Assignment 1: Lab Assignment: Differential Diagnosis for Skin Conditions
Properly identifying the cause and type of a patient’s skin condition involves a process of elimination known as differential diagnosis. Using this process, a health professional can take a given set of physical abnormalities, vital signs, health assessment findings, and patient descriptions of symptoms, and incrementally narrow them down until one diagnosis is determined as the most likely cause.
In this Lab Assignment, you will examine several visual representations of various skin conditions, describe your observations, and use the techniques of differential diagnosis to determine the most likely condition.
To Prepare
- Review the Skin Conditions document provided in this week’s Learning Resources, and select one condition to closely examine for this Lab Assignment.
- Consider the abnormal physical characteristics you observe in the graphic you selected. How would you describe the characteristics using clinical terminologies?
- Explore different conditions that could be the cause of the skin abnormalities in the graphics you selected.
- Consider which of the conditions is most likely to be the correct diagnosis, and why.
- Search the Walden library for one evidence-based practice, peer-reviewed article based on the skin condition you chose for this Lab Assignment.
- Review the Comprehensive SOAP Exemplar found in this week’s Learning Resources to guide you as you prepare your SOAP note.
- Download the SOAP Template found in this week’s Learning Resources, and use this template to complete this Lab Assignment.
The Lab Assignment
Choose one skin condition graphic (identify by number in your Chief Complaint) to document your assignment in the SOAP (Subjective, Objective, Assessment, and Plan) note format rather than the traditional narrative style. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in this week’s Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
- Use clinical terminologies to explain the physical characteristics featured in the graphic. Formulate a differential diagnosis of three to five possible conditions for the skin graphic that you chose. Determine which is most likely to be the correct diagnosis and explain your reasoning using at least three different references, one reference from current evidence-based literature from your search and two different references from this week’s Learning Resources.
week’s Learning Resources
http://www.skinsight.com/professionals
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Chapter 28 Rashes and skin lesions see attached documents
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WEEK 4 Assignment 1: Differential Diagnosis for Skin Conditions sample soap note
The purpose of this SOAP note is to describe various skin condition presentations, focusing on a particular example given. It will use medical terminologies to describe the skin condition given and provide a more probable diagnosis based on the appearance (Bnedetti, 2019). The SOAP note will also suggest differential diagnoses for the same skin condition, which can be eliminated based on the clinical presentations of the condition to reach the definitive diagnosis.
Skin Condition Picture 3
Week 4
Skin Comprehensive SOAP Note Template
Patient Initials: _JM______ Age: __29____ Gender: ___M___
SUBJECTIVE DATA:
Chief Complaint (CC): “I have been having this itchy rash on my beard for 2 weeks”
History of Present Illness (HPI): JM is a 29-year-old white male who presented at the emergency department alone and walking unsupported with a complaint of an itchy red rash on his beard that started about 2 weeks ago. He explains that when it started, he did not think but was serious because it was just a simple itch without any rash or pain. He only got worried when the rash did not go away and he developed painful blisters. The rash is located on the right side of his chin and has red swollen blisters with watery secretions. It is associated with partial hair loss on the affected area. The itch is relieved by scratching but he says this makes the pain worse by rupturing the blisters. There are no other associated symptoms and the pain is equal at all times and has no variations.
He reports that he has been using OTC paracetamol for the pain and applying petroleum jelly on the area. These helped a little with the itch.
Medications: Paracetamol 500 mg TID
Allergies: Allergic to penicillin medication, gives him skin rash and swelling
Past Medical History (PMH):
Childhood asthma that resolved at age 10 years
Past Surgical History (PSH):
No past surgeries
Sexual/Reproductive History:
He identifies as a heterosexual male, not married but he is in a committed relationship with his girlfriend of 4 years. The have a son together and are planning to get married soon.
Personal/Social History: JM is a 29-year-old male patient. He is a lawyer and works at local law firm. He is not married yet but has a girlfriend and son. He says he does not smoke tobacco/ cigarettes. He however drinks beer occasionally when he goes for parties. He takes about three beers per party. He denies use of illicit drugs. Patient says he is a Catholic but only attends church on special occasions like Christmas.
Health Maintenance:
He is an active member of a local gym where he exercises thrice a week. He also jogs every morning before work. He lives with his girlfriend and son in a supportive neighborhood. He has annual dentist appointments.
Immunization History: He reports having received all this childhood vaccinations as recommended, and takes the seasonal flu shot.
He recently received COVID-19 vaccines, all doses as recommended.
Significant Family History:
Mother 58 years has diabetes type 2.
No history of other chronic illnesses in the family.
REVIEW OF SYSTEMS:
General: reports no fever, fatigue, or recent trauma. He also reports no recent changes in appetite, diet, or weight.
HEENT:
He reports no headaches, no dizziness, no changes in vision, no tinnitus, no sore throat, no bleeding gums, no difficulty or painful swallowing, no ear discharges, no blood
Respiratory:
The patient denies difficulty breathing or breathlessness with any activity. Reports no cough, no wheezing. No history of exposure to smoke.
