psoriasisa 58 year old male presents H e a l t h M e d i c a l

Answer and turn in the questions on all case studies below. Give References

1. Case study on Psoriasis

A 58 year old male presents to your clinic with a complaint of itchy patches of red skin on his arms bilaterally. The patches are covered with loose, silvery, dry skin. The patient denies any known contact with allergens. He denies fever and any symptoms of illness. He states he has had this problem twice before, however the lesions went away in the course of a few weeks and he did not seek medical treatment. The patient’s vital signs are stable and he is afebrile. He has not medical history and admits to smoking one pack of cigarettes per day. On exam, you note large, plaque-like lesions over his elbows and forearms. You also observe one similar lesion to his scalp. This patient’s fingernails also appear discolored and pitting is noted. The lesions are covered with loose, flaky dry skin. They are non-tender and are not warm to the touch. Based on the appearance of these lesions, you quickly diagnose this patient with psoriasis. You elect not to confirm your diagnosis with a skin biopsy as based on the typical presentation of this case, you are certain of your diagnosis.

1. Why are you so sure of your diagnosis?
2. What things or events could have triggered this patient’s outbreak?
3. Why shouldn’t a topical medication be an option for treatment in some cases?
4. What is the preferred treatment for Psoriasis?
5. Identify 7 clinical manifestations that are identifiable in this disorder

2. Case studies on Impetigo

Case One: While working at XYZ Pharmacy, VM, a pharmacist, is approached by a mother and a 5-year-old boy, DS. The mother asks VM for his opinion on how to treat her son because the skin on his hands, feet, elbows, and knees is peeling. She denies that her son has recently had a sunburn or been exposed to irritating chemicals.

After further questioning, VM learns that DS was diagnosed with “strep throat” 2 weeks ago. A few days after starting treatment for his infection, his tongue was coated white. He also developed a rash on the trunk of his body. The rash was worse under his arms and between his legs. The mother described the rash as “feeling like sandpaper.”

On examination, VM notes peeling skin on the boy’s hands, feet, elbows, and knees. VM sees that the skin on the boy’s face also is starting to peel. VM tells the mother that he suspects that the boy is recovering from a mild case of scarlet fever. Scarlet fever is a complication associated with streptococcal infections. It often develops after a strep throat infection. VM assures the mother that scarlet fever is not contagious.

The mother wants to know whether she needs to take her son to the pediatrician or if there is an OTC treatment. Is treatment necessary for the boy’s peeling skin? Why?

Case Two: While working at a missionary clinic in an underdeveloped country, a pediatrician is assisting in examining patients who come for treatment. OB, a 3-year-old boy, is brought to the clinic with a facial rash. According to OB’s mother, the rash started 4 days ago as little red bumps below his nose. The rash has spread around his mouth and chin. The rash also has changed in appearance to flat, reddened areas with fluid-filled pustules.

On physical examination, the pediatrician finds OB to be a content and alert child in no acute distress. His vital signs are stable and within normal limits. The pediatrician notes that some of the pustules have ruptured, leaving weepy, red lesions and honey-colored crusts. The affected area is not excessively warm or swollen.

The pediatrician suspects that OB has impetigo. He explains to the mother that impetigo is a contagious condition that requires treatment with antibiotics. He knows that the most common pathogen causing impetigo is Staphylococcus aureus, with possible group A streptococcal co-infection. The pediatrician is aware that impetigo was traditionally treated with penicillin, but resistance has limited the usefulness of this antibiotic. Instead he hopes to use an antibiotic that effectively will cover staphylococci and streptococci.

As the pediatrician checks the supplies of medications available in the clinic, the mother comments that OB will not take any medications by mouth. She asks whether there are any medications that can be applied to the rash, rather than given by mouth.

Are there any topical options available to treat OB’s impetigo? Name a few of them and give your recommended one and why.

