FNP Adult Health Final Study Guide 2021/2022 with complete solution

What is the recommended antibiotic therapy for previously healthy patients with no risk factors for drug-resistant S. pneumonia infection that have community acquired pneumonia (CAP)? Correct answer- Macrolide (Azithromycin, clarithomycin, or erythromycin) OR Doxycycline What is the recommended antibiotic therapy for patients with chronic comorbidites, such as chronic disease of heart, liver, lungs, or kidneys; diabetes, alcoholism, malignancies, immunospression, antimicrobial use within the last 3 months that have community acquired pneumonia? Correct answer- Respiratory fluoroquinolone (moxifloxacin, gemifloxacin or levofloxacin {750 mg}) OR beta lactam plus macrolide (preferably high- dose amoxicillin (1 to 3 times daily) or amoxicillin-clavulanate (2 tabs twice daily). Alternatives include ceftriaxone, cefpodoxime, and cefuroxime (500 mg, twice daily); with doxycycline as an alternative to the macrolide) What is the recommended antibiotic therapy for suspected pseudomonas aeruginosa infection? Correct answer- Antipneumococcal antipseudomonoal beta lactam (pipercillin-tazobactam, cefepime, meropenem, or imipenem-cilastatin) plus either ciprofloxacin or levofloxacin (750 mg dose) OR Antipneumococal antipseudomonoal beta-lactam plus an amino glycoside and azithromycin OR Antipneumonoccal antipseudomonal beta-lactam plus an amino glycoside and an antipneumococcal fluoroquinolone. Aztreonam plus an amino glycoside and an antipneumococcal fluoroquinolone for patients allergic to penicillin What is the recommended antibiotic therapy for suspected community acquired MRSA infection with community acquired pneumonia? Correct answer- Addition of vancomycin or linezolid When should you obtain a chest X ray on COPD patient? Correct answer- During a COPD exacerbation when attempting to rule out a concomitant pneumonia. What Pathogen is most commonly seen in COPD caused by bacteria? Correct answer- Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae What is the preferred meds for Persistent asthma treatment? Correct answer- Low dose ICS; Low dose ICS plus LABA, or Medium dose ICS; Medium dose ICS plus LABA. What are examples of inhaled corticosteroids? Correct answer- Fluticasone (Flovent HFA) Budesonide (Pulmicort) Mometasone (Asmanex Twisthaler) Beclomethasone (Qvar) Ciclesonide (Alvesco) Flunisolide (Aerospan HFA) What are examples of long acting beta agonists? Correct answer- Advair, Dulera, and Symbicort (a combination of a long-acting beta-agonist bronchodilator and an inhaled steroid) Serevent (salmeterol) Foradil (formoterol) Perforomist (formoterol solution for nebulizers) What are x-ray findings of acute asthma attack? Correct answer- Hyperinflation, focal atelectasis, and bronchial thickening are clinical findings on chest X-ray of exacerbated asthma. How is asthma managed without medication? Correct answer- Peak flow monitoring Avoidance of asthma triggers Extensive, ongoing asthma education for the patient and family regarding disease, treatment, avoidance of triggers, asthma managed plan, and emergency actions. Use of an asthma action plan can reduce the number of ED visits as well as hospitalizations. What screening is appropriate for diabetic neuropathy? Correct answer- Urinalysis for urine protein and a Blod test to check for GFR (kidney function). The most appropriate screen for diabetic nephropathy is? Correct answer- Microalbuminuria a 26 y/o pt with long hx of chronic sinusitis presents today with temperature of 103.2F, headache, and stiff neck. Which finding below should make the NP suspect meningitis? Correct answer- A positive Kernig's and Brudzinski's sign What two tests demonstrate nuchal ridgidity? Correct answer- Kernig's and Brudzinski's sign Kernig's sign refers to the what? Correct answer- inability to allow full extension of the knee when the hip is flexed 90 degrees Brudzinski's sign refers to the Correct answer- spontaneous flexion of the hips during attempted passive flexion of the neck A pt is examined and found to have a positive Kernig's and Brudzinski's signs. What is the most likely dx? Correct answer- meningitis What symptoms point to acute meningitis rather than encephalitis? Correct answer- Photophobia and severe headache may point to Chronic subacute meningitis are usually caused by what? Correct answer- m. tuberculosis atypical mycobacteria fungi spirochetes SYMPTOMS develop over months; less acutely ill Which type of meningitis has a slower development of symptoms after exposure, usually caused bym. tuberculosis, atypical mycobacteria, fungi, or spirochetes? Correct answer- Chronic meningitis What is the leading cause of death after stroke? Correct answer- Pneumonia What class of medications can be used to tx benign prostatic hyperplasia and provide immediate relief? Correct