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  • Q1:Management of Patients with Dermatologic Disorders Case Study Exam Please complete the following 2 case studies Case 1 A 24-year-old man who regularly bites his fingernails accidentally tears out a small piece of the corner of the nail on his right index finger. The damaged skin starts to bleed lightly, so the man presses on the area with a tissue until the bleeding stops. Two days later, the man notices that the finger has become infected. A small area of skin near the corner of the nail is red and swollen. The skin is yellowish white in the center of this area, where the swelling is most noticeable. The man, who knows just enough about infections to be dangerous, opts to treat himself. He "lances" the center of the swollen area with a needle that he sterilized by heating it in a candle flame. Pus then oozes out of the opening, confirming the presence of infection. The man presses and squeezes the area around the infection to force as much of the pus out the injured area as he can. He removes the exuded pus with a sterile cotton ball, cleans the finger with a topical antiseptic and covers the area with a small bandage. Five days later, the man develops a fever and severe pain in his forearm. His arm is swollen, red, and warm to the touch, so he gets worried and goes to the nearby ED for advice. On examination, he appears sweaty and hot. His temperature is 40.40C. There is a patchy red rash with poorly delineated edges on his right arm. The rash extends from the elbow to the shoulder. Lymph nodes in the axilla are enlarged and tender. You are the provider assigned to see the patient and you take the patient's recent history and learns about the nail infection incident. 1. What is your diagnosis? 2. What are the most likely causative agents? 3. How can you identify the causative agent? 4. Does this agent cause any similar diseases? 5. What other agents cause this disease?See Answer
  • Q2:Case 2 An 18-year-old male patient presented to the emergency department complaining of four days of increasing dysphagia, dysuria, photophobia, and a macular rash extending from the trunk toward the extremities. The only medication used by the patient was tetracycline, which he had been taking for two weeks as treatment for facial acne. Vital signs were normal except for a temperature of 103.1°F. He appeared ill and had copious amounts of ocular drainage as well as small vesicles on the nasal and oral mucosa. An erythematous rash on his chest coalesced on the trunk with many small vesicles, some forming bullae. Vesicles were also present on the penis and scrotum. On investigation, the patient's white blood cell count was slightly elevated at 11.7 × 109/L. Blood, herpes, and mycoplasma cultures as well as results of both rapid plasma reagin test and anti-DNA test were negative; and results of a skin biopsy were consistent with Stevens-Johnson syndrome. The presumptive cause was tetracycline. Empirical therapy with acyclovir was started but was discontinued after results of herpes culture proved negative. A regimen of 60 mg prednisone given intravenously twice daily was also started. When the oral lesions became so painful that the patient could not swallow his own saliva, a regimen of total parenteral nutrition was started, and the patient was given a patient-controlled anesthesia pump for administration of morphine. As the vesicles spread, they coalesced into larger bullae and sloughed off. The skin lesions were treated twice daily with a mixture of urea and triamcinolone in a lotion base. Multiple chest x-ray films showed no pulmonary involvement. Because of his need for increasing wound care, the patient was transferred to the intensive care unit. Ophthalmologic and urologic consultation was obtained to address ocular and urethral symptoms. The area of denuded skin increased, and this development required even more labor- intensive treatment; the patient was therefore transferred to the county burn unit for wound management. His condition improved during the next two weeks, and he eventually recovered with minimal scarring on the back. Follow up continued an outpatient basis in the ophthalmology, dermatology, and urology departments. Please discuss, in depth, each of the following related to Stevens-Johnson syndrome using evidence-based resources: 1. Incidence 2. Course of the disease 3. Etiology 4. TreatmentSee Answer

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