Question 1

When recommending ongoing treatment for a patient who has recurrent intertrigo, what will the provider suggest? (Select all that apply.)

Accepted Answer

A, B

Question 2

When evaluating scalp lesions in a patient suspected of having tinea capitis, the provider uses a Wood's lamp and is unable to elicit fluorescence. What is the significance of this finding?

Accepted Answer

Not all fungi causing tinea capitis fluoresce under a Wood's lamp, so a lack of fluorescence does not rule out the condition.

Question 3

A previously healthy patient has an area of inflammation on one leg which has well-demarcated borders and the presence of lymphangitic streaking. Based on these symptoms, what is the initial treatment for this infection?

Accepted Answer

A

Question 4

A patient has a unilateral vesicular eruption which is described as burning and stabbing in intensity. To differentiate between herpes simplex and herpes zoster, which test will the provider order?

Accepted Answer

Polymerase chain reaction (PCR) analysis is the most accurate test for differentiating between herpes simplex and herpes zoster. PCR can detect and differentiate between the two viruses based on their DNA. Serum immunoglobulins and viral culture may not be able to accurately distinguish between the two viruses, and the Tzanck test can only diagnose herpes infections in general, but not distinguish between different types of herpes viruses.

Question 5

A patient with a purulent skin and soft tissue infection (SSTI). A history reveals a previous MRSA infection in a family member. The clinician performs an incision and drainage of the lesion and sends a sample to the lab for culture. What is the next step in treating this patient?

Accepted Answer

Given the patient's history of a family member with MRSA and the presentation of a purulent skin and soft tissue infection, prescribing trimethoprim-sulfamethoxazole is appropriate as it is effective against MRSA, which is a likely pathogen in this scenario.

Question 6

A patient has a pruritic eczematous dermatitis which has been present for 1 week and reports similar symptoms in other family members. What will the practitioner look for to help determine a diagnosis of scabies?

Accepted Answer

Intraepidermal burrows on the interdigital spaces of the hands are a classic finding in scabies infestations. While the other options may be present with other skin conditions, the burrows are specific to scabies.

Question 7

A patient has vesiculopustular lesions around the nose and mouth with areas of honey-colored crusts. The provider notes a few similar lesions on the patient's hands and legs. Which treatment is appropriate for this patient?

Accepted Answer

Vesiculopustular lesions with honey-colored crusts suggest impetigo, which is commonly caused by Staphylococcus aureus or Streptococcus pyogenes. Topical mupirocin, 2% ointment, is an appropriate treatment for localized impetigo. Culture and sensitivity testing may be performed if the infection does not respond to initial treatment or if it is severe or recurrent. Sulfamethoxazole-trimethoprim may be used if systemic treatment is necessary, but it is not the first-line therapy for uncomplicated impetigo. Surgical referral is not indicated for this condition.

Question 8

A patient who has had lesions for several days is diagnosed with primary herpes labialis and asks about using a topical medication. What will the provider tell this patient?

Accepted Answer

Topical medications can have an impact on pain and discomfort associated with primary herpes labialis, but they will not significantly shorten the healing time. Oral antivirals are necessary for treating this type of herpes, and preparations containing salicylic acid are not effective for treating viral infections.

Question 9

An older patient experiences a herpes zoster outbreak and asks the provider if she is contagious because she is going to be around her grandchild who is too young to be immunized for varicella. What will the provider tell her?

Accepted Answer

Contagion is possible until all of the herpes zoster lesions are crusted, so the patient should avoid contact with her grandchild until this point. This is because the virus can be transmitted through direct contact with the rash or fluid from the blisters. Antiviral medications can help shorten the duration and severity of the outbreak but are not 100% effective at preventing transmission. While varicella-zoster and herpes zoster are caused by the same virus, they are different infections with different presentations and patterns of occurrence.

Question 10

A patient who has never had an outbreak of oral lesions reports a burning sensation on the oral mucosa and then develops multiple painful round vesicles at the site. A Tzanck culture confirms HSV-1 infection. What will the provider tell the patient about this condition?

Accepted Answer

The initial episode of herpes is usually the most severe, and subsequent outbreaks tend to be milder. Antiviral medications can help manage symptoms and reduce the frequency of outbreaks, but there is no cure for herpes. Triggers such as stress, illness, and sun exposure can activate the virus and cause outbreaks. It is possible to transmit the virus even when lesions are not present, as the virus can shed asymptomatically.

Question 11

A patient who has recurrent, frequent genital herpes outbreaks asks about therapy to minimize the episodes. What will the provider recommend as first-line treatment?

Accepted Answer

The answer of A patient who has recurrent, frequent genital...

Question 12

What instructions will the primary care provider give to parents of a child who has scabies who is ordered to use 5% permethrin cream? (Select all that apply.)

Accepted Answer

The answer of What instructions will the primary care provider...

Question 13

A patient with intertrigo shows no improvement and persistent redness after treatment with drying agents and antifungal medications. The patient reports an onset of odor associated with a low-grade fever. What will the provider do next to manage this condition?

Accepted Answer

The lack of improvement and onset of odor and fever suggest that the condition may be bacterial rather than fungal, and a culture will help determine the specific cause and guide appropriate antibiotic therapy. Evaluating for HIV may be indicated in certain cases, but it is not the next step in managing intertrigo. Ordering topical nystatin cream or prescribing a cephalosporin antibiotic would not be appropriate without further information about the underlying cause.

Question 14

The provider is prescribing 5% permethrin cream for an adolescent patient who has scabies. What will the provider include in education for this patient?

Accepted Answer

Stuffed animals, pillows, and other items that cannot be washed should be sealed in plastic bags for at least 1 week to kill any mites that may be present. This is because scabies mites can survive for up to 72 hours without being on a human host. It is also important to note that all household members and close contacts should be treated at the same time, regardless of whether they are experiencing symptoms, to prevent the spread of scabies. Itching after treatment may persist for several weeks, but it does not necessarily indicate treatment failure.

Question 15

Although some fungal species causing tinea capitis are fluorescent with a Wood's lamp, Trichophyton tonsurans, the most common cause or tinea capitis, does not, so lack of fluorescence does not rule out the infection, make it less likely, or diagnose it. Which medication will the provider prescribe as first-line therapy to treat tinea capitis?

Accepted Answer

Oral griseofulvin is the first-line therapy for treating tinea capitis. It is effective against Trichophyton species, which is the most common cause of tinea capitis. Oral ketoconazole is not preferred due to its potential hepatotoxicity. Topical clotrimazole and tolnaftate are not effective for treating tinea capitis as they do not penetrate the hair follicle.

Quiz 47: Infections and Infestations