree distribution on trunk, proximal extremities +/- pruritis Pityriasis Distribution - ANSWER Christmas tree pattern on back Both sexes; ages 10-35, college age in spring & fall Etiology unknown, may have viral prodrome Mimics syphilis RPR/VDRL KOH prep to R/O tinea Topical lotions: Calamine (drying) Sarna (with menthol) Aveeno baths Topical/systemic corticosteroids for severe Antihistamines May improve with sun exposure Molluscum Contagiosum - ANSWER Pox virus, usually self- limiting (6 months) Common in children; HIV+ and sexually active adults Round, dome-shaped, umbilicated, flesh colored Treatment: curettage, cryosurgery, LN

Herpes Simplex - ANSWER Herpes Simples Virus Type I Virus which affects, lips, face, buccal mucosa & throat Transmission through direct contact or saliva Grouped vesicles with erythematous base Crusting signals end of viral shedding Pain, tenderness, mild paresthesia or burning prior to eruptions Virus dormant in ganglia Triggers: Sunlight, local skin trauma, fatigue, menses or fever Plan: Tzank prep or Viral culture Acyclovir 5% ointment- minimal efficacy. Apply q3h, 6X/day for 1 week Denavir cream- q2h while awake Oral antivirals not indicated for recurrent oral herpes Liquid Benadryl mixed with Maalox 1:1 as rinse Lip lesions: Apply ice, Blistex, sunscreen Herpes Zoster - ANSWER Shingles—reactivated varicella virus, dormant in ganglion cells Prodromal stage Painful vesicular eruption in dermatome, "dew drops on a rosebud" Unilateral, doesn't cross midline Usually on thorax or trigeminal dermatome Opthalmic can have complications Postherpetic neuralgia Antivirals, pain management, dressings, oral steroids Corns & Warts - ANSWER Corns (helomas) & calluses are caused by friction hyperkeratosis Conical shape causes pain from pressure OTC treatments, padding Warts: Verruca vulgaris, plana & plantaris Occur at sites of trauma Warts (Nongenital cutaneous) - ANSWER Epithelial tumor caused by HPV. Common in kids. 40% resolve spontaneously within 2 yr

Verruca vulgaris - ANSWER common wart (70%). Flesh-colored, raised, firm papule. Hyperkeratotic, absence of nl skin markings, black dots. Common on hands, finger, knees Verruca plantaris - ANSWER plantar wart (30%). Usually on pressure points, between toes. Grow inward. Punctate bleeding when pared. Verruca plana - ANSWER flat wart (4%). Flat top, round. Can be in linear distribution. Face, neck, extremities Therapy for Warts - ANSWER No single, effective treatment- high rate of reoccurrence, may need multiple treatments. Keratolytics: Salicylic acid- (10-40%) Solution or tape. Takes weeks, not for large warts. Soak or scrape wart surface before use. Not for use on face. Salicylic acid-podophyllin-cantharidin-- Cantharidin causes blister (plantar warts) Aldara or Retin A topically Cryosurgery Laser Bacterial Skin Infections - ANSWER Furuncle: acute, red, hot, tender nodule; Staph aureus folliculitis Abscess: collection of pus Carbuncle: deeper infection Painful and tender, fever I & D Systemic antibiotics CA-MRSA Infections - ANSWER Community associated Methicillin resistant staphlococcus aureus—resistant to penicillins and cephalosporins 80% are skin and soft tissue infections: furuncles, folliculitis, impetigo, cellulitis Risks: IV drug use, skin trauma, previous antibx, military, incarceration, higher BMI, gay men Management: I & D

Topical antibiotic --mupirocin Oral antibiotic—Clindamycin 300 mg tid; TMP/SMX DS 1-2 bid, Doxy Vancomycin Prevention of MRSA - ANSWER hand washing avoid exposure cover abrasions no sharing Skin Infections (Pyoderma)-impetigo - ANSWER superficial infection of epidermis Folliculits and Cellulitis - ANSWER Folliculitis: infection of upper portion of hair follicle Cellulitis: acute infection of dermis and subcutaneous tissue, Staph aureus Shaving or occlusive clothing can predispose. Pseudomonas aeruginosa from hot tubs Papular/pustular discrete lesions on face, axilla, back, extremities. Can progress to furuncle. Plan: Warm compresses after antibacterial wash; topical antibx if superficial (Emycin, Clindamycin); Diclox or Augmentin if severe; benzoyl peroxide if chronic; stop shaving and use new razors each time; change deodorant Emergent: Extensive cellulitis or toxicity Decreased arterial pulse in cool, swollen extremity Cutaneous necrosis Closed space infections of hand Periorbital due to relationship to brain Immunosupressed or diabetic host Erysipelas - ANSWER superficial edematous cellulitis by Strep pyogenes Mole or Skin Cancer? - ANSWER History: Family history (melanoma) Sun exposure—early burn, use of sun screen New lesion or change in existing lesion Physical Exam:

