Chapter 35: Examination of the Skin and Approach to Diagnosis of Skin Disorders

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A primary care provider is performing a Tzanck test to evaluate possible herpes simplex lesions. To attain accurate results, the provider will perform what intervention?

a. Blanch the lesions while examining them with a magnifying glass.

b. Gently scrape the lesions with a scalpel onto a slide.

c. Perform a gram stain of exudate from the lesions.

d. Remove the top of the vesicles and obtain fluid from the lesions.

ANS: D

The Tzanck test requires removing the tops from vesicular lesions in order to obtain fresh fluid from the base of the lesions. Blanching of blue to red lesions under a microscope helps to evaluate whether blood is in the capillaries of the lesions. Scraping lesions onto a slide is done to evaluate the presence of hyphae and spores common with candidiasis or fungal infections. Gram staining is performed to distinguish gram-positive from gram-negative organisms in suspected bacterial infections.

Multiple Response

1. When examining a patient’s skin, a practitioner uses dermoscopy for what purpose? (Select all that apply.)

a. Accentuating changes in color of pathologic lesions by fluorescence

NURSINGTB.COM b. Assessing changes in pigmentation throughout various lesions c. Determining whether lesion borders are regular or irregular d. Differentiating fluid masses from cystic masses in the epidermis e. Visualizing skin fissures, hair follicles, and pores in lesions

ANS: B, C, E

Dermoscopy is used to visualize the epidermis and superficial dermis and can reveal changes in pigmentation throughout lesions, whether borders are regular or irregular, and the various fissures, follicles, and pores present in lesions. The Wood’s light, or black light, is used to fluoresce lesions to accentuate changes in color. A direct light source is useful for differentiating fluid masses from cystic masses.