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.
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
• What is your diagnosis?
• What stage of ingrown toenail does she have?
• What is the treatment plan?
• What postprocedure instruction should she receive?
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%
• What sequence of steps would you take to treat this patient?
• What would be your postprocedure instructions to the patient?
• Should he receive a Td immunization today?
3. A 45-year-old male was in his garage grinding a piece of metal when he experienced sudden pain in his right eye. He went inside and flushed his eye with water, but he still felt like there was something in the eye. On physical examination, his visual acuity in both eyes is 20/20. There is no obvious foreign body seen in the eye; however, the conjunctiva is injected. You consider that he may have a corneal abrasion. PMHx: none SHx: divorced with no children Allergies: sulfa VS: T 98 BP 136/60 HR 70 R 12 02 sat 97%
• Describe the process involved with assessing a patient for a corneal abrasion.
• What would your treatment be if this patient was positive for a corneal abrasion?
• How would your treatment differ if there was a change in visual acuity?
• Would this patient require a tetanus shot?
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