Cardiovascular/Peripheral Vascular:
Patient denies having palpitations, no shortness of breath with activities, and no chest pains.
Gastrointestinal:
He denies diarrhea, nausea, or vomiting. He reports good bowel movements, no constipation.
Genitourinary:
Patient denies pain associated with urination, he also reports clear urine, no blood. No urgency or increased urination frequency. Denies terminal hesitancy or dribbling of micturition. No abnormal urethral discharge.
Musculoskeletal:
He denies pain or swelling in joints and muscles in both the lower and upper extremities. The patient states that he can easily play ball with his 2-year-old son without any difficulties.
Neurological:
He denies having headaches or dizzy spells. No memory loss. Denies abnormal/involuntary movements. No numbness or tingling sensations in extremities or face.
Psychiatric:
Patient denies any extreme emotional distress. He reports no auditory or visual disturbances and no feeling of self-harm.
Skin/hair/nails:
Patient complains of a big-blistered rash on his left beard. The rash is painful and oozes a clear foul-less fluid. He also reports hair loss in patches on the affected area.
He reports no change on the nails such as abnormal discoloration. He reports no other skin changes in any parts of the body.
OBJECTIVE DATA:
Physical Exam:
Vital signs: Temperature 98.6 (37C), PR 98 beats/min, RR 20 breaths/min and strong, O2 Sat 100% on room air, BP 125/78 mmHg
General: Patient is A & O, in fair general condition, well-groomed, and dressed appropriately according to the weather.
HEENT: Head is normal size, no masses, no lesions, no scars, good hair distribution throughout the scalp, no rashes, and no tenderness on palpation.
Neck: Trachea is midline. No masses, no lumps, or edema. No lymphadenopathy. No distended vessels.
Chest/Lungs: On inspection, the chest rises symmetrically with respiration, no masses, no lesions, no gynecomastia. No surgical/traumatic scars. The chest is resonant to percussion throughout. Normal vesicular breath sounds were heard on auscultation, no added breath sounds.
Heart/Peripheral Vascular: Apex beat felt on palpation, S1 and S2 heard. No murmurs, rubs, or gallops.
Abdomen: Abdomen is of normal fullness, no distension and moves with respiration. No lesions of obvious swelling, and no scars seen. The umbilicus is inverted. No tenderness on light palpation. On deep palpation, no masses, no organomegaly felt. Bowel sounds present on all 4 quadrants, no bruits.
Genital/Rectal: The patient reports that he does not have any issues with the genital. He refused thorough examination.
Musculoskeletal: No edema/swelling in upper and lower extremities. He can differentiate sharp, light, and dull touch on both extremities. The normal color of nails for race and ethnicity. Symmetrical muscle development in upper and lower extremities. Good muscle tone and strength. Good motion range in all joints. Absence of crepitus, inflammation, edema, and tenderness. Muscle strength is 5/5 in all groups
Neurological: A&O x4 in time, place, and person. He is able to follow and understand simple and complex commands. Good recent and remote memory. Cranial nerves II -XII are grossly intact. Deep tendon reflexes were intact. Able to differentiate soft, hard, blunt, and sharp sensations on upper and lower extremities. He can also distinguish between hot and cold temperatures.
Skin: There is a notable red rash on the beard, partial hair loss was noted on the affected area. Red pruritus blisters are seen. No other areas of the skin were affected.
Diagnostic results& tests:
Direct microscopic examination or,
Fungal culture – for micro-organism identification (Vazheva & Zisova, 2021).
Potassium hydroxide wet mount of plucked hairs/ scales
ASSESSMENT:
Diagnosis- Tinea barbae (Kuruvella, & Pandey, 2021)
This is the most likely diagnosis for the patient based on the location and distribution of the rash on the beard only. The rash usually forms a solitary patch that is circular, with raised scaly edge. It has ring-shaped central hypopigmentation (Bnedetti, 2019). The border can be popular and itch is always common. This is typical with the patient description.
DDx: Based on the characteristics of the skin lesion, the other differential diagnoses most likely could be as follows; (Bnedetti, 2019).
- Allergic contact dermatitis
- Bacterial folliculitis
- Pseudofolliculitis barbae
- Acne vulgaris
- Cutaneous candidiasis
Conclusion
The diagnosis of skin conditions always requires a keen examination of the characteristic resonation of various rashes or lesions they produce (Bnedetti, 2019). Lab diagnosis is used to identify particular organisms causing the condition. Proper diagnosis helps in early treatment and prevention of recurrence.
PLAN: This section is not required for the assignments in this course (NURS 6512), but will be required for future courses.
References
Bnedetti J. (2019). Description of Skin Lesions. MSD MANUAL Professional Version. https://www.msdmanuals.com/professional/dermatologic-disorders/approach-to-the-dermatologic-patient/description-of-skin-lesions
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care.
Kuruvella, T., & Pandey, S. (2021). Tinea Barbae. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK563204/
Vazheva, G., & Zisova, L. (2021). Tinea barbae profunda caused by trichophyton rubrum – an autoinoculation from a primary tinea pedis. Folia Medica, 63(2), 292-296. https://doi.org/10.3897/folmed.63.e54559