answer- Alpha-1-blockers An elderly male has benign prostatic hyperplasia (BPH). what drug should be avoided in him? Correct answer- Hydrochlorothiazide (HCTZ) A 73 y/o pt is thought to have benign prostatic hyperplasia. what would be part of the initial workup? Correct answer- DRE (digital rectal exam), urinalysis, PSA A 65 y/o pt has a firm, non-tender, symmetrical enlarged prostate gland on exam. his PSA is 3.9ng/mL. this probably indicates: Correct answer- Benign prostatic hypertrophy A 30 y/o male who is sexually active presents with pain during bowel movements. he is negative when checked for hemorrhoids, but has a tender prostate gland. what should be suspected? Correct answer- Acute bacterial prostatitis What is the recommendation from American Cancer Society for assessment of the prostate gland in a man who is 45 y/o and of average risk for development of prostate cancer? He should have: Correct answer- Screening starting at 50 yrs of age A 40 y/o male has been dx with acute bacterial prostatitis. his prostate specific antigen is elevated on dx. hwo soon should his PSA be rechecked? Correct answer- 4 weeks A common side effect of thiazide diuretics is: Correct answer- Erectile dysfunction A 50 y/o comes to the NP clinic for evaluation. he c/o fever 101F, chills, pelvic pain, and dysuria. he should be dx with: Correct answer- Acute bacterial prostatitis A 25 y/o male is training for a marathon. he reports an acute onset of scrotal pain after a 10 mile run. he has nausea and is found to have an asymmetric, high-riding testis on the right side. what should be suspected. Correct answer- Testicular torsion Which of the following meds should be avoided in a 65 y/o male with benign prostatic hyoperplasia? Correct answer- Pseudoephedrine What is the recommendation of American Cancer Society for initial screening of an African-American male male for prostate cancer? He should have: Correct answer- Discussions starting at age 40-45 years A 22 y/o male who is otherwise healthy c/o scrotal pain. his pain has developed over the past 4 days. he is dx with epididymitis. what is the most likely reason? Correct answer- Infection with chlamydia Noninfectious epididymitis is common in: Correct answer- Truck Drivers A common presentation of an inguinal hernia is: Correct answer- Groin or abdominal pain with a scrotal mass Hesselbach's triangle forms the landmark for: Correct answer- inguinal hernia The most common place for indirect inguinal hernias to develop is: Correct answer- The internal inguinal ring A 25 y/o male pt with subacute bacterial epididymitis should be txed initially with: Correct answer- Doxycycline A pt with testicular torsion will have a: Correct answer- Negative cremasteric reflex on the affected side A 50 y/o male pt reports that he has a sensation of scrotal heaviness. he reports that the sensation is worse at the end of the day. he denies pain. what is the likely etiology of these sxs? Correct answer- Inguinal Hernia An inguinal hernia is palpated on a male pt by an examiner. which word below best describes what the hernia feels like when touched by the examiner? Correct answer- Silky An example of primary prevention is: Correct answer- using a condom to prevent infection with an STD A pt was exposed to HIV through sexual intercourse. he should be followed with screening tests to identify seroconversion for: Correct answer- One year An elderly male pt is taking finasteride, a 5-alpha-reductase inhibitor. what affect might this have on his PSA level? Correct answer- It will decrease The risk of HIV transmission is increased: Correct answer- When other STDs are present A 26 y/o male pt has been dx with gonorrhea. how should he be managed? Correct answer- Ceftriaxone and azithromycin Which of the following results in a clinically insignificant increase in the prostate specific antigen (PSA)? Correct answer- Digital Rectal Exam Testicular torsion can produce: Correct answer- Scrotal edema A sexually active male pt presents with epididymitis. what finding is likely? Correct answer- Recent hx of heavy physical exercise An adolescent has suspected varicocele. he has dull scrotal pain that is relieved by: Correct answer- Recumbency What is the effect of digital rectal examination on a males's PSA level if it is measured on the same day as DRE? Correct answer- The change is insignificant A male with gonorrhea might c/o: Correct answer- Dysuria A dx of osteoporosis can be made when: Correct answer- Bone mineral density is 2/5 standard deviations below the mean A localized tumor in the prostate gland associated with early stage prostate cancer is likely to produce: Correct answer- An absence of signs and symptoms Hematuria is not a common clinical manifestation in: Correct answer- Early prostate cancer Digital rectal exam may be performed to assess the prostate gland. which