Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer.
So, if you're ready, let's jump right in.
Margaret Fitzgerald: Which of the following are the most common features of skin changes noted in areas of the feet affected by tinea pedis?
A: Widely distributed and consistently raised with areas of hyperpigmentation.
B: Located on the dorsal aspect with central clearing and a raised border.
C: Involving plantar crusting and interdigital fissures.
D: Remaining stable over time with lateral lichenification.
And the correct answer here is C: Involving plantar crusting and interdigital fissures.
First, let's determine what kind of a question this is, given that we're being told the person that we would be seeing has tenia pedis, we're now being asked to describe the findings associated with this condition. And whenever you're doing additional information gathering, that would be an assessment question. Some background information, tenia pedis is a form of a common cutaneous fungal infection and is more often known as just athlete's foot.
The risk factors for tinea pedis include any activity or action that can result in the interruption of the skin's integrity. That can include activities such as prolonged use of tight-fitting occlusive footwear, so think of things like plastic shoes, excessive sweating, and prolonged exposure to water.
And the prolonged exposure to water can simply be from swimming a lot. These conditions also contribute to the proliferation of the causative dermatophytes. The injured skin is exposed to the dermatophyte, whether within footwear or in a surface such as at a gym or around a swimming pool. Tenia pedis in an otherwise well adult usually responds to standard therapies and resolves.
That's it. Particularly, if you could work with the patient to minimize the risk factors. However, this condition, given the interruption of skin integrity, can result in complications in the presence of co-morbidity, including diabetes. These complications can include cellulitis, osteomyelitis, and lymphangitis. I'll cover tinea pedis treatment in another podcast. With this in mind, let's take another look at the question and the responses we've been given. Which of the following are the most common features of skin changes noted in areas of the feet affected by tinea pedis? A: Widely distributed and consistently raised with areas of hyperpigmentation.
This is incorrect. The skin lesions associated with tenia pedis tend to be localized to certain areas of the feet and hyperpigmentation is not involved. B: Localized to the dorsal aspect of the foot with central clearing and raised border. Again, this is not correct. Remember what the dorsal surface of the foot is. That's the instep or the top of the foot.
And by the way, skin lesions with a central clearing are described as annular and an example of an annular lesion is the classic bull's eye lesion seen with Lyme disease. So wrong location, wrong description of the lesion. C: Involving plantar crusting and interdigital fissures. This is, of course, the right answer. And really what it is, it's the right location and the right description.
If you thought, ‘Great, another piece of clinical information I need to memorize,’ I challenge you rather to think of it as the following: how does this disease take hold? Most common via macerated or other injured skin. How does the skin most often become macerated? By being wet. What part of the foot has the skin most consistently moist?
That would be plantar aspect and also between the toes. So, the interdigital fissure, often with the complaint of itch or burn to the area, is a classic early presentation of tenia pedis and often continues throughout the entire process of tenia pedis, with those fissures getting deeper if the disease is untreated. Option D: Remains stable in size over time with lateral lichenification
This answer, of course, is incorrect, as tinea pedis can spread over time involving a greater area of the foot. Lichenification, a thickening of the skin or skin lesions, is most often noted in chronic rubbing or other irritation. It's not a usual finding in tenia pedis. One of the more common times that you'll run into lichenification is in the antecubital fossa of a person with poorly controlled eczema where they're rubbing that area a lot because the area is so itchy and that will cause the lichenification.
Key takeaway, I'm going to say it one more time. Common diseases occur commonly and commonly come up on the primary care-focused family and adult gero primary care exams. Tinea pedis is likely the most common superficial fungal infection of the skin that you will see in clinical practice.
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