SPECIALISTS EXAM
COMPREHENSIVE CASE STUDY IHUMAN WEEK #5 36 YRS-
OLD FEMALE REASON FOR ENCOUNTER ITCHY RASH
ACTUAL SCREENSHOOTS PROVIDED
SPECIALISTS EXAM
SPECIALISTS EXAM
SPECIALISTS EXAM
SPECIALISTS EXAM
IHuman -CASE- RASH QUESTION TO ASK
How can I help her today?
Does she have any other symptoms you would like to discuss?
What treatment has she had for the cough? Is she coughing
any sputum?What treatment has she had for the rash?
On what part of her body did the rash start and
where did it spread?Is her rash painful or itchy?
What treatment has she had for
the rash?Has she been having
fevers?
When did the fever
start?How high is
the fever?
Is she taking any over the counter
medication?How is her appetite any
recent change?
Did she have any other problems two to four days?
How many wet diapers does your child have
per day? How many stools diaper does your
child have per day?Does she have any
allergies?
DIAGNOSIS
Exanthema subitum HHV 6/ roseola
Human parvovirus 19 Rubella
(German measles)Measles
URI
NO TEST REQUIRED
History
Reason for encounter: rash on abdomen, b/l UEs and b/l Les
History of present illness: fever started 3 days ago, stopped
SPECIALISTS EXAM
SPECIALISTS EXAM
last eveningCough and rhinorrhea started 3 days ago
SPECIALISTS EXAM
SPECIALISTS EXAM
ROS
Gener
al(-)
fever
(-) significant weight change
(-) significant appetite
changeHEENT/neck
(+)
rhinorrhea
(+) cough
CARD
(-
)CP/pressure/disco
mfort(-) decrease in
activity
(-)
SOB
RESP
(-) SOB
(-) wheezing
(-) difficulty catching a
breath(-) chronic
cough
(-) sputum production
SPECIALISTS EXAM
SPECIALISTS EXAM
GI
diaper stools about 2
per dayGU
Diaper urine 4-5
per dayMSK….
NEUR
No history of seizures
INTEGUMENTARY/breast
(+) rash on abdomen, b/l UEs
and b/l LEsPsychiatric….
Endocrine
No history of diabetes,
endocrine/thyroid problems
Hemolytic/lymp
No history of
anemia
Allergic/Immuno
logic
No history of allergies, immunizations up to date
PMH
None
Hospitalizations/sur
geries:
Born full term 38 wees GA. Born via NSVD. No complications during
delivery or after birthPreventative health
Growing and developing well. Meeting all developmental milestones.
Medicati
onsnone
Allergies
NKDA
Immunizati
onsall up
to date
Social Hx
Lives in an apartment with both parents
Family Hx
Mother 32: healthy
Father 35: healthy
SPECIALISTS EXAM
SPECIALISTS EXAM
PHYSICAL
ASSESMENT
Skin/hair/nails
Inspection of
skin:
Skin is warm and dry. There is a maculopapular pink rash on abdomen and
extremities. Normal skinturgor
HEENT/neck:
Inspect eyes:
Eyelids: no ptosis, erythema or
swelling:Conjunctivae: pink, no
discharge Sclerae: anicteric
Orbital area: no edema, redness, tenderness or lesion
noted.Inspect pupils:
R pupil: normal reactive
SPECIALISTS EXAM
SPECIALISTS EXAM
L pupil: normal
reactiveInspect
ears:
Normal appearing external structures; no deformities or edema. No
discharge notedOtoscopic examination of ears:
Normal-appearing external auditory canals. Tympanic membrane translucent,
non-injected and pinkish-gray in color. No scaring, discharge or purulence
noted. Normal landmarks. Normal mobilitywit insufflation.
Nose inspection
No discharge/polyps. No edema/tenderness over the frontal or
maxillary sinuses.Look up nostrils:
Normal exam
Inspect mouth/pharynx:
No hoarseness; oropharynx not injected, clear mucosa, tonsils without exudate.
Tongue normal color,symmetrical, no swelling or ulcerations. Normal gag reflex.
Neck inspection:
No visible scars, deformities or other lesions. Trachea midline and freely mobile. No
asymmetry oraccessory respiratory muscle use with quiet breathing.
CHEST WALL & LUNGS
Visual inspection of AP chest:
The chest is symmetrical and the AP diameter is normal. The excursion with
respiration is symmetricaland there are no abnormal retractors or use of accessory
muscles. No distension, scars, masses or rashes.
