Now that you have considered the evidence at hand, you should start to build a h
ID: 226018 • Letter: N
Question
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 That Apply From Below
BackGround Story:
MEDICAL HISTORY (Hx)
The patient is a female, age 68. She is from Minneapolis, MN. She was admitted to emergency room for a sudden onset of vomiting, fever, and chills. Upon admittance, hospital staff noted that she had several large, erythematous (red) patches on her body. The patient is unmarried and not presently sexually active. She works part time in her local community center, and volunteers at a dog rescue organization. She lives in an apartment by herself and does not have any pets. She has not traveled recently, and does not report any use of illicit drugs. She has a family history of chronic rheumatoid arthritis and is currently on a course of steroids for the same. A little more than a month ago, she had a bad crash while biking. She broke her nose and wrist, and required surgery to correct both breaks. Post-surgery, the patient reported soreness and pain associated with the site of injury, and a generalized feeling of malaise. She had checked in with her surgeon at several points throughout her convalescence, and was reassured that her symptoms were not out of the range of normal recovery. Last week she noticed that several small, flat, red lesions on her wrist had developed. Upon admittance to the emergency room, she had large, diffuse red patches (similar to macules, but much larger) resembling sunburn across her neck, chest, and abdomen, as well as desquamation (peeling skin) on the tip of her nose and the palms and soles of her feet. You ask the patient to remove her sweater, and as she does, you notice several large (~1.5 cm across), raised purplish lesions that resemble blood blisters on the underside of her right arm and wrist.
Access "Diseases in Focus" Tables 21.1, 21.2, and 21.3.
Answer Choices:
pediculosis
measles, rubella fifth disease, roseola candidiasis staphylococcal skin infection (folliculitis, impetigo, scalded skin syndrome, toxic shock syndrome) smallpox, monkeypox chickenpox, shingles herpes simplex streptococcal skin infection (necrotizing fasciitis, erysipelas) Pseudomonas dermatitis, otitis externa acne buruli ulcer warts ringworm sporotrichosis scabiespediculosis
Explanation / Answer
Measles: Because she had fever and rashes as well. Rubella cannot be the case because in rubella the red patches appear first on face then spread from head to toe. Cannot be fifth disease becaus eit shows pain in joints. Cannot be candidiasis because it affects sking between fingers and toes. May be staphylococcal skin infection May be smallpox and chickenpox Cannot be herpes simplex because its sores appear around the mouth and genitals. May be streptococcal skin infection May be pseudomonas dermatitis Cannot be acne as lesions are spreading fast. Can be buruli ulcer Cannot be warts because warts are not pink Can be ringworm Can be sporotrichosis Cannot be scabies because the patient has large patches Cannot be pediculosis as it is infection by lice
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