Question 1

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?

Accepted Answer

This child's presentation is consistent with Stevens-Johnson syndrome or toxic epidermal necrolysis, which are severe and potentially life-threatening skin reactions often triggered by medications such as antibiotics. Admission to a pediatric intensive care unit with the consultation of a pediatric intensivist is necessary for supportive care and management. Treatment may include discontinuation of the offending agent, fluid and electrolyte management, wound care, and analgesics. Acyclovir, antihistamines, and prophylactic antimicrobial medications are not indicated for the management of Stevens-Johnson syndrome or toxic epidermal necrolysis.

Question 2

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?

Accepted Answer

The condition described is acanthosis nigricans, which is often associated with insulin resistance and can be an early sign of type 2 diabetes mellitus. The initial step in managing this condition involves performing metabolic laboratory tests to assess for underlying insulin resistance or diabetes.

Question 3

A child who has psoriasis, who has been using a moderate-potency topical steroid on thick plaques on the extremities and a high-potency 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?

Accepted Answer

Anthralin ointment in high strength applied for 10 to 30 minutes daily is a treatment option for psoriasis that can be added when topical steroids are not sufficiently effective. It works by slowing down the growth of skin cells.

Question 4

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?

Accepted Answer

The child's symptoms are indicative of urticaria, likely due to an allergic reaction to strawberries. Diphenhydramine, an antihistamine, is appropriate for initial treatment to alleviate the symptoms.

Question 5

A 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?

Accepted Answer

Fungal cultures on family members and pets are performed to identify potential carriers and prevent reinfection, as tinea capitis can be contagious and spread within households.

Question 6

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?

Accepted Answer

Café au lait spots are a hallmark finding in neurofibromatosis, a genetic disorder that can lead to the development of tumors on or under the skin, as well as other complications. While café au lait spots can also be a benign finding, the presence of multiple spots increases the likelihood of an underlying genetic disorder like neurofibromatosis. Endocrine disorders, malignancy, and Sturge-Weber syndrome are not typically associated with the presence of café au lait spots.

Question 7

A school-age child has a rash without fever or preceding symptoms. Physical examination reveals a 3-cm 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?

Accepted Answer

The description of the rash matches pityriasis rosea, which is a benign and self-limited condition. The initial action is to reassure the child's parents about the nature of the rash.

Question 8

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?

Accepted Answer

Ketoconazole 2% topical cream is an antifungal treatment effective for seborrheic dermatitis, which is likely the condition described.

Quiz 34: Dermatologic Disorders

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 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 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?

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?

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?