SARAH MICHELLE STUDY GUIDE
(COMPLETE) FOR 2024
Lichen Planus - CORRECT ANSWER -An inflammatory condition of the skin and mucous
membranes.
-commonly seen with MG, ulcerative colitis, and vitiligo (My Uncle Vern)
-can be brought on by stress and infection
Where does lichen planus occur? - CORRECT ANSWER -flexor surfaces of the limbs
-mouth, genitals, skin
An adolescent patient presents to the clinic with a large bullae in between his fingers. The
nurse practitioner diagnoses him with bullous impetigo. Which bacteria is the likely cause?
A. Pseudomonas aeruginosa
B. Staphylococcus aureus
C. Corynebacterium minutissimum
D. Escherichia coli - CORRECT ANSWER The correct answer is Staphylococcus aureus.
The most common bacterial causes of bullous impetigo include Staphylococcus aureus and
Streptococcus pyogenes. Pseudomonas aeruginosa is a common cause of otitis externa, while
Escherichia coli is the most common cause of a urinary tract infection and Corynebacterium
minutissimum causes erythrasma, a superficial skin infection.
A 23-year-old patient who is pregnant has what appears to be erythema migrans on her left
lower leg. Which of the following would be the best treatment option for this patient?
A. Doxycycline (Vibramycin)
B. Azithromycin (Z-pak)
C. Levofloxacin (Levaquin)
D. Amoxicillin (Amoxil) - CORRECT ANSWER The correct answer is amoxicillin (Amoxil).
This patient has Lyme disease, which is commonly characterized by erythema migrans, which
is a stereotypical bull's eye lesion at the site of the tick bite. First-line treatment for Lyme
disease, regardless of age, is doxycycline (Vibramycin), but the CDC still recommends using
amoxicillin (Amoxil) in pregnancy for the treatment of Lyme disease.
A parent presents with their two young children, both of whom have erythematous papules
and burrows around their ankles and some tracking lines between their toes. Which of the
following would be the best treatment for this condition?
A. Griseofulvin (Gris-PEG)
B. Permethrin (Nix)
C. Terbinafine (Lamisil)
D. Mebendazole (Emverm) - CORRECT ANSWER The correct answer is permethrin (Nix).
This is a classic description of scabies, which is treated with permethrin (Nix). Scabies almost
always presents between the fingers and toes, as well as around the lower ankles and feet.
Scabies commonly affects everyone in the household at once. Griseofulvin (Gris-PEG) and
,terbinafine (Lamisil) are both antifungal medications commonly used to treat things such as
ringworm or onychomycosis. Mebendazole (Emverm) is commonly used to treat enterobiasis,
or pinworms.
A 37-year-old patient presents to the clinic today with painful clustered vesicles on an
erythematous base near the lip. Which of the following is the most likely cause?
A. Herpes simplex virus type 1 (HSV-1)
B. Herpes simplex virus type 2 (HSV-2)
C. Human papillomavirus (HPV)
D. Coxsackievirus - CORRECT ANSWER The correct answer is herpes simplex virus type 1
(HSV-1). This description is most consistent with herpes simplex virus type 1 (HSV-1), or a
cold sore. Herpes simplex virus type 2 (HSV-2) is most commonly the cause of genital herpes,
although HSV-1 can also cause genital herpes from oral-genital exposure. Human
papillomavirus (HPV) is commonly asymptomatic, or appears as genital warts. Coxsackievirus,
also known as hand, foot, and mouth disease, usually occurs in children and appears as
numerous vesicles around the affected areas.
A 43-year-old woman presents to the office today for evaluation of what she believes to be
persistent aphthous stomatitis. She reports that it has been present for the last two months
and she has not found any relief with the usual symptomatic treatments. Upon further
assessment, the nurse practitioner finds several large oral lesions and ulcers. Which of the
following may have caused this?
A. Lichen sclerosus
B. Lichen simplex chronicus (LSC)
C. Coxsackievirus A16
D. Lichen planus - CORRECT ANSWER The correct answer is lichen planus. This patient is
suffering from chronic ulcerative stomatitis (CUS), which is commonly characterized by oral
lesions that are larger in size and number that last weeks to months and do not respond to
symptomatic treatment. While it is not fully understood, lichen planus has been linked to CUS
as a known cause. Coxsackievirus A16 causes hand, foot, and mouth disease and usually
occurs in children, and appears as multiple vesicles in the affected areas. Lichen sclerosus
causes patchy and discolored skin, while lichen simplex chronicus (LSC) results from a
chronic itch-scratch-itch cycle.
A 52-year-old man presents to the office today for evaluation of what he believes to be
persistent aphthous stomatitis. He reports that it has been present for the last two months
and he has not found any relief with the usual symptomatic treatments. Upon further
assessment, the nurse practitioner finds several large oral lesions and ulcers. What would be
the most appropriate treatment option to offer today?
A. Hydroxychloroquine (Plaquenil)
B. Nystatin (Mycostatin)
C. Diphenhydramine hydrochloride/Dexamethasone/Nystatin (Magic Mouthwash)
D. Hydrocortisone (Cortef) - CORRECT ANSWER The correct answer is hydroxychloroquine
(Plaquenil). This patient is suffering from chronic ulcerative stomatitis (CUS), which is
commonly characterized by oral lesions that are larger in size and number that last weeks to
months and do not respond to symptomatic treatment. Hydroxychloroquine (Plaquenil) is the
drug of choice for treatment. Nystatin (Mycostatin) is used to treat fungal infections in the
mouth, such as candidiasis. Magic mouthwash, while used as symptomatic treatment for
,aphthous stomatitis, is not beneficial for CUS, as CUS requires treatment of the underlying
problem. Hydrocortisone (Cortef) will not be beneficial for CUS, but can be used to treat a
wide variety of conditions such as eczema.