term does NOT describe a prostate gland that may have a tumor? Correct answer- Boggy A patient presents with sudden onset of "crushing chest pressure," diaphoresis, pallor, and extreme weakness. Electrocardiogram and serum enzyme changes support a diagnosis of acute myocardial infarction (AMI). The nurse practitioner would expect: Correct answer- ST changes, prominent Q wave, elevated CPK-MB and LDH, and cardiac troponin I. A patient with a past history of documented coronary arterial blockage less than 70% complains of chest pain several times per day (while at rest) which is relieved with nitroglycerin. What is the most appropriate initial action for the nurse practitioner? Correct answer- Refer to a cardiologist as soon as possible. A patient presents to the rural health clinic with severe chest pain. The nurse practitioner places the patient on a cardiac monitor and observes a normal sinus rhythm with elevated ST segments. His blood pressure is 130 75 mmHg. What is the likely cause of this patient's chest pain? Correct answer- Cardiac Ischemia Harry comes to your office with waxing and waning ischemic symptoms over a period of days and weeks, an increase in angina while at rest, and transient ST changes on his electrocardiogram. This presentation leads you to believe that he is experiencing??? Correct answer- Unstable Angina Jamie, age 49, who has a history of hyperlipidemia, has symptoms that lead you to suspect unstable angina. Your next action would be to ??? Correct answer- Hospitalize the client in a monitored setting with pharmacological control of ischemia, arrhythmias, and thrombosis as appropriate. Pt w a positive hx of a tick bite about 2 wks ago and erythema migrans has a positive ELISA for borrelia. The Western blot is positive. What medication is appropriate and what is the diagnosis? Correct answer- Receive doxycycline for Lyme disease LYME DISEASE History? (Hollier 1/17) Screening test? (Hollier 1/17) Confirmatory test? (Hollier 1/17) Treatment? (Hollier 1/17) Correct answer- HISTORY of positive tick bite SCREENING TEST: ELISA CONFIRMATORY TEST: Western Blot TREATMENT: Doxycycline = Amoxicillin = or cefurixime x21 days SCABIES Rx ? Correct answer- Rx: Permethrin What is Bactrim no longer for uti? Correct answer- More resistant to E. coli Best choice med for uncomplicated uti? Correct answer- Macrodantin What Type of hearing loss: presbycusis, Meniere disease, acoustic neuroma? Correct answer- Sensorineural hearing loss The typical perpetrator in a domestic violence situation is one who: Correct answer- Has a hx of being a victim of abuse a pt with cough and fever is found to have infiltrates on chest x-ray. What is his likely dx? Correct answer- Pneumonia how should a 20 y/o college age student who presents with cough, night sweats, and weight loss be screened for TB? Correct answer- TB skin test what laboratory test could help differentiate acute bronchitis from pneumonia in a patient with a productive cough? Correct answer- Chest x-ray you examine a 28 y/o female who has emigrated from a country where TB is endemic. She has documentation of receiving Bacille CalmetteGuerin (BCG) vaccine as a child. with this information, you consider that: Correct answer- a TST finding of 10mm or more induration shuld be considered a positive result a 33 y/o female works in a small office with a man recently dx with active pulmonary TB. Which of the following would be the best plan of care for this woman? Correct answer- she should receive TB chemoprophylaxis if her TST result is 5mm or more in induration What is the most sensitive marker of myocardial infarction? Correct answer- Troponin What is a characteristic finding on EKG for myocardial ischemia? Correct answer- Flipped T waves The cardiac finding most commonly associated with unstable angina is Correct answer- S4 According to recommendations of the American Heart Association (AHA), which of the following antibiotics should be used for endocarditis prophylaxis in patients who are allergic to penicillin? Correct answer- Azithromycin What is the treatment for prophylactic dental procedure for prevention of endocarditis? Correct answer- Amoxicillin 2g oral for adults or 50mg/kg What kind of heart disease can result in syncope? Correct answer- hypertrophic cardiomyopathy What heart sound is characteristic of mitral valve prolapse? Correct answer- Mid- systolic click What is the purpose primary objective of screening? Correct answer- to detect a disease in its early stages, to treat it, and deter its progression. What is the CAGE questionnaire? Correct answer- -screening tool for the identification of patients at risk for substance use disorders -yes to two or more-- possible substance abuse What does CAGE stand for? Correct answer- C- cut down (Do you fee the need to cut down on drinking) A- annoyed (have people annoyed you