17 May Widespread Painful Rash Case Study
Review the Widespread Painful Rash Case Study. (Word) Answer all the questions in the case study using at least 500 words.
Please answer the using atleasr 500 words:
Clinical Discussion Questions:
1. What is the differential diagnosis?
2. What is the most likely diagnosis? Why?
3. Demonstrate your understanding of the pathophysiology in regard to the most likely diagnosis.
4. Should tests/imaging studies be ordered? Which ones? Why? Think about tests/imaging beyond the primary care setting as well.
5. What are the next appropriate steps in management?
6. What are the causes, risk factors, and treatment for this diagnosis? Provide references for your responses.
7. What are the pertinent ICD-10 and CPT (E/M) codes for this visit? Provide a short rationale.
8. What are appropriate parent/patient education topics for this case?
9. If not managed appropriately, what are the medical/legal concern(s) that may arise?
10. Think about interprofessional collaboration for this case. Provide a list of specialties or other disciplines and indicate what contribution these professionals might make to managing the patient.
Bedside Manner Questions:
11. What would your communication style/approach be with this mother and patient?
12. If a patient and her mother are distressed by the diagnosis, what might offer support?
Widespread Painful Rash Case Study
Directions: Review the case study then answer the clinical discussion and bedside manner questions.
Case Study
Chief Complaint
“Widespread painful rash.”
History of Present Illness
A mother and her 9-year-old daughter present to a pediatric clinic for a second opinion regarding the daughter’s symptoms of fever, sore throat, and a painful rash. She had been seen 3 days earlier by her regular PCP, who diagnosed a viral infection. Her parents were concerned and sought a second opinion because she had a persistent high fever and her rash had worsened. The rash had extended to her extremities, had multiple areas of blistering, and continued to be painful. Within the past 24 hours, she developed sores on her lips and purulent discharge from both eyes. She is currently on Day 9 of antibiotic treatment for uncomplicated cystitis.
Ten days prior to this visit, she had seen her regular PCP for evaluation of dysuria. She had no fever at that time. She was diagnosed with cystitis and prescribed a course of sulfamethoxazole-trimethoprim. The dysuria resolved within 24 hours and did not recur. Five days after starting the antibiotic, she developed a fever up to 40°C (104°F), generalized malaise, a mild sore throat, and skin pain. On Day 6 of antibiotic treatment, she developed a rash on her face and trunk and was seen again by her PCP. Her parents stated the rash was deep red and consisted of irregular blotchy areas with one or two small blisters. Her parents were told her symptoms were most likely due to a viral infection because she was already taking an antibiotic.
They were advised to continue the antibiotic as prescribed and to give acetaminophen PRN for fever. No follow-up was scheduled.
Review of Systems
The patient’s ROS is positive for generalized weakness, decreased appetite, eye pain, and photophobia. Her ROS is negative for headache, neck pain, vomiting, diarrhea, or abdominal pain.
Relevant History
The patient’s history is significant for several episodes of otitis media, one previous episode of cystitis about 2 years earlier, and two episodes of streptococcal pharyngitis since starting kindergarten. There is no history of chronic illness. Her immunizations are up to date for age.
Allergies
No known drug allergies; no known food allergies.
Medications
• Sulfamethoxazole-trimethoprim 400 mg/80 mg PO BID.
• Acetaminophen 325 mg PO QID PRN for pain.
Physical Examination
Vitals: T 39.6°C (103.3°F), P 96, R 18, BP 92/56 mmHg, HT 127 cm (50 in.), WT 28.2 kg (62 lbs), BMI 17.4.
General: Ill-appearing, in moderate discomfort.
Skin, Hair, and Nails: Face, trunk, and extremities with extensive erythematous and dark purple irregularly-shaped macules with overlying vesicles of varying sizes (up to approximately 3 to 4 cm in diameter) and areas of deep skin erosion covering a small percentage of total skin surface; skin tender to light touch. No abnormal findings with hair or nails.
Head: No scalp lesions.
Eyes: Moderate conjunctival injection with small amount of purulent discharge bilaterally.
ENT/Mouth: Tympanic membranes translucent with normal mobility, oropharynx with mild erythema, lips erythematous with several areas of erosion and crusting.
Neck: FROM without discomfort; no resistance to flexion; no lymphadenopathy.
Lungs: Clear to auscultation bilaterally.
Heart: RRR, S1 and S2 normal intensity, no murmurs or extra heart sounds.
Abdomen: Soft, non-tender; no mass or hepatosplenomegaly.
Genital/Rectal: No lesions of external genitalia.
Musculoskeletal: No joint swelling, full range of motion.
Neurologic: Responds appropriately to questions; cranial nerves intact; strength and sensation not assessed due to skin lesions and tenderness; walks but appears to be in pain with movement.
Clinical Discussion Questions
1. What is the differential diagnosis?
2. What is the most likely diagnosis? Why?
3. Demonstrate your understanding of the pathophysiology in regard to the most likely diagnosis.
4. Should tests/imaging studies be ordered? Which ones? Why? Think about tests/imaging beyond the primary care setting as well.
5. What are the next appropriate steps in management?
6. What are the causes, risk factors, and treatment for this diagnosis? Provide references for your responses.
7. What are the pertinent ICD-10 and CPT (E/M) codes for this visit? Provide a short rationale.
8. What are appropriate parent/patient education topics for this case?
9. If not managed appropriately, what are the medical/legal concern(s) that may arise?
10. Think about interprofessional collaboration for this case. Provide a list of specialties or other disciplines and indicate what contribution these professionals might make to managing the patient.
Bedside Manner Questions
11. What would your communication style/approach be with this mother and patient?
12. If a patient and her mother are distressed by the diagnosis, what might offer support?