An 80-year-old woman, who is a new patient to the nurse practitioner, is brought to the office
today by her caregiver. The caregiver reports that the patient has a past medical history of a
traumatic brain injury (TBI) and is primarily bed bound at the living facility. While bathing the
patient this morning, the caregiver noticed an area of increased redness on the patient's heel.
Upon further assessment, the nurse practitioner finds a 3 cm X 3 cm erythematous but intact
area on the posterior heel. The area is non-blanchable. What treatment plan should the nurse
practitioner recommend today?
A. A prescription for cephalexin (Keflex) as this is likely erysipelas
B. Pressure reduction accomplished by frequent position changes and a pressure relief ankle
foot orthosis (PRAFO) boot as this is a stage II pressure injury
C. A prescription for sulfamethoxazole/trimethoprim (Bactrim) as this is suspicious for
cellulitis
D. D - CORRECT ANSWER The correct answer is daily foam dressing changes and use of a
pressure relief ankle foot orthosis (PRAFO) boot as this is a stage I pressure injury. Since this
patient is primarily bed bound, she is at an increased risk of pressure injury. Pressure injuries
commonly occur in bony places such as the heels, elbows, and sacrum. Foam dressing
changes and pressure reduction with PRAFO boots, along with frequent position changes are
all beneficial in treating and preventing pressure injuries. Since the skin is intact, this is a
stage I pressure injury. If the skin was broken open, this would then classify as a stage II
pressure injury. Antibiotics are not helpful in treating these, unless an open sore becomes
infected.
The nurse practitioner is discussing next steps in treatment of acne with a 16-year-old patient
and her mother. The patient has not been responding to her current treatment regimen of
tretinoin (Retin-A). Which next step in treatment might the nurse practitioner suggest?
A.
Topical clindamycin (Cleocin T)
B.
Oral cephalexin (Keflex)
C.
Oral doxycycline (Vibramycin)
D.
A referral to dermatology for isotretinoin (Accutane) - CORRECT ANSWER The correct
answer is oral doxycycline (Vibramycin). Acne treatment is commonly approached using a
step up method. Patients should begin treatment with topical washes such as benzoyl
peroxide. If this is unsuccessful, treatment will usually step up to topical antibiotics or
tretinoin (Retin-A). Stepping up treatment from there would include a prescription for an oral
antibiotic, such as doxycycline (Vibramycin) and lastly, a referral to dermatology for
something stronger such as isotretinoin (Accutane) if needed.
The nurse practitioner is evaluating a patient with a history of methicillin-resistant
Staphylococcus aureus(MRSA) who presents today with a superficial, erythematous rash with
well-demarcated borders on the anterior aspect of the left lower leg. Which of the following
would be the most appropriate treatment option for this patient today?
A. Sulfamethoxazole/trimethoprim (Bactrim)
B. Doxycycline (Vibramycin)
, C. Ciprofloxacin (Cipro)
D. Amoxicillin - CORRECT ANSWER The correct answer is amoxicillin. The likely diagnosis
is erysipelas, or superficial cellulitis. The key finding in this question is that the erythema has
a well-demarcated border. Erysipelas is best treated with a penicillin or cephalosporin, such
as cephalexin (Keflex). Although the patient has a history of MRSA, there is not currently a
known MRSA infection at this time, therefore sulfamethoxazole/trimethoprim (Bactrim) and
doxycycline (Vibramycin) are not indicated. Ciprofloxacin (Cipro) is not commonly a first line
treatment option for skin infections.
A 38-year-old woman presents with an acneiform facial rash covering the cheeks, nose, and
nasolabial folds. Which of the following would be an appropriate diagnosis?
A.
Lupus
B.
Rosacea
C.
Erysipelas
D.
Cystic acne - CORRECT ANSWER The correct answer is rosacea. The facial rash for
rosacea and lupus present similarly; however, the malar rash associated with lupus spares the
nasolabial folds while rosacea does not spare this area. Additionally, rosacea can be identified
by its classic acneiform presentation. Erysipelas can occur on the face, but is most commonly
described as having sharply demarcated borders. Cystic acne does not typically present as
one large facial rash.
Lichen planus is known to be a comorbidity that occurs with which of the following
conditions?
A.
Myasthenia gravis
B.
Amyotrophic lateral sclerosis (ALS)
C.
Irritable bowel syndrome (IBS)
D.
Tinea versicolor - CORRECT ANSWER The correct answer is myasthenia gravis. Lichen
planus (LP) is an inflammatory skin condition often seen on the flexor surfaces of the limbs,
mouth, or even genitalia. As well, LP is commonly associated with other autoimmune or
inflammatory conditions, such as myasthenia gravis, ulcerative colitis, vitiligo, and alopecia
areata. Amyotrophic lateral sclerosis is a rare genetic condition affecting voluntary muscle
control, and is not commonly associated with LP. While ulcerative colitis, a form of
inflammatory bowel disease (IBD), is linked to LP, irritable bowel syndrome (IBS) is not. Tinea
versicolor is a fungal infection presenting as hypopigmented macules, and is not typically
linked to LP.
A 64-year-old patient presents with vulvar itching and painful, bleeding skin with intercourse.
On examination, the nurse practitioner notes patchy areas that appear thinned and white on
the patient's bilateral vulvae. Which of the following is included in the most appropriate
treatment plan for this patient?
A.
Hydrocortisone 2.5% topical
B.
