MEDICAL HISTORY (Hx) The patient is a male, age 9. He is from Reno, Nevada. He w

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MEDICAL HISTORY (Hx) The patient is a male, age 9. He is from Reno, Nevada. He was admitted to the clinic with a deep, red, swollen abscess on the nape of his neck. The patient is a student at a local grade school. He is also in a scout troop that meets most weekends and after school. The patient's dad is a highschool teacher, and his mother is an engineer. The family has a history of heart disease (paternal) and diabetes (maternal). The boy owns a pet boa constrictor and a gopher snake. Ten days ago, he went on a four-day backpacking trip with his scout troop. On the second morning of the trip, he noticed a "spider bite" on his neck. Two of the other children on the trip had similar bites on their arms and face, respectively. The troop-leader applied a topical antibiotic ointment to the bites and administered each child an adhesive bandage. The next day, the boy noticed that the bandage had fallen off at some point during the morning hike. When the trip ended, two days later, the boy's parents noticed that the bite appeared red and somewhat swollen. Concerned, the boy's father swabbed the bite with alcohol and ointment and applied an adhesive bandage. The next day, the bite still appeared raised and inflamed. After a few days, it began to feel hard and hot to the touch, and the patient often complained of tiredness and headaches. He was febrile upon admission to the clinic. The abscess on his neck is roughly 2 inches in diameter, with a yellowish center and weeping, crusted tips.

Part B Review possible diagnoses Now that you have considered the evidence at hand, you should start to build a hypothesis about what disease your patient has. In the beginning of your diagnostic process you should try to think broadly and consider any and all reasonable possibilities. You can then narrow down these possibilities by performing diagnostics that can support or refute your hypothesis Select all conditions that could reasonably apply to your patient O measles, rubella O fifth disease, roseola O candidiasis staphylococcal skin infection (folliculitis, impetigo, scalded skin syndrome, toxic shock syndrome) O smallpox, monkeypox O chickenpox, shingles O herpes simplex O streptococcal skin infection (necrotizing fasciitis, erysipelas) O Pseudomonas dermatitis, otitis externa acne O Buruli ulcer O warts O ringworm O sporotrichosis O scabies O pediculosis

Explanation / Answer

Many conditions of the skin may produce the same symptoms as a spider bite. Staphylococcal infections as most spiders are harmless; the two exceptions in the U.S. are the black widow and brown recluse spiders.

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