Value: 100 points
Due: Day 7
Gradebook Category: Final Exam
This Final Exam features 100 questions. Approximately 50% will be content from modules 10–14 and the remainder from the course as a whole.
Please review the course syllabus for the Exam Policy; you are responsible for knowing and adhering to these guidelines.
Note: Please complete this exam to test your knowledge of course concepts. Note that you can only attempt this exam once and that it must be completed in one sitting. Do not open the exam until you are ready to complete it. This exam requires the use of Respondus.
Your numerical score will be available upon the completion of this exam, but you will not be able to view the questions or answers once the exam has been submitted.
This quiz has been configured so that students may only attempt it using the Respondus LockDown Browser.
Attempts allowed: 1
Time limit: 1 hour 40 mins
Summary of your previous attempts
Reflective Response
Differential diagnoses
1. Atopic dermatitis is a chronic skin condition where it becomes inflamed and itchy (Howe, 2023a). This is an appropriate diagnosis because the patient has history of asthma which is one of the risk factors for atopic dermatitis (Howe, 2023a). He is also exhibiting cardinal signs such as dry skin and severe pruritis (Howe, 2023a). The patient is also exhibiting associated features of atopic dermatitis such as Dennie-Morgan lines and crust like lesions with serum oozing upon physical exam (Howe, 2023a). The patient also has a relapsing history of this similar skin condition when he was 6 years old and 4 years old which is consistent with Atopic dermatitis which usually has a early age of onset (Howe, 2023a). Skin biopsy and lab testing such as IgE levels are not indicated, however can be ordered to determine other skin conditions (Howe, 2023a).
2. Seborrheic dermatitis is a skin condition that usually affects the scalp and causes red itchy patches that are greasy (Sasseville, 2023). This diagnosis is a possibility because the patient is presenting with extensive redness and pruritis with multiple flare ups in the past (Sasseville, 2023). However, this diagnosis can be ruled out because he does not have salmon-red patches with greasy scale and his scalp is not involved (Sasseville, 2023). It is more common around areas with sebaceous glands such as the center of the face, outside the ear and upper trunk area which are not affected by this patient (Sasseville, 2023).
3. Psoriasis is a chronic skin condition that causes skin redness and silvery scales around the elbows, knees, lower back, face, and scalp (Feldman, 2023). This diagnosis is a possibility because it occurs frequently in children, his elbows are involved, and he has redness to his skin (Feldman, 2023). However, this diagnosis can be ruled out because he doesn’t have similar risk factors seen with psoriasis such as genetic factors, exposure to smoking, history of obesity and not taking medications that are often associated with worsening psoriasis such as lithium, beta blockers, antimalarials and NSAIDS and tetracycline (Feldman, 2023). Classic signs of psoriasis include Koebner phenomenon and Auspitz sign which the patient does not present with upon physical examination (Feldman, 2023).
4. Scabies is a contagious conditions caused by infestation of mites creating itchy skin (Goldstein, 2023). This diagnosis is considered because the patient is having itchy skin, however there is no sign of infestation upon physical exam and usually scabies is seen in the webs of the fingers, wrist, genitalia, and these areas are not involved with the patient (Goldstein, 2023). Again, this diagnosis can be ruled out if there are no presence of mites, mite eggs or fecal matter from the mites (Goldstein, 2023).
Final diagnosis: Atopic Dermatitis
Pharmacology
• Diphenhydramine 12.5 mg q 8 h
• Hydrocortisone 2.5% apply to skin two times per day for two to four weeks (Howe, 2023b).
Non-Pharmacology
• Warm baths to keep skin hydrated and provide cooling relief to skin (Howe, 2023b)
• Apply emollients, (petroleum jelly) to relieve itching and use wet wraps to soothe skin and reduce itching (Howe, 2023b)
Labs/ Diagnostics
• Diagnosis of AD is based on clinical findings (Garzon et al., 2019).
• Skin biopsy and lab testing such as IgE levels to rule out other skin conditions (Howe, 2023a).
• Patch testing to determine allergen to skin (Howe, 2023a).
Referrals/ Interprofessional Communications
• No referral is needed at this time. However, if the patient does not respond well to therapy can place referral to dermatology (Howe, 2023b)
• Referral to allergist (Howe, 2023b)
Patient Education
1. Avoid certain conditions that can trigger symptoms such as heat and low humidity (Howe, 2023b)
2. Find ways to relieve stress and anxiety such as through breathing exercises and meditation to reduce flare up (Howe, 2023b)
3. Apply emollients and moisturizers two times per day and right after shower and washing hands (Howe, 2023b)
4. Use mild or soap-free cleansers when taking showers or bath (Howe, 2023b)
5. Treat any bacterial or viral infection (Howe, 2023b)
6. Keep fingernails short to reduce skin scratching and worsening of skin (Garzon et al., 2019).
7. Evaluate for any food triggers (Garzon et al., 2019).
8. Encourage cotton clothing as they are more breathable and refrain from fabrics such as wool and nylon (Garzon et al., 2019).
9. Wash bedding in hot water weekly, vacuum the house frequently, and remove the carpet in order to reduce house dust mites (Garzon et al., 2019).
10. Antihistamines such as hydroxyzine can cause drowsiness and behavioral changes (Garzon et al., 2019).
11. Topical steroids can cause skin thinning, increase hair growth and cause bruises easily (Howe, 2023a).
Follow up
• Follow up in two weeks to determine if treatment effective (Howe, 2023a).
• If symptoms haven’t improved will evaluate alternative medication and referral to Dermatology (Howe, 2023a).
Health Maintenance
• The patient should be up to date with his immunization including the flu vaccine in order to prevent any asthma exacerbation and prevent a flare up for AD (Garzon et al., 2019).
Social determinant of health
· It is important for the patient to have access to health care and transportation to appointment (Garzon et al., 2019). Since he is a pediatric patient he relies on his parents to provide stability and access to health appointments and ensuring he gets his medication (Garzon et al., 2019). This is important to help prevent triggers and reduce flare up for AD (Garzon et al., 2019).
References
Feldman, S. R. (2023). Psoriasis: Epidemiology, Clinical manifestations, and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/psoriasis-epidemiology-clinical-manifestations-and-diagnosis?search=Atopic%20derminitis&topicRef=1729&source=see_link
Garzon, D., Starr, N., Brady, M., Gaylord, N., Driessnack, M. & Duderstadt, K. (2019). Burns’ pediatric primary care. (7th ed.). Elsevier Publishing Company.
Goldstein, B. G. (2023). Scabies: Epidemiology, clinical features, and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/scabies-epidemiology-clinical-features-and-diagnosis?search=Atopic%20derminitis&topicRef=1729&source=see_link
Howe, W. (2023). Atopic dermatitis (eczema): Pathogenesis, clinical manifestations, and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/atopic-dermatitis-eczema-pathogenesis-clinical-manifestations-and-diagnosis?search=Atopic%20derminitis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=2
Howe, W. (2023). Treatment of atopic dermatitis (eczema). UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/treatment-of-atopic-dermatitis-eczema?search=Atopic%20derminitis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=1#H605392661
Sasseville, D. (2023). Seborrheic dermatitis in adolescents and adults. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/seborrheic-dermatitis-in-adolescents-and-adults?search=Atopic%20derminitis&topicRef=1729&source=see_link
