Test Bank for Primary Care: The Art and Science of Advanced
Practice Nursing and Interprofessional Approach 6th Edition M
Dunphy / 9781719644655 / Chapter 1-88 ,All Chapters with
Answers and Rationals .
George is a 15-year-old Caucasian male who presents with rough, scaly, cauliflower-like, flesh-colored
lesions on his third and fourth fingers of his left hand. He says they don't hurt much, but "they've
grown a little over the past month" and he hates the way they look and wants to get rid of them.
What is George's diagnosis and how do you treat him? What microbe causes George's condition?
What second line treatment is also an option? - ANSWER: George has veruccae vulgaris or "warts,"
caused by HPV. You treat George with cryotherapy; debriding the excess skin, freezing the wart with
LN2 for a few seconds, letting it thaw completely, then repeating for a couple cycles. You tell George
to cover the lesions with Compound W after it has heals from the cryo and occlude it with duct tape,
and return to see you for another round of cryo in two weeks. You advise him that the warts will not
disappear immediately and that he will have to make multiple visits for additional therapy. If cry fails,
you could also try injecting the lesions with candida.
Ben is an 8 year old male who presents with an itchy scalp. His mother says he takes baths every
other day so she doesn't know how he could have an infection. What do you expect to find on your
PE. How do you dx and tx Ben? - ANSWER: Ben has head lice, or pediculosis. On his PE you find nits
and lice on the hair follicles in his scalp. You tell his mother that the infestation is not associated with
poor hygiene, and you suspect that Ben got infected at school. You tell them that everyone should be
treated for lice. Use a lice comb to remove nits from wet hair, then suffocate the remaining lice by
covering the scalp in mayo under a shower cap for 2 hours before rinsing. Repeat the treatments one
week later to kill any remaining/ newly hatched lice. Wash all clothes in hot water and dry on high
heat. Put all nonwashables in plastic bags for 2 weeks to kill any lice on them. Vacuum pillows and
throw away the bag. Ben can return to school but should not touch heads or share clothes with other
kids.
Chris is a 32-year-old male who presents with malaise, wart-like lesions on his genitals, and
erythematous, 2-3mm, round lesions on his palms. He reports that he has had multiple male sexual
partners in the past 3 months. What test do you run? How do you dx and treat Chris? Pt education? -
ANSWER: Chris has secondary syphilis, caused by T. pallidum. You would test serum to confirm dx. Tx
is a single shot of penicillin IM. You advise Chris to make sure all his partners are screened treated,
and to use protection. He should not be sexually active until his symptoms have resolved entirely.
Marian is a 30-year-old female who presents with clusters of erythematous papules in the webs of her
fingers. Mary says the rash isn't painful, but she doesn't know where it came from. She regularly
frequents used-clothing and vintage stores. This is the first time she's had a rash like this? What is
Mary's dx and how do you treat her? Pt education? - ANSWER: Marian has scabies, and infestation of
the Sarcoptes scabiei mite that burrows under the skin. Mary's rash is from her first infestation, likely
caused by wearing unwashed clothes from a vintage-store a few weeks ago. You prescribe permethrin
cream and tell her to apply it from the neck down, then wash off 8-14 hours later. Repeat in 2 weeks.
Make sure everyone in her household follows this tx plan. She should wash all her clothes in hot
water and dry on high heat and bag everything that can't be washed for 3 days. She should always
wash secondhand clothes before wearing them from now on.
Cory is a 70-year-old Caucasian male who presents with a vesicular, red, rash on his right lower back
that has spread slightly down and around to his right abdomen over the past day. He says the pain
began before the rash, but the rash is incredibly painful to the touch and he can't sleep at night
because "the sheets touching the blisters is too painful." What disease do you think Cory has? What
disease do you think he had sometime in his past? How do you treat Cory? How might Cory have
prevented the infection? - ANSWER: Cory has Herpes Zoster, or "shingles," a reactivation of the
varicella virus, so you suspect that Cory had chicken pox sometime in his past. Because he's come in
,to see you so soon after the rash began, you can prescribe Acyclovir with confidence it will help heal
the rash. You suggest ibuprofen to help with his pain. You inform Cory that there are two available
vaccines, and the newer one, Shingrix, has been shows to be more effective. You tell him that anyone
over 50 who has had chicken pox should come get vaccinated to reduce the possibility of developing
shingles later.
