Deck 37: Dermatologic Disorders

Question 1

A school­age child is brought to clinic after a pediculosis capitis infestation is
reported at the child's school. If this child is positive, what will the primary care pediatric nurse practitioner expect to find on physical examination, along with live lice near the scalp?
A. Excoriated macules along the child's collar and underwear lines
B. Inflammation and pustules on the face and neck
C. Itching of the scalp, with skin excoriation on the back of the head
D. Linear or S­shaped lesions in webs of fingers and sides of hands

Answer 1

Itching of the scalp, with skin excoriation on the back of the head

Question 2

A child will need an occlusive dressing to treat lichen simplex chronicus. What
will the primary care pediatric nurse practitioner tell the parents about applying this treatment?
A. Apply ointment before the dressing.
B. Plastic wrap should not be used.
C. The dressing should be applied to dry skin.
D. Change the dressing twice daily.

Answer 2

Apply ointment before the dressing.

Question 3

An adolescent has acne characterized by papules and pustules mostly on the
forehead and chin. What will the primary care pediatric nurse practitioner prescribe?
A. Azelaic acid applied daily at nighttime
B. Benzoyl peroxide applied twice daily
C. Topical erythromycin with benzoyl peroxide
D. Tretinoin applied nightly after washing the face

Answer 3

Topical erythromycin with benzoyl peroxide

Question 4

An adolescent has acne with lesions on the cheeks and under the chin. Which distribution is this?
A. Athletic
B. Frictional
C. Hormonal
D. Pomadal

Question 5

When prescribing topical glucocorticoids to treat inflammatory skin conditions, the primary care pediatric nurse practitioner will
A. initiate therapy with a high­potency glucocorticoid.
B. order lotions when higher potency is necessary.
C. prescribe brand­name preparations for consistent effects.
D. use fluorinated steroids to minimize adverse effects.

Question 6

A 3­year­old child has head lice. What will the initial treatment recommendation be to treat this child?
A. Lindane
B. Permethrin
C. Pyrethrin
D. Spinosad

Question 7

A child has several circular, scaly lesions on the arms and abdomen, some of
which have central clearing. The primary care pediatric nurse practitioner notes a smaller, scaly lesion on the child's scalp. How will the nurse practitioner treat this child?
A. Obtain scrapings of the lesions for fungal cultures.
B. Order prescription­strength antifungal creams.
C. Prescribe oral griseofulvin for 2 to 4 weeks.
D. Recommend OTC antifungal creams and shampoos.

Question 8

A child has small, firm, flesh­colored papules in both axillae which are mildly pruritic. What is an acceptable initial approach to managing this condition?
A. Application of trichloroacetic acid 25% to 50% using a dropper
B. Applying liquid nitrogen for 2 to 3 seconds to each lesion
C. Reassuring the parents that these are benign and may disappear spontaneously
D. Referral to a dermatologist for manual removal of lesions with curettage

Question 9

A previously healthy school­age child develops herpes zoster on the lower
back. What will the primary care pediatric nurse practitioner do to manage this condition?
A. Order Burow solution and warm soothing baths as comfort measures.
B. Prescribe oral acyclovir 30 mg/kg/day in 4 doses/day for 5 days.
C. Recommend topical antihistamines to control itching.
D. Stress the need to remain home from school until the lesions are gone.

Question 10

A child is diagnosed with tinea versicolor. What is the correct management of this disorder?
A. Application of selenium sulfide 2.5% lotion twice weekly for 2 to 4 weeks
B. Oral antifungal treatment with fluconazole once weekly for 2 to 3 weeks
C. Sun exposure for up to an hour every day for 2 to 4 weeks
D. Using ketoconazole 2% shampoo on lesions twice daily for 2 to 4 weeks

Question 11

A 4­year­old child has clusters of small, clear, tense vesicles with an
erythematous base on one side of the mouth along the vermillion border, which are causing discomfort and difficulty eating. What will the primary care pediatric nurse practitioner recommend as treatment?
A. Mupirocin ointment applied to lesions 3 times daily
B. Oral acyclovir 20 to 40 mg/kg/dose for 7 to 10 days
C. Topical acyclovir applied to lesions 4 times daily
D. Topical diphenhydramine and magnesium hydroxide

