PRESENTATION: The patient presents with two lesions on her arm. She says they itch a little
bit but do not hurt. The mother says the lesions have been there for about 1 week.
MEDICAL HISTORY: The patient’s annual well-child appointments to your office have been
unremarkable and she is current on all her vaccinations.
PSYCHOSOCIAL: The child goes to daycare. She has a new kitten.
HEALTH HABITS: She is a picky eater and likes fruits but not vegetables.
SUPPLEMENTS: She takes a children’s daily multiple vitamin.
MEDICATIONS: none
ALLERGIES: none known
VITAL SIGNS: Her temperature is 98.4EF (36.9EC), heart rate is 100 bpm and regular with no
murmur, and her respiratory rate is 22/min.
PHYSICAL EXAMINATION: She has no lymphadenopathy and no systemic symptoms.
Physical examination reveals two 1 to 2 cm reddish, round, annular plaques. The advancing
borders of the lesions are slightly raised and scaling, and there are a few pinpoint pustules around
the edge. There are no other similar lesions. She has a few small excoriations around her wrist.
PRELIMINARY LAB RESULTS: Lab results are pending.
DIAGNOSTIC IMAGING: Diagnostic imaging was not performed at this appointment.
1. The most likely diagnosis is _______, but you must also consider _______ in your
differential.
A. impetigo; pemphigus and scabies
B. impetigo; urticaria and varicella
C. tinea corporis; impetigo and Lyme disease
D. tinea corporis; pityriasis rosea and varicella
2. To focus your diagnosis, which lab test should be performed?
A. serum antibody testing to detect fungus
B. microscopic examination to detect hyphae
C. microscopic examination to detect tiny worms
D. culture on blood agar to detect hemolytic colonies
3. What needs to be done to prepare the sample for evaluation?
A. gram stain the collected cells
B. apply 10% KOH to the skin scraping
C. grow the collected cells on blood agar
D. illuminate the lesion with a Wood’s Lamp
4. If the lesion tested positive for ________, a diagnosis of ________ would be confirmed.
A. Borrelia burgdorferi; scabies
B Epidermophyton; tinea corporis
C. Enterobius vermicularis; impetigo
D. Staphylococcus aureus; Lyme disease
5. Which one of the following drugs would be most indicated for her condition?
A. acyclovir
B. penicillin
C. tetracycline
D. turbinafine
6. Which one of the following botanical medicines would most effectively treat her condition?
A. oral Passiflora incarnata
B. oral Selenicereus grandiflora
C. topical Podophylum peltatum
D. topical Melaleuca alternifolia
OR A DIFFERENT FORMAT FOR THIS TYPE OF QUESTION WOULD BE:
7. You consider topical treatment with Melaleuca alternifolia, and decide that:
A. it would be safe for her and is indicated for her condition.
B. it would be safe for her, but it is not indicated for her condition.
C. it would not be safe for her due to her age, although it is indicated for her condition.
D. it would be neither safe for her, nor is it indicated for a patient who has this condition.
8. You determine that the child is very aggravated by the itching. The lesions itch and burn
intensely when she is in her bed at night and after she bathes in hot water. She prefers to be
barefoot and sticks one foot out of the covers at night. Which one of the following
homeopathic preparations best addresses her presentation?
A. sulphur
B. chamomilla
C. calcarea carbonica
D. pulsatilla pratensis
Answers:
1. C 2. B 3. B 4. B 5. D 6. D 7. A 8. A
Turbinafine (TER bin a feen)
Use: Antifungal for the treatment of tinea pedis (athlete's foot), tinea cruris (jock itch), and tinea corporis (ringworm) [OTC/prescription formulations]; tinea versicolor [prescription formulations]Action: Synthetic allylamine derivative which inhibits squalene epoxidase, a key enzyme in sterol biosynthesis in fungi. This results in a deficiency in ergosterol within the fungal cell wall and results in fungal cell death.
C/I: Hypersensitivity to drug
Interactions: none known
Patient Education: Cream, gel, or spray for topical use only. Wash and dry area thoroughly before applying. Avoid contact with eyes, nose, or mouth. Do not use occlusive dressings. Report irritation or development of rash to healthcare provider.
No comments:
Post a Comment