Milly is a 22-year-old female who presents with a rash that looks like a bulls eye on her left calf. She
complains of fatigue and malaise. She was camping in Northern Minnesota a couple weeks ago and
thinks she might have an "infected bug bite" and thinks she needs abx. What does Milly have? What is
her rash called? What is it caused by? How do you tx her? - ANSWER: Milly has Lyme disease, caused
by a tick bite (Ixodes scapularis), causing a Borrelia burgdorferi infection. The rash is very
characteristic and is called erythema migrans. You tell her that she does need abx and you prescribe
doxycycline 14-21.
Laura is a 16-year-old Caucasian female who presents with a vegetation of hypopigmented macules
with fine scale on her back that vary in size. She started a summer job taking care of her city's public
garden areas and spends her whole day outside during the hottest hours. What is Laura's diagnosis?
How do you confirm it? How do you tx her? - ANSWER: Laura has pityriasis versicolor caused by
Malassezia yeast. This infection is most commonly seen in adolescents, and often occurs during the
summer months, exacerbated by sweat. You can confirm your diagnosis using a KOH test or a Wood's
lamp test (her skin will fluoresce yellow/green). You tell Laura she can buy selenium sulfide shampoo
to wash her skin and that she isn't contagious. You suggest she wears plenty of sunscreen and
breathable clothes when she works.
Dave is a 32-year-old Caucasian male who presents with pearly, pink, umbilicated papules on and
around his genitals that emit a thick material when squeezed. He says they don't hurt but he's
worried he's contracted genital warts. He's had unprotected sex with 2 partners in the past three
months. What is your diagnosis for Dave? Do you run any tests? What other population do you
commonly find this infection in? What is the microbial cause of this infection? If Dave presented with
these types of lesions on other parts of his body outside his genitals, what comorbidity would you
suspect? - ANSWER: Dave has Molluscum contagiosum, caused by a virus in the poxviridae family. You
tell him he does not have warts, but he did likely contract this highly contagious virus from one of his
sexual partners. Because Dave has had unprotected sex, you advise and he agrees to run an STD
panel, all of which come back negative. You tell him that the infection will resolve spontaneously,
normally in months, but possibly in years, and he shouldn't have sexual contact until the lesions are
gone. He should inform his partners that they should also seek treatment. You offer curettage or
cryotherapy or cantharone as an alternative, more immediate treatment. This condition is also very
commonly seen in children. When seen in adults with lesions outside of the genital region, the pt
often has HIV.
Billy is a 12-year-old Asian-American male who presents with a pruritic, scaly, erythematous patch on
his inner left elbow. His mother says his arm looked fine at first but he wouldn't stop itching it and he
developed the lesion, then the scaling described above. He recently started attending an all-day
outdoor summer camp with his friends. How do you diagnose and treat him? Pt. education? -
ANSWER: Billy has atopic dermatitis (eczema), aggravated by the heat and sweat of playing outdoors
all day at summer camp. You prescribe Billy a topical corticosteroid like hydrocortisone cream and
suggest Benadryl and cold, wet compresses to address the itching. You advise his mother to make
sure Billy stays cool and in the shade while he's at camp.
John is a 14-year-old Asian-American boy who presents with pustules, papules, inflammation, and
nodules on his cheeks and forehead. You notice some scarring around the existing lesions. John says
he "can't get rid of these zits" and that he's been "washing his face like crazy" a couple times a day.
How do you help John? What medication would you suggest if initial treatment doesn't work? -
ANSWER: John is right! He has severe cystic acne with scarring. You explain to John that he should be
more gentle when washing his face, as he may be encourage his skin to produce even more oil,
exacerbating the problem. You right him a prescription for tretinoin (a topical retinoid), clindamycin (a
topical abx) to be alternated with benzoyl peroxide topically. You also write him an rx for doxycycline
,(oral abx). You refer him to a dermatologist for a second opinion and so that s/he can write John an rx
for Isotretinoin if initial treatment is unsuccessful.
Ming is a 23-year-old Asian-American male who presents with a completely hyperkeratotic toenail w/
subungual debris. He has a hx of tinea pedis. He says the nail is painless except when he is wearing
shoes, and he doesn't like the way it looks and wants to resolve it. What lab do you order? How do
you diagnose and treat Ming? Would your treatment differ if the nail were only affected near the tip?