Question 12

A child has an area of inflammation on the neck that began after wearing a
hand­knot woolen sweater. On examination, the skin appears chafed with mild erythematous patches. The lesions are not pruritic. What is an appropriate initial treatment?
A. Application of a lanolin­based emollient
B. Burow solution soaks and cool compresses
C. Oral antihistamines given 4 times daily
D. Topical corticosteroids applied 2 to 3 times daily

Question 13

An adolescent who recently spent time in a hot tub while on vacation has
discrete, erythematous 1­ to 2­mm papules that are centered around hair follicles on the thighs, upper arms, and buttocks. How will the primary care pediatric nurse practitioner manage this condition?
A. Culture the lesions and treat with appropriate IM antibiotics.
B. Hospitalize for incision and drainage and intravenous antibiotics.
C. Order an antistaphylococcal beta­lactamase­resistant antibiotic.
D. Prescribe topical keratolytics and topical antibiotics.

Question 14

A child is brought to clinic with several bright red lesions on the buttocks. The
primary care pediatric nurse practitioner examines the lesions and notes sharp margins and an "orange peel" look and feel. The child is afebrile and does not appear toxic. What is the
course of treatment for these lesions?
A. Hospitalize the child for intravenous antibiotics and possible I&D of the lesions.
B. Initiate empiric antibiotic therapy and follow up in 24 hours to assess response.
C. Obtain blood cultures prior to beginning antibiotic treatment.
D. Perform gram stain and culture of the lesions before initiating antibiotics.

Question 15

The primary care pediatric nurse practitioner is teaching a parent of a child
with dry skin about hydrating the skin with bathing. What will the nurse practitioner include in teaching?
A. Apply lubricating agents at least 1 hour after the bath.
B. Have the child soak in a lukewarm water bath.
C. Keep the child in the bath until the skin begins to "prune."
D. Soaping should be done at the beginning of the bath.

Question 16

A 9­month­old infant has vesiculopustular lesions on the palms and soles, on
the face and neck, and in skin folds of the extremities. The primary care pediatric nurse practitioner notes linear and S­shaped burrow lesions on the parent's hands and wrists. What is the treatment for this rash for this infant?
A. Ivermectin 200 mcg/kg for 7 to 14 days, along with symptomatic treatment for itching
B. Permethrin 5% cream applied to face, neck, and body and rinsed off in 8 to 14 hours
C. Treatment of all family members except the infant with permethrin 5% cream and ivermectin
D. Treatment with permethrin 5% cream for 7 days in conjunction with ivermectin 200 mcg/kg

Question 17

An adolescent female has grouped vesicles on her oral mucosa. To
determine whether these are caused by HSV­1 or HSV­2, the primary care pediatric nurse practitioner will order which test?
A. Direct fluorescent antibody test
B. Enzyme­linked immunosorbent assay
C. Tzanck smear
D. Viral culture

Question 18

An infant is brought to clinic with bright erythema in the neck and flexural
folds after recent treatment with antibiotics for otitis media. What is the treatment for this condition?
A. 1% hydrocortisone cream to affected areas for 1 to 2 days
B. Oral fluconazole 6 mg/kg on day 1, then 3 mg/kg/dose for 14 days
C. Topical keratolytics and topical antibiotics for 7 to 10 days
D. Topical nystatin cream applied several times daily

Question 19

A pre­school age child has honey­crusted lesions on erythematous, eroded
skin around the nose and mouth, with satellite lesions on the arms and legs. The child's parent has several similar lesions and reports that other children in the day care have a similar rash. How will this be treated?
A. Amoxicillin 40 to 5 mg/kg/day for 7 to 10 days
B. Amoxicillin­clavulanate 90 mg/kg/day for 10 days
C. Bacitracin cream applied to lesions for 10 to 14 days
D. Mupirocin ointment applied to lesions until clear

Question 20

A school­age child has several annular lesions on the abdomen
characterized by central clearing with scaly, red borders. What is the first step in managing this condition?
A. Fluoresce the lesions with a Wood's lamp.
B. Obtain fungal cultures of the lesions.
C. Perform KOH­treated scrapings of the lesion borders.
D. Treat empirically with antifungal cream.

