Chapter 47: Alterations of the Integument in Children

MULTIPLE CHOICE
1. Which immunoglobulin (Ig) is elevated in atopic dermatitis?
a. IgA
c. IgE
b. IgM
d. IgG
ANS: C

In 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. The remaining options will not be elevated as related to atopic dermatitis.
PTS: 1

REF: Page 1654

2. Which leukocytes are elevated in atopic dermatitis?

a. Eosinophils
c. Basophils
b. Neutrophils
d. Monocytes
ANS: A

In 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. Other leukocytes will not be elevated as related to atopic dermatitis.
PTS: 1

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3. Which clinical manifestation is considered the hallmark of atopic dermatitis?

a. Papular rash
c. Vesicles that burst and form crusts
b. High fever
d. Itching
ANS: D

Of the options, only itching 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.
PTS: 1

REF: Pages 1654-1655

4. Frequently, diaper dermatitis is secondarily infected with which organism?

a. Escherichia coli
c. Proteus spp.
b. Candida albicans
d. Staphylococcus aureus
ANS: B

Of the options available, frequently the infant with diaper dermatitis is secondarily infected
with C. albicans.
PTS: 1

REF: Page 1655

5. The disruption in cellular adhesion observed in bullous impetigo is caused by an exfoliative

toxin related to which organism?

a. Staphylococcus aureus
b. Streptococcus pyogenes

c. Escherichia coli
d. Candida albicans

ANS: A

Bullous 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. This selection is
the only option that identifies the correct organism.
PTS: 1

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6. The staff member of a crowed day care center is a source for which bacterial infection?
a. Atopic dermatitis
b. Staphylococcal scalded-skin syndrome
c. Impetigo
d. Tinea capitis
ANS: C

Impetigo 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 day care facilities. The other options are not as infectious as impetigo.
PTS: 1

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7. Skin lesions that rupture, creating a thin, flat, honey-colored crust, are the hallmark clinical

manifestation of which skin disorder?

a. Rubella
b. Tinea capitis

c. Atopic dermatitis
d. Bullous impetigo

ANS: D

Of the options available, only the vesicular impetigo lesions that begin as small vesicles with
a honey-colored serum are the hallmark clinical manifestation of bullous impetigo. Yellow to
white-brown crusts form as the vesicles rupture and extend radially (see Figure 47-4).
PTS: 1

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8. Skin lesions caused by tinea corporis are best described as:

a. Pink-to-red coalescing maculopapular rash on the scalp or trunk
b. Vesicles that rupture, creating a thin, flat, honey-colored crust
c. Circular (round or oval) lesions with erythema and scaling patches
d. Red papules, vesicles, and pustules in clusters
ANS: C

Lesions 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. None of the other options accurately describe
the lesions associated with tinea corporis.
PTS: 1

REF: Pages 1657-1658

9. What is a common contact source of tinea corporis?

a. Mites
c. Ponies

b. Kittens

d. Ticks

ANS: B

Contact with only kittens and puppies is considered a common source of tinea corporis.
PTS: 1

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10. What is the cause of molluscum contagiosum?

a. Bacteria
c. Fungi
b. Virus
d. Rickettsia
ANS: B

The 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

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11. Thrush is a superficial infection that commonly occurs in children and is caused by which

organism?
a. Staphylococcus
b. Streptococcus

c. Herpesvirus
d. Candida albicans

ANS: D

C. 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. This description is not accurate for any of
the other options.
PTS: 1

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12. How is thrush best defined?

a. Presence of Candida in the mucous membranes of the mouths of infants
b. Presence of bacteria in the nasal mucous membranes of infants
c. Any viral infection of the mucous membranes of the mouths of infants
d. Acute immune response to oral medication, located in the mucosal lining of the

mouths of infants
ANS: A

Thrush is the term used to describe the presence of Candida in the mucous membranes of the
mouth of infants and, less commonly, in the mouth of adults. This selection is the only option
that accurately describes thrush.
PTS: 1

REF: Page 1658

13. Which viral disease has an incubation period of 14 to 21 days and duration of 1 to 4 days?
a. Rubeola
c. Roseola
b. Rubella
d. Varicella
ANS: B

Only rubella has an incubation period that ranges from 14 to 21 days and a duration of 1 to 4
days.
PTS: 1

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14. Rubella (German or 3-day measles) is a common communicable disease of children caused by

what type of organism?

a. Virus
b. Bacterium

c. Fungus
d. Yeast

ANS: A

Rubella is a common communicable disease in children and young adults and is caused only
by a ribonucleic acid (RNA) virus that enters the bloodstream through the respiratory route.
PTS: 1

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15. Rubeola is a highly contagious acute disease in children caused by which type of infection?
a. Bacterial
c. Yeast
b. Fungal
d. Viral
ANS: D

Rubeola, a highly contagious acute disease in children, is a result of only a viral infection.
PTS: 1

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16. Which clinical manifestation is present in rubeola but not in rubella?

a. Conjunctivitis
c. Presence of a cough
b. Enlarged lymph nodes
d. Runny nose
ANS: A

Prodromal symptoms of rubeola include high body temperature (up to 40.5 C [104.9 F]),
malaise, enlarged lymph nodes, runny nose, conjunctivitis, and a barking cough. Prodromal
symptoms of rubella are few but may include enlarged cervical and postauricular lymph
nodes, low-grade fever, headache, sore throat, runny nose, and cough.
PTS: 1

