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Case: Krista Hampton

IHUMAN CASE STUDY 5 KRISTA HAMPTON UPDATED 2024 WITH
COMPLETE SOLUTION
Instructions: Type patient encounter information directly into each box of the template similarly to your case studies
...
Hampton is a 25 y/o female presenting with an itchy and tender

“I have this ugly looking rash on my upper thighs”

rash bilaterally on her inner thighs, and her left inner forearm
...
She states
she spent time hiking, tried a new sunscreen, tried new foods such as scallops
and a new drink, as well as spending time in the hot tub with her boyfriend
...


PMHx:
Child: “usual coughs and tummy ache nothing
remarkable
...

Grandmother (age 88) has prior heart attack, stent
and HTN
...

Father alive and well, treated for HTN
...

Sister - 21 alive and well
...
”

Ceclor (Cefaclor) second generation cephalosporin – Patient developed hives

Menstruation cycle duration: “seems fine to me,”

as child when taking this antibiotic for otitis media

regular periods
Sexual hx and concerns: Denies concerns

List of Current Medications/supplements: Birth control pill

LMP: unknown

Supplements: None

Breast screening: Conducts self-breast exams
Last Pap Smear: 1 year ago, with no signs of
abnormalities
Gravida para status/Childbirth hx:
Nulliparous

Case: Krista Hampton
Review of Systems: (ROS) Use this column to

From the ROS: list/highlight the current symptoms/complaints to

document the ROS below
...
States
normal bowel movements
GU: Denies pain, burning, blood in urine, denies
difficulty starting or stopping urinating, dribbling,
incontinence, urgency during night or day, or any
changes in the frequency of urination
MS: Denies muscle weakness, joint pain, stiffness,
or swelling
Heme: Denies bruising, bleeding gums, nose
bleeds, abnormal bleeding, or history of anemia
Endocrine: Denies heat and cold intolerance,
increased thirst, increased sweating, frequent
urination, or changes in appetite
Derm: Patient states” Ugly looking rash on my
upper thighs, now it’s on my left inner forearm
too”, rash is “itchy and getting more tender”
D wnloaded by: Topm ostScholar | ngura89@gmail
...


to generate a list of pertinent “(+) or (-)” symptoms below:

Vitals: Height: 5' 5" (165
...
0 kg) (BMI 20
...
6 F (oral)
Pulse: 76 bpm - regular
Blood pressure: 116/62 mmHg - supine/sitting

D wnloaded by: TopmostScholar | ngura89@gmail
...
Left inner forearm is noted with itchy
swelling
...
Bilateral inner
erythematous papules in linear configuration
thighs noted with raised confluent erythematous papules 10x12cm with
with vesicles
...
Conjunctivae pink, no discharge
...
com
Distribution of this document is illegal

Neck: Deferred
Pulm: Respirations even and unlabored bilaterally,
good chest wall expansion, lung sounds clear to
auscultation bilaterally both anterior and posterior
CV: Heart rate and rhythm normal, no significant
change while standing, squatting and during
Valsalva maneuver, no JVD
...
Hampton is a 25 y/o female presenting with an

reviewed today during virtual visit

itchy and tender rash bilaterally on her inner thighs, and her left inner
forearm
...


boyfriend
...


foods such as scallops and a new drink, as well as spending time in the hot
tub with her boyfriend
...
Upon
examination, the left inner forearm is noted with itchy erythematous papules
in a linear configuration with vesicles
...


List the differential diagnoses (Must not
Miss/Leading/Alternate/Concluding – total of 3
*Include ICD 10 codes after each

Plan
Treatment:

•

Steroid creams or ointments
...
MNM/Leading/Concluding: Allergic Contact Dermatitis L23
...
MNM: Cellulitis L03
...
MNM: Herpes Zoster (Shingles) B02
...
A
topical steroid may be applied one or two
times a day for two to four weeks
...
In severe cases, your
doctor may prescribe oral corticosteroids
to reduce inflammation, antihistamines to
relieve itching or antibiotics to fight a
bacterial infection
...


•

Most adults require an initial dose of 4060 mg
...


•

The systemic corticosteroids must be
administered for 2 weeks, because shorter
courses are notorious for allowing poison
ivy dermatitis to relapse
...


To help reduce itching and soothe inflamed skin,
try these self-care approaches and education:

D wnloaded by:

•

Avoid the irritant or allergen
...


•

Your doctor may give you a list of products
that typically contain the substance that
affects you
...


•

Apply an anti-itch cream or lotion to the
affected area
...


•

A steroid ointment may be applied one or
two times a day for two to four weeks
...


•

Take an oral anti-itch drug
...


•

Apply cool, wet compresses
...


•

Repeat several times a day
...


•

Trim your nails
...


•

Topical soaks with cool tap water
...
com

tsp/pint) can be soothing
...


Some individuals with widespread vesicular
dermatitis may obtain relief from lukewarm
oatmeal baths
...


•

Sprinkle the water with baking soda or an
oatmeal-based bath product
...


•

Rinse and dry hands well and gently after
washing
...


D wnloaded by: TopmostScholar | ngura89@gmail
...
For example,
plastic gloves lined with cotton are good if
your hands are often wet

Consultation and/or referral: N/A
Follow up: If symptoms do not improve or worsen
after treatment

IHUMAN TOTAL CASE SCORES:
#1: 100

Based on patient’s age/risk factors, what
preventive screening would be recommended at
today’s or a future visit:
STI screening
Flu vaccine if necessary
Well woman’s exam with pap smear every 3 years
per guidelines

Reflective Thinking Exercises
Instructions: Review the Case summary of your IHUMAN case, noting strengths and areas of needed improvement
...
Essay should be no longer than 1-1
...
Points will be
assigned as to the quality/depth of the student’s reflection
...
History-Taking: Describe your history taking scores and strengths you identified when gathering data
...
Note any missed areas that
could be safety issues/errors leading to missed or incorrect diagnosis
...
The number of questions required by the expert were not
that many in number and were easily discovered by using OLDCARTS
...
That concept threw me off because I
always go through the ROS in order to rule out any other accompanying symptoms/and systems
...
Physical Exam: Describe your physical exam scores and strengths you identified when performing selected exams on your
patient
...


The physical exam the expert was looking for was a very focused exam with focus on the eyes and skin
...
The patient had a rash that was on her thighs bilaterally, I thought it was appropriate to check the GU system, at least
externally to make sure there was no spreading to the vaginal/labia area
...
I am still leaning towards being more thorough than missing something yet staying within a short time
frame
...
Evidence-based decision making: Discuss the evidence-based resource(s) utilized while seeing the patient
...
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wra8d9i@
d gymoauil
...


4
...


I am still working on conducting a focused exam versus being nervous to miss anything
...
The suggested system was only integumentary in this case
...
It is still a challenge for me to select the appropriate
diagnostic tests for each individual diagnosis
...


References

Cellulitis | Cellulitis treatment | MedlinePlus
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d
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https://medlineplus
...
html
Contact dermatitis - Symptoms and causes
...
Mayo Clinic
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mayoclinic
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(2007, January 1)
...
https://www
...
com/skin-problems-and-treatments/contact-dermatitis

Shingles
...
WebMD
...
webmd
...
(n
...
WebMD
...
webmd
...
htm

UpToDate
...
d
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uptodate

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