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case study

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Dermatologic Differential of Common Skin Lesions and Rashes

Name Cause Sign/symptoms Diagnostics Treatment Concerns
Rocky
Mountain
Spotted
Fever

Tick bite
Rickettsia
rickettsii

Fever, chills,
severe
headache, n/v,
photophobia,
myalgia,
conjunctival
injection,
arthralgia; 2-5
days after onset
– rash
(petechiae)
starts on
hands/feet to
trunk (palmar
rash)

Antibody
titers to
rickettsia
Punch
biopsy
CBC, LFT,
CSF

Doxycycline
100mg BID
for 7-14 days
– can be fatal
if not started
on treatment
within 8
days.
Remove tick
by grasping
closest to
skin and
apply steady
upward
pressure

Can be
fatal (3-
9%)
Highest
in
southeast
ern/sout
h central
regions
of US
Most
common
Apr –
Sept

Erythema
Migrans
(Lyme
disease)
Meningococ
cemia

Varicella /
Zoster

Malignant
Melanoma

Basal Cell
Carcinoma

Actinic
Keratosis

Erythema
Multiforme
(Stevens-
Johnson
syndrome)

Differential Diagnoses of Eye Emergencies

Name Cause Signs/Sym
ptoms

Diagnostics Treatments Concerns

Corneal
Abrasion

Trauma,
foreign
body,
incorrect
use of
contact
lenses

Acute
onset
severe eye
pain with
tearing.
Reports
feeling of
foreign
body
sensation

Eye exam
with
Fluorescein
dye

Flush eye with
sterile normal
saline. Evert eyelid
to look for foreign
body. Topical
antibiotic
trimethoprim-
polymyxin B
(Polytrim),Ciproflox
acin (Ciloxan),
Ofloxacin (Ocuflox)
to affected eye 3-5
days.
Do not patch eye.

Contact
Lens-
Related
Keratitis
– acute
onset red
eye,
blurred
vision,
watery
eyes,
photoph
obia,
foreign
body
sensation

Hordeolum
(Stye)

Chalazion
Pinguecula
Pterygium
Subconjunctiv
al
Hemorrhage

Primary
Open-Angle
Glaucoma

Macular
Degeneration

Differential Diagnoses of Common Headaches

Name Sign/symptom
s

Aggravating
factors

Acute
treatment

Prophylaxis

Migraine
Without Aura

Throbbing pain
behind one
eye,
photophobia,
N/V
phonophobia,
last 4-72 hr.

Red wine,
MSG,
aspartame,
menstruation,
stress

Ice pack on
forehead, rest
in dark quiet
room
Triptans, Tigan
suppositorie

TCAs
Episodic
migraine (<14
days per
month)
Beta-blockers

Migraine With
Aura

Trigeminal
Neuralgia (CN
V)

Cluster
Muscle Tension

Part 2: Case Study

A 48-year-old male presents with a two-month history of nighttime headaches that are
becoming more frequent. The pain awakens him at night. He has no other somatic
complaints and no other significant medical history. Complete chart below.

In SOAP format, discuss what questions you would ask the patient (Review of Systems),
what physical exam elements you would include, what further testing you would want to
have performed (if any), differential and working diagnosis, treatment plan, including
inclusion of complementary and OTC therapy, referrals and other team members needed
to complete patient care.

Differential Signs/Symptoms
Gold
Standard
Diagnostics

Gold Standard Treatment

Ex:
Temporal
arteritis
(giant cell
arteritis/GC
A)

Unilateral pain, temporal
area with scalp
tenderness, skin over
artery is indurated,
tender, warm and
reddened; amaurosis
fugax (temporary
blindness).

Medical
urgency –
refer to ED or
Ophthalmolog
ist

High dose steroids
* Dose and route of
administration of glucocorticoids
for newly diagnosed GCA varies
depending on whether patient
presents with or without
threatened or established visual
loss at diagnosis.

1.

2.

3.

4.

5.

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