by criticizing your drinking G- guilty (have you ever felt bad or guilty about drinking) E- eye opener (Do you need an eye opener in the AM?) What are some health promotion tips for smokers? Correct answer- Get pneumonia vaccine 43 year old woman has a 12 hour history of sudden onset of right upper quadrant abdominal pain with radiation to the shoulder, fever, and chills. She has had similar, milder episodes in the past. Examination reveals marked tenderness to right upper quadrant abdominal palpation. Her most likely diagnosis is: Correct answer- acute cholecystitis. What tool is used to examine diabetic feet? Correct answer- 10g monofilament What are risk factors for breast cancer? Correct answer- white greater than 50 early menarche (under 12) late menopause (after 50) nulliparity or late first pregnancy Principles of treating patients with RA include: Correct answer- early use of disease- modifying antirheumatic drugs (DMARDs) to slow or halt joint damage. First line therapy for acne vulgaris with closed comedones? Correct answer- benzoyl peroxide What is the most common symptoms of GERD? Correct answer- Dyspepsia (heartburn) What is first-line medical treatment for GERD? Correct answer- Proton Pump inhibitors What are the signs/symptoms of GERD? Correct answer- 1. Retrosternal burning 2. Bitter taste in mouth 3. Belching, hiccups, dysphagia 4. excessive salivation 5. Frequently occurs at night &/or in recumbent position 6. May be relieved by sitting up, antacids, water or food When prescribing antihypertensive therapy for a man with BPH and hypertension, the NP considers that: Correct answer- an alpha, antagonist should not be used as a solo or first-line therapeutic agent. Which of the following is recommended by the Centers for Disease Control and Prevention as single-dose therapy for uncomplicated urethritis caused by N. gonorrhoeae when an oral product is the most appropriate option? Correct answer- cefixime A 48-year-old man asks the nurse practitioner for a prescription for sildenafil (Viagra). He is currently taking transdermal nitroglycerin, hydrochlorothiazide, and potassium supplements for cardiac problems, as well as a multivitamin with iron. Which medication would be a cause for concern if taken with the sildenafil? Correct answer- Transdermal nitroglycerin Rationale: Taking drugs like sildenafil with nitrates may lead to dangerous hypotensive episodes. Patients prescribed sildenafil (Viagra) should be instructed regarding the potential fatal drug interaction with which medication(s)? Correct answer- nitroglycerin When taken in conjunction with nitroglycerin, sildenafil can cause severe hypotension unresponsive to treatment. The mechanism of action of metformin (Glucophage) is as: Correct answer- a drug that increases insulin action in the peripheral tissues and reduces hepatic glucose production. What is Lantus? Correct answer- basal/long acting insulin A patient is diagnosed with type 1 diabetes. What clinical characteristics does the nurse expect to see in this patient? (Select all that apply.) Correct answer- Ketosis-prone Younger than 30 years of age Little endogenous insulin What are the different classifications of obesity? Correct answer- Obesity Class I: BMI 30-34.9 Obesity Class II: BMI 35-39.0 Severe Obesity Class III: 40.0 Acute otitis media findings include? Correct answer- Reddened, inflamed tympanic membrane Tympanic membrane may appear to be dull and bulging What is treatment for strep throat? Correct answer- penicillin VK PO for 10 days. If pt is PCN allergy, macrolides (-mycin drugs) can be used instead. What is the most common cause of dementia? Correct answer- alzheimer-type which of the following therapeutic modalities is useful for severe uncontrollable atopic dermatitis? Correct answer- Ultraviolet light ATOPIC DERMATITIS Def? (Hollier 11/19) Tx goal? (Hollier 9/19) Tx: Least appropriate vehicle? (Hollier 9/19) Tx: Most appropriate vehicle? (Hollier 9/19) Rx? (Hollier 11/19) Correct answer- Def: chronic inflammatory skin disorder involving a genetic defect in proteins supporting the epidermal layer. Tx goal: needs continuous skin hydration Tx: Least appropriate: lotions. Lotions worsen xerosis due to evaporation of water on skin. Lotions have high water content and low oil content. creams have lower water content. Tx: Most appropriate: Ointments have no water and are excellent agents to use on dry skin as well as to prevent dry skin. Rx: low-potency steroid such as low-potency topical hydrocortisone cream TINEA VERSICOLOR Timing? (Hollier 8/19) Ss? (Hollier 8/19) Tx? (Hollier 8/19) Correct answer- TIMING: Usually occurs in spring & summer when pt has darkened after sun exposure. Ss: The areas affected do not tan and so become very noticeable. Chest & back r common areas to observe tinea versicolor. 