Value: 100 points
Due: Day 7
Gradebook Category: QBank
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HPI: A 9-year-old boy, Taumi, with a history of recurrent skin infections presents with extensive redness and pruritus of the popliteal and antecubital fossae, arms, and abdomen. He’s scratched the lesions, especially at night, with the result that his sleep was disturbed. Despite the use of chronic moisturizing therapy and topical corticosteroids, he is having a seasonal flare of his condition. When he was 6 years old, he also experienced bronchial asthma with a persistent cough. This is not the first time he’s experienced this type of rash and has had issues since he was 4 years old. His mothers, Patricia and Fran, are bringing him into the clinic today for another exacerbation. They have tried the following: diphenhydramine 25mg q8h prn, hydrocortisone 2% QID, Zyrtec 10mg QD, and Aquaphor QID. The medications help some, but he’s still uncomfortable.
Below is a list of questions of subjective information that I would ask the patient’s mother to help formulate the differential diagnoses and plan:
1. Has your child been diagnosed with or currently being treated for asthma? Kampe et al., (2017) discussed the incidence of different skin conditions in both allergic and non-allergic asthmatic patients; explaining that self-reported allergic rhinitis and eczema were the most relevant skin conditions for this group of patients.
2. Does your child have any history of environmental allergies that you know of?
3. Does your son have any allergies to medications?
4. Is your son experiencing any respiratory symptoms?
5. Have you used any new skin products on your son, such as a new detergent, body lotion or body wash product?
6. Has your child ever required a dermatology evaluation for this condition?
7. Does your child exhibit signs of runny nose or watery eyes?
8. Does your child complain of secretions in the back of his throat?
9. Has your child experienced a fever with this type of condition?
10. Has the rash spread to any other areas of the body other than what you have mentioned?
11. Is there anything that makes the rash worse?
12. Is your son taking any new medications other than what you mentioned?
13. Are there any pets in the home?
14. Has your son been bitten by an insect or tic?
15. Has your son traveled anywhere within the last 30 days?
16. Has your son had any exposure to sick contacts?
17. Does your son have any food allergies? Research states that people who have food allergies have an increased risk of developing other conditions such as asthma and atopic diseases; the association between these two conditions can progress to a severe state causing anaphylaxis.
18. Have you prepared any new foods or has your son eaten anything unusual?
Foong, R.X., du Toit, G., & Fox, A.T. (2017). Asthma, food allergy, and how they relate to each other. Frontiers Pediatrics, 5(89). doi:10.3389/fped.2017.00089
Kampe, M., Vosough, M., Malinovschi, A., Alimohammadi, M., Alving, K., Forsberg, B.,..& Janson, C. (2017). Upper airway and skin symptoms in allergic and non-allergic asthma: Results from the Swedish GA2 LEN study. Journal of Asthma, 55(3), 275-283. https://doi.org/10.1080/02770903.2017.1326132