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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.
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