Question 21

An African­American child has recurrent tinea capitis and has just developed
a new area of alopecia after successful treatment several months prior. When prescribing treatment with griseofulvin and selenium shampoo, what else will the primary care pediatric nurse practitioner do?
A. Monitor CBC, LFT, and renal function during therapy.
B. Order oral prednisone daily for 5 to 14 days.
C. Perform fungal cultures on family members and pets.
D. Prescribe oral itraconazole or terbinafine.

Question 22

A child who has psoriasis, who has been using a moderate­potency topical
steroid on thick plaques on the extremities and a high­potency topical steroid on more severe plaques on the elbows and knees, continues to have worsening of plaques. In consultation with a dermatologist, which treatment will be added?
A. Anthralin ointment in high strength applied for 10 to 30 minutes daily
B. Calcipotriol cream applied liberally each day to the entire body
C. Oral steroids and methotrexate therapy until plaques resolve
D. Wideband ultraviolet therapy for 15 minutes twice daily

Question 23

The primary care pediatric nurse practitioner notes velvety, brown thickening
of skin in the axillae, groin, and neck folds of an adolescent Hispanic female who is overweight. What is the initial step in managing this condition?
A. Consultation with a pediatric dermatologist
B. Performing metabolic laboratory tests
C. Prescribing topical retinoic acid cream
D. Referral to a pediatric endocrinologist

Question 24

A child is brought to the clinic with a generalized, annular rash characterized
by raised wheals with pale centers. On physical examination, the child's lungs are clear and there is no peripheral edema. A history reveals ingestion of strawberries earlier in the day. What is the initial treatment?
A. Aqueous epinephrine 1:1000 subcutaneously
B. Cetirizine once in clinic and then once daily for 2 weeks
C. Diphenhydramine 0.5 to 1 mg/kg/dose every 4 to 6 hours
D. Prednisone 1 to 2 mg/kg/day for 1 week with rapid taper

Question 25

A child who has been taking antibiotics is brought to the clinic with a rash.
The parent reports that the child had a fever associated with what looked like sunburn and now has "blisters" all over. A physical examination shows coalescent target lesions and widespread bullae and areas of peeled skin revealing moist, red surfaces. What will the primary care pediatric nurse practitioner do?
A. Consult with a pediatric intensivist for admission to a pediatric intensive care unit.
B. Order oral acyclovir 20 mg/kg/day in two doses for 6 to 12 months.
C. Prescribe systemic antihistamines and antimicrobial medications as prophylaxis.
D. Recommend analgesics, cool compresses, and oral antihistamines for comfort.

Question 26

A school­age child has a rash without fever or preceding symptoms. Physical
examination reveals a 3­cm ovoid, erythematous lesion on the trunk with a finely scaled elevated border, along with generalized macular, ovoid lesions appearing in a "Christmas tree" pattern on the child's back. What is the initial action?
A. Obtain a KOH preparation of a skin scraping to verify the diagnosis.
B. Prescribe topical steroid creams to shorten the course of the disease.
C. Reassure the child's parents that the rash is benign and self­limited.
D. Recommend topical antihistamines and emollients to control the spread.

Question 27

During a well child examination of an infant, the primary care pediatric nurse
practitioner notes 10 café au lait spots on the infant's trunk. What is the potential concern associated with this finding?
A. Endocrine disorders
B. Malignancy
C. Neurofibromatosis
D. Sturge­Weber syndrome

Question 28

An adolescent who had cradle cap as an infant is in the clinic with thick crusts
of yellow, greasy scales on the forehead and behind the ears. What will the primary care pediatric nurse practitioner recommend?
A. Daily application of ketoconazole 2% topical cream
B. High­potency topical corticosteroids applied daily
C. Mineral oil and shampoo on the affected areas
D. Selenium sulfide shampoo twice weekly to the face