100 or more. TREATMENT: Topical selenium sulfide or oral antifungal agent. Which finding below is typical in a pt with Bell['s palsy? Correct answer- Unilateral numbness of the cheek Bell's palsy is a weakness or temporary paralysis of which cranial nerve? Correct answer- Facial nerve (VII) a 70 y/o pt is concerned and comes into the clinic with complaints of headache, slurred speech, and onset of sxs within the last 60 mins. When the pt is examined, her complaints are confirmed by the examiner. What is the likely etiology of this event? Correct answer- Stroke the classic description of a TIA is "a sudden onset of focal neurological sxs that last less than: Correct answer- 24 hours a pt reports a hx of transient ischemic attack 6 months ago. His daily medications are lisinopril, pravastatin, and metformin. After advising him to quit smoking, what intervention is most important in helping to prevent stroke in him? Correct answer- Taking a Baby aspirin daily A pt dx with cluster headaches should eliminate what? Correct answer- should eliminate triggers like nicotine and alcohol cluster headaches are not as common as migraine or tension headaches, true or false? Correct answer- True cluster headaches occur in cyclical patterns, true or false? Correct answer- True which of the following would NOT be part of the differential dx for an 84 y/o pt with dementia sxs? Correct answer- Normal aging process a family member of a newly dx'd Alzheimer's disease patient asks how long the pt will have to take donepezil, an acetylcholinesterase inhibitor, before learning whether it is beneficial or not. You reply: Correct answer- 6-12 months an elderly pt with organic brain syndrome is at increased risk for elder abuse because she: Correct answer- declining cognitive function an elderly pt is at increased risk of stroke and takes an aspirin daily. Aspiring use in this pt is an example of: Correct answer- Primary prevention which of the following criteria is attributed to migraine headache without aura? Correct answer- Pain lasts 4-72 hours which headache listed below is more likely to be triggered by food? Correct answer- migraine most pts with migraine headache sxs do not need imaging for dx. Which finding in a pt with migraine headache sxs would compel the examiner to order an imaging study? Correct answer- Rapidly increasing frequency of headache a pt with acute anxiety will experience the fastest relief of sxs when he is tx with: Correct answer- Benzodiazepine which sx below is true of cluster headaches but not migraine headaches? Correct answer- the length of the headache duration is about 30-90 mins which criterion below is a criterion for Alzheimer's Disease? Correct answer- Impairment of executive function a pt cannot stick his tongue out of his mouth and move his tongue from side to side. What CN is responsible for this movement? Correct answer- XII which class of medications is NOT used for migraine prophylaxis? Correct answer- Triptans the class of medications known as triptans, which includes sumatriptan is used for Correct answer- abortive agents for migraine headaches which recommendation below reflects CDCs recommendation for administration of the zoster vaccine? Correct answer- it should be given to immunocompetent adults age 60 and older all of the following characteristics may be found in an odler adult with dementia. Which one is common in a pt with Alzheimer's disease, but uncommon in a pt with another type of dementia? Correct answer- Indifference Acute coronary syndrome ECG change is what? Correct answer- ST segment elevation a male pt has a family hx of bipolar disorder in two first degree relatives. Bipolar disorder: Correct answer- Often affects multiple family members a 38 y/o pt dx with bipolar disease has taken lithium for many months. his mood has stabilized he was told to report frequent urination while taking lithium. what might be the underlying cause of his frequent urination? Correct answer- Diabetes insipidus what is the usual age of onset of sxs for pts with bipolar disorder? Correct answer- Between 15 and 30 years a 34 y/o bipolar pt has been placed on a fluoxetine and valproate for manic depressive sxs. he has had great improvement in his sxs and has returned to work. the psychiatrist has released him to your care. what must be monitored in this pt? Correct answer- Valproate levels Platelet count Liver function studies carbamazepine is used in pts with bipolar disorder for mood stabilization. prescribers who have pts taking carbamazepine should be alert to: Correct answer- Drug-Drug interactions a newly dx pregnant teenager has suspected depression. before a dx is made, she should have a CBC, TSH, renal and liver function tests and: Correct answer- Urine toxicology which statement about bulimia nervosa is accurate? Correct answer- High dose SSRIs are used to treat this. a pt with anorexia nervosa had