How so? - ANSWER: Ming has onychomycosis, a fungal toenail, likely infected a long time ago when
he had tinea pedis. You run a fungal culture to confirm your dx. Because the whole nail is infected you
rx Terbinafine oral (Lamisil) for 12 weeks. You run liver tests prior to beginning the drug, and tell Ming
you will monitor throughout. You advise him that the tx is 50-76% effective, and if he is cured, he
should put terbinafine cream on his nail prophylactically daily to prevent recurrence. If a small portion
of the nail were infected, you would tx topically w/ vicks vapor rub, urea compound (to thin the nail),
or funginail
Colin is a 58-year-old Caucasian male who was recently laid off from work and who presents with a
well-defined, salmon-colored plaque on his neck and reaching into his hairline. The plaque has silvery
scaling. Colin says he hasn't noticed any hair loss since the patch started to appear - he believes its
grown a bit over time. When asked, he says his mother experiences something similar at times, but
her "patch" shows up on her elbows. How do you diagnose and treat Colin and what is one sign that
could help to confirm your diagnosis? What complication do 5-8% of those with Colin's disease also
suffer from? - ANSWER: Colin has chronic plaque psoriasis. You could gently scrape a few of the scales
off to examine for pinpoint bleeding (Auspitz' sign) to help confirm. You advise him to remove the
scales gently after soaking in water. You advise that he can use tar shampoo topically, and because
the plaque is small you could also give him a steroid injection (triamcinolone) if he would prefer or if
the shampoo is inadequate. 5-8% of those with psoriasis also suffer psoriatic arthritis - red, swollen,
tender joints in the hands and feet and sometime smaller joints.
Eric is a 29-year-old male who presents with a headache, malaise, and a "rash" on his genitalia.
Physical exam shows a crop of painful, pruritic, white ulcers on his genitals. Social history reveals 9
sexual partners in the past year. His symptoms started 5 days ago and he says the ulcers started as
"red bumps." What test do you run, what is your diagnosis, and how do you treat Eric? Pt education? -
ANSWER: Eric has Herpes Simplex virus. You run a viral culture to confirm. You explain that his first
outbreak will be the most severe, and further outbreaks will be preceded by itching and tingling, with
fewer lesions. You explain that the infection will remain in his body indefinitely and he will always be
contagious. He needs to inform his sexual partners, and abstain from sex when lesions and prodrome
are present. Condom use could help reduce transmission. Reducing stress will help reduce outbreaks.
You tell him you can also prescribe him an oral antiviral (acyclovir) to control the symptoms and
reduce transmission if he has frequent outbreaks.
Megan is a 20-year-old female who present with an erythematous, edematous, painful, fluctuant
index finger on her left hand. She has a hx of biting her nails and her cuticles. PE shows the signs are
localized and Megan has no other symptoms. What are the possible microbial causes of this infection?
How do you diagnose and tx Megan? In chronic cases what causes the secondary infxn? - ANSWER:
Megan has paronychia, an infection of the nail bed generally caused by S. aureus or strep. You treat
her with I&D and instruct her to use topical bacitracin and hot soaks w/ antibacterial soap to hep
resolve the infection. Chronic cases of paronychia are due to secondary infection with Candida yeast.
Rachel is a 27-year-old female who presents with a crop of cauliflower-like lesions on her genitals. She
has a history of smoking and has had 4 sexual partners in the last 6 months. What test would you
perform? How do you diagnose Rachel? What possible treatments could you offer her? - ANSWER:
Rachel has Condyloma Acuminatum, or genital warts. You could use the vinegar test to check for
whitening of the lesions to confirm your dx. Treatment options included excision and cryotherapy,
which are less expensive but more painful, and imiquimod cream topically, which is painless but less
expensive. You explain that she should abstain from sex until the lesions have resolved, and she
should inform her sexual partners to seek treatment if needed. Once the lesions are gone, she is very
unlikely to transmit the infection to a new partner. However, recurrences of the warts are common.
