Week 4 Assessment Discussion
Differential Diagnosis for Skin Conditions
Name: Mr. G.T
Age: 36 years
Marital Status: Married
Allergies: Sulphur creams and drugs
SUBJECTIVE DATA: (Graphic 5)
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
Past Medical History (PMH):
Immunization History: Laparoscopic Cholecystectomy
Surgical History: Cardiac Surgery 10 years ago
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.
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
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.
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