[Professor’s name appears here]
[University name appears here]
[Date appears here]
QUESTION 1:
Insect bite:
Insect bites are common in tropical areas and can produce skin rash with leg sparing depending on the site of the bite. They can even mount an immune reaction which can cause erythema.
Seabather’s eruption (Monckton et al., 2011)
It is the eruption of the rash and it occurs due to the bite of sea larvae. Two common marine larvae are thimble jelly fish and sea anemone.
Contact dermatitis:
It is the inflammation of the dermis of the skin. There is infiltration of the immunoglobulins and cellular components due to constant irritation of the skin. It is usually elicited by a foreign object recognized as an allergen.
Patient has a history of travel to Florida which can harbor tropical disease. Florida has a coast line and it is possible that he contracted heat rash from exposure to the sunlight while being at the beach. The history of contact allergy is ruled out. Also, particular attention is noteworthy over the type of the rash which spares the legs.
The differential diagnoses for case study 4 are:
Recurrent Tonsillitis:
Tonsila are a the lymph nodes guarding the oral cavity. Bacterial infiltration leads to nidus formation and constant irritation from it causes pus formation, swelling and pain.
Bacterial pharyngitis”
The walls of the pharynx are infiltrated with bacteria causing infection.
In this scenario, middle aged female complains of recurrent throat infection. On examination there is tonsillar erythema without exudates which can point out the viral etiology of the disease. Although. Presence of high grade fever can point towards bacterial etiology.
QUESTION 2:
In the above scenario, it is very essential to note that the type of disease and the etiology can be easily reached if great attention is given to the patient history. Medical personnel should give equally importance to physical examination findings as well. Like for instance, in the first scenario, the history of travel, no known drug allergy, pattern of rash distribution and similarly the physical findings like the characteristic, size and consistency of the rash are very indicative of a particular disease.
QUESTION 3:
In the first scenario, it is advisable to give patient anti-histamines. For the rash, topical corticosteroids should be given. Importance of personal hygiene should be emphasized and appropriately delivered to the patient.
In the fourth scenario, the fever should be adequately managed by administering paracetamol. Since there is swelling and tenderness, patient should be given intravenous fluids. A broad spectrum antibiotic should be given after taking throat swab and then switching to a sensitive anti-biotic. A complete blood picture should also be sent to see the white cell count and differential count.
References
Ely, J., & Stone, M. (2016). The Generalized Rash: Part I. Differential Diagnosis. American Family Physician, 81(6), 726-734. Retrieved from http://www.aafp.org/afp/2010/0315/p726.html
Monckton, R. et al. (2011). Pruritic erythematous maculopapular rash. The Journal Of Family Practice, 60(10), 613-615. Retrieved from http://www.jfponline.com/specialty-focus/dermatology/article/pruritic-erythematous-maculopapular-rash/a87bfda4e008aa8147fbf3c975acd5cd.html