REF: Pages 1658-1660

17. What is the cause of chickenpox?

a. Poxvirus
b. Varicella-zoster virus

c. Adenovirus
d. Human papillomavirus

ANS: B

Only a varicella-zoster viral infection produces chickenpox (varicella) and herpes zoster
(shingles).
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18. Which contagious disease has clinical manifestations of burrows several millimeters to 1 cm

long, papules, and vesicular lesions with severe itching that worsens at night?
c. Scabies
d. Rubeola

a. Pediculosis
b. Tinea capitis
ANS: C

Only scabies has symptoms that appear 3 to 5 weeks after infestation. The burrows, papules,
and vesicular lesions cause severe itching that worsens at night.
PTS: 1

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19. Which contagious disease creates a primary skin lesion that is a pinpointed macule, papule, or

wheal with hemorrhagic puncture site?

a. Pediculosis
b. Tinea capitis

c. Scabies
d. Rubeola

ANS: A

Of the options available, only the primary lesion of the body louse (pediculosis) exhibits a
pinpoint red macule, papule, or wheal with a hemorrhagic puncture site.
PTS: 1

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20. Which contagious disease is caused by the itch mite?

a. Miliaria
c. Pediculosis
b. Tinea corporis
d. Scabies
ANS: D

Scabies is the only contagious disease caused by the itch mite, Sarcoptes scabiei.
PTS: 1

REF: Page 1661

21. Which vascular anomaly is associated with a congenital malformation of dermal capillaries

that does not fade with age?

a. Cutaneous hemangioma
b. Port-wine (nevus flammeus) stain

c. Strawberry hemangioma
d. Cavernous hemangioma

ANS: B

A port-wine stain is the only option that is present at birth or within a few days after birth and
does not fade with age.
PTS: 1

REF: Pages 1663-1664

22. Which skin disorder is characterized by a vesicular eruption after prolonged exposure to

perspiration, with subsequent obstruction of the eccrine ducts?

c. Pediculosis
d. Miliaria

a. Scabies
b. Tinea corporis
ANS: D

Of the available options, only miliaria is characterized by a vesicular eruption after prolonged
exposure to perspiration, with subsequent obstruction of the eccrine ducts.
PTS: 1

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23. What is the treatment plan for a strawberry hemangioma?

a. Cosmetic surgical removal
c. Oral antibiotics
b. Topical steroid therapy
d. Support of its involution
ANS: D

Approximately 90% of strawberry hemangiomas involute by 5 to 6 years of age, usually

without scarring; therefore self resolution is the usual treatment plan.
PTS: 1

REF: Page 1663

MULTIPLE RESPONSE
24. Which statements are true of scalded skin syndrome? (Select all that apply.)
a. Virulent group II staphylococci cause the scalded skin syndrome.
b. A trauma burn triggers the syndrome.
c. The syndrome results in a separation involving the epidermis.
d. Toxins resulting from scalded skin syndrome are circulated through the blood.
e. The lesions of scalded skin syndrome are sites of the infective organism.
ANS: A, C, D

Virulent group II staphylococci, which produce an exfoliative toxin that attacks desmoglein
and adhesion molecules and that causes a separation of the skin just below the granular layer
of the epidermis, cause the scalded-skin syndrome. The toxins are usually produced at body
sites other than the skin and arrive at the epidermis through the circulatory system.
Staphylococci are not typically found in the skin lesions themselves.
PTS: 1

REF: Page 1656

25. Which acne lesions are classified as inflammatory? (Select all that apply.)
a. Closed comedones
b. Opened comedones
c. Nodules
d. Papules
e. Pustules
ANS: C, D, E

Acne lesions may be divided into inflammatory lesions (pustules, papules, nodules) and
noninflammatory lesions (closed and open comedones).
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26. Which statements are true regarding Koplik spots? (Select all that apply.)
a. Koplik spots are associated with rubeola.
b. They appear as white spots.
c. The lesions are surrounded by a red ring.
d. The lesions of Koplik spots are large in size.
e. Koplik spots are primarily found on buccal mucosa.
ANS: A, B, C, E

Rubeola infection begins with characteristic pinpoint white spots surrounded by an

erythematous ring that develops over the buccal mucosa and are known as Koplik spots.
PTS: 1

REF: Pages 1659-1660

MATCHING

Match the viral disease with the skin lesions produced. Viral diseases may be used more than
once.
______ A. Rubella (German measles)
______ B. Rubeola (red measles)

______ C. Roseola (exanthema subitum)

______ D. Varicella (chickenpox)
______ E. Herpes zoster (shingles)
27.
28.
29.
30.
31.

Erythematous macular rash over the trunk and neck that lasts 24 hours
Pinpoint white spots surrounded by an erythematous ring over the buccal mucosa
Groups of vesicles on an inflammatory base following the course of a sensory nerve
Pink-to-red coalescing maculopapular rash on the scalp or trunk
Red papules, vesicles, and pustules in clusters on the trunk, scalp, or face

27. ANS: C
PTS: 1
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MSC: After the fever, roseola exhibits an erythematous macular rash that lasts approximately 24 hours
and primarily develops over the trunk and neck.
28. ANS: B
PTS: 1
REF: Pages 1659-1660
MSC: Rubeola's characteristic pinpoint white spots are surrounded by an erythematous ring, develop
over the buccal mucosa, and are known as Koplik spots.
29. ANS: E
PTS: 1
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MSC: Herpes zoster occurs in partially immune individuals who have had varicella.
30. ANS: A
PTS: 1
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MSC: Rubella exhibits a faint, pink-to-red coalescing maculopapular rash that develops on the face
and spreads to the trunk and extremities 1 to 4 days after the onset of initial symptoms (see Figure 478).
31. ANS: D
PTS: 1
REF: Page 1660
MSC: The first sign of illness may be itching or the appearance of vesicles, usually on the trunk,
scalp, or face. The rash later spreads to the extremities. Characteristically, lesions can be observed in
various stages of maturation with macules, papules, and vesicles present in a particular area at the
same time (see Figure 47-9).