differential diagnoses tables.

PART 1: Complete the following differential diagnoses tables. 

TABLE 1. DERMATOLOGIC DIFFERENTIAL OF COMMON SKIN LESIONS AND RASHES

NameCauseSigns/SymptomsDiagnosticsTreatmentConcernsRocky Mountain Spotted FeverTick bite Rickettsia rickettsiiFever, 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, CSFDoxycycline 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 pressureCan be fatal (3-9%)
Highest in southeastern/south central regions of US Most common Apr – SeptErythema Migrans (Lyme disease) MeningococcemiaVaricella / ZosterMalignant MelanomaBasal Cell CarcinomaActinic KeratosisErythema Multiforme (Stevens-Johnson syndrome)

Table 2. Differential Diagnoses of Eye Emergencies

NameCauseSigns/SymptomsDiagnosticsTreatmentConcernsCorneal AbrasionTrauma, foreign body, incorrect use of contact lensesAcute onset severe eye pain with tearing. Reports feeling of foreign body sensationEye exam with Fluorescein dyeFlush eye with sterile normal saline. Evert eyelid to look for foreign body. Topical antibiotic trimethoprim-polymyxin B (Polytrim),Ciprofloxacin (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, photophobia, foreign body sensationHordeolum (Stye)ChalazionPingueculaPterygiumSubconjunctival HemorrhagePrimary Open-Angle GlaucomaMacular Degeneration

Table 3. Differential Diagnoses of Common Headaches

NameSigns/SymptomsAggravating FactorsAcute TreatmentProphylaxisMigraine Without AuraThrobbing 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 suppositorieTCAs
Episodic migraine (<14 days per month)
Beta-blockersMigraine With AuraTrigeminal Neuralgia (CN V)ClusterMuscle Tension

PART 2: Case Study

Select one of the following case studies and corresponding Differentials Table to complete. In the subject line of your post, please identify which case study you are responding to. 

See the following case study.

Complete the corresponding “Differentials Table” to align your clinical reasoning – include 5 differentials (excluding example provided).

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. 

Note: Document at least one scholarly source to connect your response to national guidelines and evidence-based research in support of your ideas.

CASE STUDY: 

Sally is a 22-year-old female who recently became bothered by a rash that is itchy, red, inflamed, and dry. She also has scaly areas that she says are getting worse. The rash is only around her umbilicus and on her elbows. Both of her parents have psoriasis, but she doesn’t believe this is the problem, because it appears to be different from her parents’ lesions. She is living in Florida, is under a lot of stress in high school, and just recovered from a lingering upper respiratory infection (URI).

DifferentialSigns/SymptomsGold Standard DiagnosticsGold Standard TreatmentEx: Actinic KeratosisScaling, dry, round, flesh-colored lesions on skin that do not heal; usually sunexposed areas; sizes range from microscopic to several centimeters.Clinical diagnosisFor patients with multiple thin lesions on the face or scalp, treatment with topical fluorouracil cream is first-line therapy.
Applied to AK lesions, fluorouracil cream causes inflammation and lesion necrosis. Inflammation typically subsides approximately two weeks after topical fluorouracil is discontinued. It typically takes four to six weeks (two to four weeks of which are active treatment) for the skin to progress through erythema, blistering, necrosis with erosion, and re-epithelialization. In patients with extensive AK, the treated area may become extremely inflamed. Thus, pretreatment patient information and education must be thorough to ensure adherence to treatment.
Inflammatory response during treatment of AK with topical fluorouracil. 1.2. 3. 4.5. 

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