, Carey is a 22-year old Caucasian female who presents with erythematous plaques around the hair
follicles on her anterior thighs and hips. She recently returned from a spa weekend with girlfriends
and she noticed the rash shortly after she got back. What do you suspect is Carey's diagnosis? What
microbe is causing it? What other microbe is most commonly the cause of this infection? How do you
treat Carey? - ANSWER: Carey has spa folliculitis caused by P. Aeruginosa bacteria. You tell her that
she likely got this infection from the hot tub at her hotel and that you'll follow up with the hotel
regarding the presence of the bacteria. Folliculitis is more commonly caused by S. aureus. You tell
Carey that the infection will resolve spontaneously and she can help expedite the healing by washing
the area with soap and water and using topical benzoyl peroxide.
Jeremy is a 25-year-old African American male who presents with red-purple, pustular plaques around
his hair follicles on his chin and cheeks. He says they don't itch, but they seem to crop up every time
he shaves. What is Jeremy's diagnosis and how do you treat him? What is the microbial cause most
likely to be? - ANSWER: Jeremy has folliculitis barbae, folliculitis in the beard area, and it is likely
caused by S. aureus. Shaving is complicating the infection and you advise Jeremy to use
hydrocortisone cream after shaving and making sure that he uses proper technique. You advise him
that the infection should resolve on its own, but could leave scarring. You suggest using topical
benzoyl peroxide and soap and water to help resolve the infection.
Seth is a 22-year-old Caucasian male who presents with a pruritic, erythematous, annular lesion with
a raised edge and central clearing. He says it started as a scaly bump but has since turned into this
lesion. He said he had a pretty normal week - he took went to school, work, and took his dog to the
dog park so he could groom her coat for the start of summer. What do you think Seth has? Why do
you suspect he doesn't have Lichen planus? What two tests could you perform to confirm your dx?
What are the other variations of this condition? How do you tx? - ANSWER: Seth has tinea corpora or
ringworm, caused by tinea, a dermatophyte yeast. Other forms include tinea barbae, tinea pedis,
tinea capitis, tinea unguum, tinea manuum, and tinea cruris. They may present slightly differently, but
all cause itching and all can be treated the same way. You don't think Seth has lichen planus because
his lesion is very perfectly annular and because he mentioned grooming his dog for the first time and
people often get ringworm from their pets. You can confirm your diagnosis by using the KOH test and
looking for hyphae or using a Wood's lamp, causing the fungal lesion to fluoresce green. You prescribe
Lamisil AT topically to treat the ringworm and suggest that Seth makes sure his dog receives
treatment so he isn't reinfected.
Michelle is a 29-year-old Caucasian female who presents with erythematous patches and 1mm
papules and pustules on both her cheeks and her chin. She says she's always had rosy cheeks but the
"bumps and pimples" are new. She thinks she has late-onset acne. What do you tell her and how do
you treat her? What's another classic characteristic of Michelle's disease that she doesn't present
with? - ANSWER: Michelle doesn't have acne (no comedones!), she has papulopustular rosacea. You
tell Michelle the cause of her rosacea is unknown, but may be related to active sebaceous glands and
the vasculature of her skin. The condition is chronic but you tell her she can manage it by avoiding
triggers (hot showers, direct sunlight, strenuous exercise, spicy food, hot beverages, emotional stress)
and using Metronidazole (an abx) topically. An additional sign of rosacea in Michelle would have been
the presence of telangiectasias in her lesional areas.
Mary is a 6-year-old Caucasian female who presents with a crop of erythematous, honey-crusted
erupted lesions on her upper lip. Her mother says the lesions appeared 3 days ago and she's worried
that Mary got them from school or will spread them to her friends. Mary has a tendency to pick her
nose. How do you diagnose and treat Mary? If Mary is uninsured, how does treatment change? What
is the likely microbial cause of her disease? Describe the other forms of this disease. - ANSWER: Mary
has impetigo, a highly contagious condition, likely due to her nose-picking, most commonly caused by
S. aureus. You tell her mother she should stay at home until the lesions are resolved, as it is difficult to
cover facial lesions to prevent further spread. You treat Mary with topical Bactroban, an expensive
drug, TID for 10 days. If uninsured, you would advise bacitractin as an alternative. The other forms of
impetigo are bullous (vesicles converge rapidly to form large bullae that burst and have a thin,
varnish-like crust), and ecythema (a rare, ulcerative pyoderma caused by GABH that leaves scarring)
