Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 48: Alterations of the Integument in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Which immunoglobulin (Ig) is elevated in atopic dermatitis?a. IgAb. IgMc. IgEd. IgGANS: CIn the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL-13) and chemokine ligand 1 (CCL1) and 18 (CCL18) with increases in IgE, eosinophils, and macrophages. IgA, IgM, and IgG are not involved in atopic dermatitis.PTS: 1 DIF: Cognitive Level: Remembering 2. Which leukocytes are elevated in atopic dermatitis?a. Eosinophilsb. Neutrophilsc. Basophilsd. MonocytesANS: AIn the acute phase of atopic dermatitis, inflammation is associated with the activation of T helper 1 (Th-1) cells with an overexpression of cytokines (interleukin [IL]-4, IL-5, and IL13) and chemokine ligand 1 (CCL1) and 18 (CCL 18) with increases in IgE, eosinophils, and macrophages. Neutrophil refers to white blood cells and eosinophils are one component. Basophils and monocytes are not elevated in atopic dermatitis.PTS: 1 DIF: Cognitive Level: Remembering 3. A child has atopic dermatitis. What assessment finding does the healthcare professional associate with this condition?a. Papular rashb. High feverc. Vesicles that burst and form crustsd. ItchingANS: DItching is considered a hallmark of atopic dermatitis, and rubbing and scratching to relieve the itch are responsible for many of the clinical changes of atopic dermatitis. Atopic dermatitis is not characterized by high fever, vesicles, or papular rash.PTS: 1 DIF: Cognitive Level: Remembering 4. A baby has diaper dermatitis. What secondary infection does the healthcare professional assess for?a. Escherichia colib. Candida albicansc. Proteus spp.d. Staphylococcus aureusANS: BFrequently the infant with diaper dermatitis has a secondary infection with C. albicans.PTS: 1 DIF: Cognitive Level: Remembering 5. The disruption in cellular adhesion observed in bullous impetigo is caused by an exfoliative toxin related to which organism?a. Staphylococcus aureusb. Streptococcus pyogenesc. Escherichia colid. Candida albicansANS: ABullous impetigo is a rare variant of impetigo caused by S. aureus. The staphylococci produce a bacterial toxin called exfoliative toxin (ET), which causes a disruption in desmosomal adhesion molecules with blister formation characteristic of bullous impetigo. The other organisms are not involved in this disorder.PTS: 1 DIF: Cognitive Level: Remembering 6. A parent of a child in a crowded daycare is worried about the staff passing on a bacterial infection to the child. Which infection would be most likely?a. Atopic dermatitisb. Staphylococcal scalded-skin syndromec. Impetigod. Tinea capitisANS: CImpetigo is a common bacterial skin infection in infants and children and is particularly infectious among people living in crowded conditions with poor sanitary facilities or in settings such as daycare facilities. The other options are not as infectious as impetigo.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. A parent reports a child has skin lesions that rupture, creating a thin, flat, honey-colored crust. What treatment does the healthcare professional educate the parent about?a. Supportive care onlyb. Oral griseofulvinc. Topical corticosteroidsd. Topical mupirocinANS: DThis child has bullous impetigo, which is treated with topical mupirocin. Supportive care is used in rubella, which has a faint-pink to red, coalescing maculopapular rash develops on the face, with spread to the trunk and extremities, Oral griseofulvin would be appropriate for tinea capitis, which is found on the scalp. Corticosteroids would be useful for itchy rashes such as atopic dermatitis.PTS: 1 DIF: Cognitive Level: Applying 8. A child has been diagnosed with tinea corporis. Which lesion would the healthcare professional assess for in this condition?a. Pink-to-red coalescing maculopapular rash on the face or trunkb. Vesicles that rupture, creating a thin, flat, honey-colored crustc. Circular (round or oval) lesions with erythema and scaling patchesd. Red papules, vesicles, and pustules in clustersANS: CLesions caused by tinea corporis are often erythematous, round, or oval-scaling patches that peripherally spread with clearing in the center, creating the ring appearance, which is why this disease is commonly referred to as ringworm. A pink-to-red rash is characteristic of rubella. The honey-colored crusts cover the lesions of bullous impetigo. Clusters of papules, vesicles, and pustules characterize varicella.PTS: 1 DIF: Cognitive Level: Remembering 9. Parents do not want the child to contract tinea corporis. Which animal would they limit the child’s exposure to?a. Mitesb. Kittensc. Poniesd. TicksANS: BContact with kittens and puppies is considered a common source of tinea corporis.PTS: 1 DIF: Cognitive Level: Remembering 10. The student learns that the cause of molluscum contagiosum is which of these?a. Bacteriab. Virusc. Fungid. RickettsiaANS: BThe poxvirus is the only organism that induces epidermal cell proliferation and blocks immune responses that would control the virus as noted with molluscum contagiosum.PTS: 1 DIF: Cognitive Level: Remembering 11. The healthcare professional teaches a parent group that which organism causes thrush?a. Staphylococcusb. Streptococcusc. Herpesvirusd. Candida albicansANS: DC. albicans infection is a superficial fungal infection that commonly occurs in children. C. albicans is part of the normal skin flora in certain individuals and invades susceptible tissue sites if the predisposing factors are not eliminated.PTS: 1 DIF: Cognitive Level: Remembering 12. A child has white plaque in the mouth with a few shallow ulcers. What treatment does the healthcare professional educate the parent about?a. Nystatin oral suspensionb. Warm saline rinsesc. Topical antiviralsd. No specific treatmentANS: AThis infant has thrush, caused by Candida albicans. The treatment is an antifungal mouth rinse such as nystatin. Warm saline rinses and antiviral medications will not treat this fungal infection.PTS: 1 DIF: Cognitive Level: ApplyingCopyright © 2019, Elsevier Inc. All Rights Reserved. 3 13. The healthcare professional is teaching a
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