A 35-year-old Hispanic female presents to the office. She complains of severe pain in her left 1st metatarsal (big toe) on the m

Case Study 1

A 35-year-old Hispanic female presents to the office. She complains of severe pain in her left 1st metatarsal (big toe) on the medial corner of her nail bed. She reports that the pain has gradually worsened over the last week and she can now barely walk. She has tried soaking her foot in Epsom salts and putting antibiotic cream on her toe, none of which have helped. On physical exam her toe is swollen and erythematous with tenderness. She also has purulent drainage present.

PMHx: none

SHx: married with two children

Allergies: none

1.    What is your diagnosis (include staging)?

2.    What is the treatment plan?

3.    What post-procedure instruction should she receive?

Case Study 2

A 47-year-old male presents to the clinic. He has a 3-inch laceration on his right forearm and reports that he was replacing a bedroom window when the window broke, cutting his right arm. He reports that "it bled quite a bit." He wrapped it in a shirt and came directly to the clinic. He does not know when he had his last Td shot, but he thinks it was at least 12 years ago.

On physical examination you observe a 3-inch laceration extending through the dermis layer of skin not affecting tendons or ligaments and determine if sutures are warranted.

PMHx: asthma

SHx: married with no children

Allergies: none

VS: T 98 BP 134/60 HR 78 R 18 02 sat 98%

1.    What sequence of steps would you take to treat this patient?

2.    What would be your post-procedure instructions to the patient?

3.    Should he receive a Td immunization today?