Week 4 Assessment Discussion

Week 4 Assessment Discussion

Differential Diagnosis for Skin Conditions

Name: Mr. G.T

Age: 36 years

Gender: Male

Marital Status: Married

Race: Caucasian

Allergies: Sulphur creams and drugs


Chief Complaint: The patient has a painful rash on the left side of his back

History of Present Illness:  Mr. G.T is a 36 years old Caucasian man representing with rash that is unilateral on the left side of his back. The patient complains of a tingling and burning pain that has worsened on touch for the last 48hours. Today in the morning when he woke up, he noticed some rash. The patient has been taking ibuprofen to ease the pain but the pain worsens especially at night.Week 4 Assessment Discussion


  1. Fish Oil 500mg PO twice daily
  2. Keppra 250mg per oral BID
  3. Topiramate 100mg once daily
  4. Trazodone 100mg PO nocte
  5. Norco 5mg-325mg PO every six hours
  6. Aspirin 81mg PO twice daily

Past Medical History (PMH):

  1. Liver masses
  2. Seizures
  3. Hemiplegia
  4. Chronic headache

Immunization History: Laparoscopic Cholecystectomy

Surgical History: Cardiac Surgery 10 years ago

Family History:

  • Father: 80 years old-Alive and well. On treatment for diabetes/hypertension.
  • Mother: Died at 70 years of age from breast cancer
  • Siblings: One living sister, 42 years old, alive and well. No known comorbidities

Social History:

Patient has Medicare, works out 5 times a week, eats healthy and has a personal trainer. The patient has neurologist and a primary care physician who he visits twice-yearly.  Friends and family offer him moral support. Patient is undergoing stressful moments after suffering massive stroke at 33 years. He struggles to sleep and is usually awake most of the time.

Sexual Orientation: straight

Review of Systems (ROS):

General: Insomnia, frequent headaches and occasional fever

HEENT:  Denies hearing loss. Denies loss of eyesight or blurred vision. Denies sore throat or runny nose. Denies any dental issue.

Respiratory: Denies breathing problems. No history of ant tuberculosis infection


Cardiovascular: Previously suffered PFO and CVA. Denies chest pain. Denies heart palpitations.Week 4 Assessment Discussion

Gastrointestinal: Denies diarrhea. Denies abdominal pain. Denies weight loss. Denies constipation

Genitourinary: Denies penile discharge. Denies difficult voiding.

Musculoskeletal: Weak on the left side. Denies swelling. Denies joint pain.

Psychiatric: Stressed up due to the stroke case. Denies mental illness. Denies depression.

Neurological: Had a seizure a month ago. Frequent headaches. Frequent seizures

Skin: rashes that are fluid filled. Red bumps. Tingling and burning sensation. A painful rash on the left side of his back.

Hematologic: denies anemia history. Denies bleeding gums.

Endocrine: Denies thyroid problems. Denies frequent and excessive thirst.

Allergic/Immunologic: Denies reoccurring infections.


Physical Examination:

Vital Signs:

  • Weight- 234lbs
  • Height- 5’7’’
  • BP- 127/98
  • BMI- 24.3
  • Spo2 88% on room air
  • Pulse 110 bpm

General: Well groomed, oriented and alert, mildly uncomfortable, noticeable left side weakness

HEENT: Mucous membrane moist. Nose flaring. Normal conjunctivae.

Neck: No bruits. No JVD. Supple.

Chest/ Lungs: Clear auscultation consensually

Heart/Peripheral Vascular: Normal peripheral circulation. Regular rhythm. Regular rate. No gallop.

Abdomen: Round, no recoil tenderness, BS X4

Musculoskeletal: Normal development of muscles. Presence of left side hemiparesis.

Neurological: The mood is congruent.

Skin: Erythematous, No cyanosis noted. No palpable lymph nodes. Presence of vesicular rash on the left side of the back.Week 4 Assessment Discussion


Primary Diagnosis:

The primary diagnosis is Herpes Zoster/ Shingles. Herpes Zoster is caused by the Varicella virus. After someone suffered from chicken pox, the varicella virus remains dormant in the nerves (Ball et al, 2018). The sensory nerve ganglia therefore gets reactivated and it is later spread to the targeted tissues. Thereafter, a single dermatome gets involved in the skin. The lesions however do not cross the midline. Patients suffering from herpes zoster present with low grade fever, malaise, tingling and painful sensations before appearance of the rash and mild headache. Stress is a known factor to trigger acute herpes zoster.

Differential Diagnosis:

  1. Contact Dermatitis- a life threatening rash that is red and itchy majorly caused by contact with an allergic reaction (Ball et al, 2018).
  2. Herpes Simplex- associated with pain, tingling and soreness. Vesicles have an erythematous base (McQuillan et al, 2018).
  3. Psoriasis- inflamed, scaly, thick, raised skin with red and pink plaques (Cunningham et al, 2016)
  4. Varicella Zoster- vesicles have disseminated distribution (Chen et al, 2017).

The patient is therefore suffering from herpes zoster based on the graphic appearance. Herpes zoster mostly presents with fluid filled vesicles unilaterally.


Ball, J. W., Dains, J. E., Benedict, G. W., Flynn, J. A., Solomon, B. S., Stewart, R. W., &       Monahan, F. D. (2018). Student Laboratory Manual for Seidel’s Guide to Physical    Examination-E-Book: An Interprofessional Approach. Elsevier Health Sciences.

Chen, V. C. H., Wu, S. I., Huang, K. Y., Yang, Y. H., Kuo, T. Y., Liang, H. Y., … & Gossop,             M. (2017). Herpes zoster and dementia: a nationwide population-based cohort study. The             Journal of clinical psychiatry, 79(1), 0-0.

Cunningham, A. L., Lal, H., Kovac, M., Chlibek, R., Hwang, S. J., Díez-Domingo, J., … &     Vanden Abeele, C. (2016). Efficacy of the herpes zoster subunit vaccine in adults 70    years of age or older. New England Journal of Medicine, 375(11), 1019-1032.

McQuillan, G. M., Kruszon-Moran, D., Flagg, E. W., & Paulose-Ram, R. (2018). Prevalence             of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States, 2015-     2016 (pp. 1-8). US Department of Health and Human Services, Centers for Disease            Control and Prevention, National Center for Health Statistics.

Week 4 Assessment Discussion