Lungs
auscultation
Right clear
(normal)Left
clear (normal)
CARDIO
Heart auscultation:
Normal S1
S2
Lymphatic
:
No pathologically enlarged lymph nodes in the cervical, supraclavicular, axillary and
inguinal chains ABDOMAN:
Abdomen inspection: Flat symmetric with no scars, deformities, striae or lesions.
SPECIALISTS EXAM
SPECIALISTS EXAM
Abdomen palpation: No pain, tenderness, masses or pulsation abdomen
palpation. No guarding,rebound tenderness. No hepatosplenomegaly. Liver
span normal. The spleen is not palpable.
Abdomen auscultation: normoactive bowel sounds in all 4 quadrants
EXTREMETIES:
Visual inspection: no swelling or deformity. There is no cyanosis, clubbing or
edema.
Problem statement:
Gemma Jones is a 2-year-old girl, accompanied by her mother. The mother reports
a rash that started today on her abdomen this morning but it spread to her
extremities. Additionally, the mother reports cough, rhinorrhea, and fever that has
started 3 days ago (fever has resolved). Patient is up to date withall immunizations.
Or
Gemma Jones is a 2 years old girl that came in with CC of a nonpruritic rush that
has started on her abdomen today but progressed to her upper and lower
extremities. Three days prior she developed acough, runny nose, and fever (last
fever yesterday-resolved). The mother reports no change in
SPECIALISTS EXAM
SPECIALISTS EXAM
appetites. Wet and stool diapers are unchanged and adequate. She does not
have any medical orallergy history, and she lives home with both parents
Assessment/management plan
Exanthem subitum (Roseola) B08.20
Roseola is a generally mild infection caused by two strains of herpes virus. It's
common, usuallyaffecting children by age two. It occasionally affects adults.
Symptoms include several days of high fever, followed by a rash that may appear
as many smallpink spots. Other symptoms may include loss of appetite, irritability,
swollen lymph nodes, red spots on the soft palate, runny nose, or sore throat.
There is no specific treatment for roseola infantum. The majority of cases of
roseola infantum aremild and self-limited.
Treatment is supportive with rest, maintaining fluid intake and antipyretics such
as acetaminophen or ibuprofen to control the fever. Due to the rash likely being
nonpruritic, treatment is unnecessary. There is currently no vaccination or
antiviral therapy for the acute phase of this virus. Adequate hand washing is very
important to prevent the spread of the disease.
Tylenol oral suspension OTC
SIG: take 5ml PO every 4 hours as needed
Max dose 25ml/24 hours, do not exceed do not exceed 75 mg/kg/day from all
sources
Children's Advil oral suspension OTC
SIG: take 5ml PO every 6-8 hours as needed,
max 20ml in 24 hours give with food to avoid GI upset
Education: The rash should resolve within 24 hours. You can alternate Tylenol and
Ibuprofen forfever reduction. You should increase the child fluid intake and allow
for plenty of rest. Take all medications as directed and do not exceed the
recommended dosage. Do not give any other medications that have combined
acetaminophen or ibuprofen in medication.
Tylenol/acetaminophen is an over-the-counter medicine taken to relieve fever and
pain. It's a safedrug when used correctly for a wide variety of problems. The
dosage is based on the child’s weight/age. But too high a dose can make a child
very sick, so it's important to know how to properly give acetaminophen. When
SPECIALISTS EXAM
SPECIALISTS EXAM
administering the medication, make sure you a dropper, syringe, or cup that came
with the product to prevent overmedicating/overdose.
Side effects of Tylenol can include:
• Headache
• Nausea
• Rash
Advil/Ibuprofen/Motrin is a medicine used to reduce fever and pain as well. It is
considered asnonsteroidal ant-inflammatory drug. It also OTC medication and
just like Tylenol dosage is determined by weight/age of the child. Just like
Tylenol, this medication must be administeredwith a dropper, syringe, or cap
that came with the product to avoid overdosing.
Side effects that may occur with taking Advil:
SPECIALISTS EXAM
SPECIALISTS EXAM
• Upset stomach
• nausea,
• vomiting,
• headache,
• diarrhea,
• constipation,
• dizziness
• drowsiness
Allergy alert: Ibuprofen may cause a severe allergic reaction, especially in people
allergic to
aspirin. Symptoms may include hives, facia swelling, asthma, shock, etc.
Roseola infantum is a clinically diagnosed, self-limited illness that can be
treatedsymptomatically. It does not warrant a referral at this time.
SPECIALISTS EXAM
