Question

hapter 3 Skin
CASE STUDY 1
Chief Complaint
A 19 y.o. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the “flu or something.” She returned 3 weeks ago from a spring break trip to the beach. The rash started out “like acne,” located on her face, back, and chest. She now thinks she must have caught something during her trip, as she has developed joint pain in addition to the rash. The pain is most notable in her hands, although she has some stiffness and pain in both of her wrists, ankles, and knees.
Past Medical History
Denies surgeries or serious illnesses/hospitalizations
Physical Examination
Vital signs: T 99.6, BP 110/78, RR 20, HR 82, HT 5′8″, WT 124 lbs.
General: Well developed and neurologically intact. No acute distress.
CV: RR&R, no murmurs.
Respiratory: Clear A&P.
MS: Notable for mild swelling bilateral hands; other joints without visible abnormalities. ROM of fingers slightly decreased with mild stiffness of movement and tenderness to interphalangeal palpation. ROM to other joints is intact, but with mild discomfort on motion to bilateral elbows, wrists, ankles, and knees.
Skin: Warm and dry with resilient turgor. Red maculopapular lesions scattered on cheeks and nose, more sparsely scattered on upper chest and back. No other lesions identified.
Questions
What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?
What further history, further examination, and diagnostic studies are warranted to explore your differential diagnosis?
History:
Physical examination:
Diagnostic studies:
What is the final diagnosis?

Answer 1

Differential Diagnosis:

• Psoriatic arthritis: It is an inflammatory joint condition leads to joint swelling, stiffness, and tenderness. It relates to patient symptoms.
• Systemic Lupus erythematous: It is an autoimmune disorder caused by environmental and hormonal changes.
• Measles: The most common symptoms of measles are maculopapular lesions. It can spread through physical contact and the detection of the virus is necessary to confirm the diagnosis.

History:

• History of fever, anorexia, cough.
• History of family health history and genetical problem.
• collect a detailed history of environmental exposure.
• Collect a history of sensitivity to light.
• Collect the history of vaccination.
• Collect the history of the previous infection.

Physical examination:

• Examination of nail beds for nail pitting.
• Examine the finger shape.
• Assess lung sounds and cardiac murmurs.
• Examine the characteristic of skin rash.
• Assess for dehydration.

Diagnostic Studies:

• X-ray of hands to check joint damage.
• Complete blood count to detect the inflammation.
• A blood test to detect the virus.
• Blood test for C-Reactive protein.
• Urinalysis to detect uric acid level.
• MRI scan to detect joint erosion.

final Diagnosis:

Psoriatic arthritis.