sxs that began about 6 months ago. she presents today and is dxed with anorexia nervosa. she has a lab evaluation. what might be expected? Correct answer- Normal lab values a pt presents to your clinic numerous times with vague complaints. she seems to respond poorly to medical tx that is given to her. what should be considered when obtaining a hx from her? Correct answer- Physical abuse or depression what sx listed below is typical of depression? Correct answer- Early morning wakening a pt reports that she takes kava kava regularly for anxiety with good results. what should the NP evaluate? Correct answer- Liver function studies a good first choice of antidepressants in an older adult is: Correct answer- An SSRI the preferred medication class to tx pts with an initial episode of depression is: Correct answer- SSRIs serotonin syndrome may result from taking an SSRI and: Correct answer- dextromethorphan a depressed pt is started on an SSRI. when should another antidepressant be tried if there is no response? Correct answer- 8-12 weeks a pt may derive benefit from a tricyclic antidepressant if he experiences depression and: Correct answer- Chronic pain a pt with bipolar disease has purchased a $10,000 baby grand piano. he does not play the piano. this behavior is typical during: Correct answer- mania a pt presents to the NP's clinic and states that she feels sad and thinks she is depressed. what info is important to elicit in order to dx her with depression? Correct answer- How long have you felt like this? depression is dx on clinical presentation. what time frame is important for distinguishing between depressed mood and clinical depression? Correct answer- 2 weeks serotonin is thought to play a role in the etiology of: Correct answer- Depression a pt with bulimia nervosa probably has concurrent: Correct answer- Anxiety impaired blood flow to the extremities is caused by which of the following common disorders? Correct answer- Peripheral vascular disease When the PVD disease is arterial, it is usually the result of Correct answer- accumulated fatty streaks and fibrous plaques (high levels of LDH) when the PVD disease is venous, it is usually related to Correct answer- venous incompetence secondary to valve obstruction, leading to chronic venous insufficiency and varicose veins JNC-8 recommends what four classification of medication for the initial tx of hypertension? Correct answer- thiazide type diuretics ACEi ARBs CCBs the most expedient way to slow the progress of peripheral arterial occlusive disease is: Correct answer- Stop tobacco use What is most often caused by peripheral vascular disorders? Correct answer- impaired blood flow to the extremities results in leg aches and is J., an obese 42 y/o, cut his rt leg 3 days ago while climbing a ladder. Today his rt lower leg is warm, reddened, and painful without a sharply demarcated border. What do you suspect? Correct answer- Cellulitis balanitis is associated with: Correct answer- Candida infection of the penis which tx would you order for anogenital pruritus? Correct answer- High fiber diet for constipation tinea unguium is also known as: Correct answer- onchomycosis which of the following types of cellulitis is referred to as "flesh eating bacteria"? Correct answer- necrotizing fasciitis S., age 29 has a carbuncle on his neck. After an I&D, an antibiotic is ordered. What is the most common organism involved? Correct answer- staphylococcus aureus the "herald patch" is present in almost all cases of: Correct answer- pityriasis rosea T., a 24 y/o African American mother of 4 young children, presents in the clinic today with varicella. She states that 3 of her children also have it and that her eruption started than 24 hrs ago. Which action may shorten the course of the disease in T.? Correct answer- Acyclovir You are teaching M., age 18, about his tinea pedis. You know he doesn't understand your directions when he tells you which of the following? Correct answer- I should wear rubber shoes in the shower to prevent transmission to others which skin lesion is morphologically classified as pustular? Correct answer- Acne rose J., age 59, presents with recurrent, sharply circumscribed red papules and plaques with a powdery white scale on the extensor aspect of his elbows and knees. What do you suspect? Correct answer- psoriasis M., age 32 comes into the clinic. She has painful joints and a distinctive rash in a butterfly distribution on her face. The rash has red papules and plaques with a fine scale. What do you suspect? Correct answer- systemic lupus erythematosus permethrim (elimite) applied over the body overnight from the neck down is the preferred tx for: Correct answer- Scabies J., age 32 is pregnant and has genital warts (condylomata) and would like to have them txed. What should you order? Correct answer- trichloracetic acid