Solar keratosis (aka, actinic or senile) vs seborrheic keratosis Basal cell carcinoma—nodular; pigmented; sclerosing; superficial Squamous cell carcinoma Melanoma Atypical Melanocyte - ANSWER 1:6 develop skin CA Examine thoroughly! Refer suspicious to Derm Know your "ABCDE"s Asymmetry] Boarder Color Diameter Elevation Changes or symptoms are not normal Superficial Spreading Melanoma - ANSWER Mostly on arms, legs, Trunk Round, irreg boarder Black, brown, red, blue Dermatitis Medicamentosa - ANSWER Fixed drug reaction (TCN) Can be delayed (2 weeks) Variety of manifestations from benign, self limiting severe, life threatening FDE solitary or multiple Can itch, form bulla, erode Topical steroid or antibiotic Acute Drug Reaction - ANSWER Exanthemous reaction Most common ACDR Often caused by PCN's Starts on trunk Macular, confluent Desquamation Stop drug

Antihistamines Topical or po steroids Red Flags: Acute Drug Reactions - ANSWER Confluent erythema Facial edema (tongue) Skin pain Palpable purpura Skin necrosis

  • Nikolsky's sign High fever Lymphadenopathy Respiratory distress Pediculosis - ANSWER lice Nits on hair shaft. Treat with OTC Nix, RID, A- 200 Treat bedding, clothing, contacts Scabies - ANSWER Mite infestation Severe pruritis Direct or indirect transmission—institutional risks Skin colored ridges (burrows) with terminal vesicle/papule Scabies scrape: contents of vesicle with KOH to see mite OTC permethrin Treat clothing & contacts Scabies Distribution - ANSWER Paronychyia - ANSWER Soft tissue infection—Staph, Strep, or fungal Erythema, swelling, pain Pseudomonas subungually—green Paronychias treat with warm soaks, oral antibiotics or I & D Prevention: good nail care Onychomycosis - ANSWER Chronic, progressive infection of nail

Nail is yellowed, thickened, irregular Look for tinea Lamisil or Spronox Pulse dosing 3 months to clear 6 - 12 mo for normal nail High rate of recurrence Prevention Burns - ANSWER Superficial: (1st degree) Epidermis is red, slightly edematous, dry, painful & hypersensitive; no skin loss or blister (sun burn). Heals in 1 week Superficial partial-thickness: (2nd degree) May blister, more swollen, sensitive to air. Heals 2-3 weeks. Deep partial-thickness: (3rd degree) White, dry, less sensitivity to pain, blanches with pressure Full thickness burns: (4th degree) White or blackened. Extends into muscles, nerve, vessels, bone Burn Care Plan - ANSWER 1st degree: Cool compresses; analgesic; Nupercainal cream or Benzocaine spray; moisturizer 2nd degree: Same as 1st degree, monitor closely to assess healing & signs of infection Cleanse wound with normal saline; debride open blisters; apply Silvadene 1% cream. For sulfa-allergic patients use nitrofurazone cream (Furacin). Bactroban if on face Apply nonadherent DSD & gauze to absorb drainage. Do not wrap. Hospitalize if > 10% or full thickness Bite Wounds - ANSWER Dog bites: Hands, crushing injuries; 65% are kids < 11 yr old. 20% chance of infection Cats: Deep puncture wounds. 50% chance of infection. Pasteurella multocida is cause of infection in 50% of dog bites, 80% of cat bites Human bites: Strep, Staph, Hep B, HIV Bites of the hand have the highest infection rate; face the lowest Rabies may be transmitted thru saliva; airborne in rat-infestation

Dog Bite Plan - ANSWER Good history of event- stray or known animal, shot history of person and animal Document ROM & neurovascular status distally Wound cleansing with waterpik or syringe, debridement. Scrub surrounding area X-ray if near joint for baseline Td & rabies prophylaxis Do not suture wounds likely to become infected (bites >6-12 hours, puncture bites, hand bites) Antibiotics: Augmentin (20- 40mg/kg) or Emycin (30-50mg/kg) for 5 - 7 days for prophylaxis if human, cat or deep. 10 - 14 days for cellulitis Vibramycin, clindamycin & fluoroquinolone for adult (clindamycin & Bactrim for children) Consider rabies vaccine for unprovoked attack, unknown animal If animal vaccinated, observation by owner for 10 days. Report to animal control. Refer facial or severe bites Education re: strays, supervision with animals Rabies - ANSWER In small rodents is rare Skunks, bats, raccoon, coyotes & foxes may harbor viruses & may bite cats & dogs Rabies produces acute febrile illness with CNS problems & death if untreated Rabies prophylaxis is given on days 0,3,7,14 & 28 Vaccines: Human Diploid Cell vaccine(HDCV), Purified chick embyo cell vaccine (PCEC) & Rabies vaccine adsorbed (RVA) 1st dose infiltrated into site with remaining IM into deltoid if HDCV. Babies in thigh 20 IU/kg of body weight Rabies immune globulin with 1st dose of active immunization if never given previously Rabies vaccine instituted within 48 hours; may be discontinued if animal shown to be free of virus Re-examine bites in 24-48 hours Spider Bites - ANSWER Brown Recluse spider Native to Midwest and southwestern states

Violin pattern on back Live in warm, dark, dry places Not aggressive, bites when trapped against skin Poisonous venom can cause tissue necrosis and rarely more serious systemic complications—ARF, hemolysis, coma,death Bite A/W redness, itching, N&V, fever, myalgia Occ. blistering, blue discoloration, necrosis, infection Labs: CBC, lytes, UA Treatment: wash, ice, elevate, rest, antibiotics prn, debridment prn NO heat, steroid cream, suction or excision Black Widow Throughout USA, mostly southwest Shiny black, red hourglass on abd Neurotoxic venom spreads quickly throughout body