3. The Case of the Aging Surfer

Seth, a thirty-eight year-old white male of Scandinavian descent, has lived his entire life in Southern in Florida. He is very concerned with maintaining a “healthy” appearance. Seth is very athletic and especially enjoys surfing. He has been surfing since the age of twelve and he started making surfboards while he was in high school. After obtaining a college degree in marketing Seth decided to start his own business making surfboards and giving surfing lessons for a local resort near his home. During a routine physical examination the physician assistant that Seth sees commented on the presence and appearance of a small growth (approximately 2-cm in diameter) above Seth’s right eyebrow. This growth was shiny with a pearly border, a central ulcer and engorged surface blood vessels. The physician assistant was concerned that this might be a tumor and asked Seth a number of questions to aid in the diagnosis. Seth reported that he noticed this growth approximately six months ago but thought nothing about it since he often developed “pimples” when he was working on surfboards because of the heat and dust. Seth noticed that the growth would occasionally bleed, but he thought the bleeding most often occurred when he absently scratched above his eyebrows when he was working. Seth also reported that after bleeding the growth would “crust over” and appear to heal, but not disappear. Seth also thinks the lesion has increased in size, but he can’t be certain.

The physician assistant asks Seth to come back in two days to visit with the attending physician and encourages Seth to be sure to use sunscreen whenever possible, especially when he is surfing or teaching surfing classes. Upon returning to see the physician, Seth is told that he probably has a basal cell carcinoma. This, the physician explains, is a cancer that while not benign, rarely metastasizes and grows very slowly. This type of cancer usually occurs in areas that have the greatest exposure to the sun (i.e. the face, head, and neck). While this cancer would probably not metastasize, the physician suggests surgical removal to minimize damage to any underlying tissues and a histological examination of the excised tissue to confirm the diagnosis.

Seth is concerned that if this is indeed cancer he will have to undergo radiation and/or chemotherapy and suffer from both hair loss and nausea like his mother did when she was being treated for breast cancer 10 years ago. The physician assures Seth that these treatments are not required for basal cell carcinoma and explains that this cancer usually remains localized to the specific area of the skin and does not usually spread to other tissues, so radiation and chemotherapy would not be necessary. Seth then asks why it is necessary to remove the tumor if it will not spread and is told that while the tumor does not spread to other body areas it will continue to grow and also invade deeper layers of the skin, such as the dermis, and destroy normal tissues. Seth agrees to the procedure and schedules a follow-up appointment to discuss the results of the biopsy the following week. At the follow-up appointment, Seth is told that the lesion was indeed a basal cell carcinoma. He is told that it will be important for him to try to use both sunscreens, specifically those containing para-amino benzoic acid or PABA, and protective clothing as much as possible to minimize the effects of the ultraviolet (UV) rays of the sunlight. Seth is also told that while he should not be overly concerned, he should also pay close attention for similar lesions in the future, since a person with a single basal cell carcinoma is likely to develop additional basal cell carcinomas in the future.

1. Define those unfamiliar terms (to you) in the text.

1. How are benign and malignant tumors similar and different from each other?

1. Describe the anatomy of the skin and the relationship of these layers to the type of cancer that Seth presents with.

1. What are oncogenes and how are they believed to be related to cancer?

1. Identify both the primary risk factors that Seth presents with and other risk factors that may or may not be related to Seth’s case.

1. How do chemotherapy and radiation therapy act as treatments for cancer?

1. Why does chemotherapy cause the side effects of hair loss and nausea?

4. CASE on melanoma

A 10 year old boy who lived in Florida all of his life was diagnosed with melanoma. The boy previously had a mole that was ignored.

1. Why is melanoma the deadliest type of skin cancer?
2. List the methods that may be used to reduce the likelihood of developing melanoma
3. How is melanoma differentiated from the other types of skin cancer? What are the possible treatments?

1. Case study on Psoriasis

A 58 year old male presents to your clinic with a complaint of itchy patches of red skin on his arms bilaterally. The patches are covered with loose, silvery, dry skin. The patient denies any known contact with allergens. He denies fever and any symptoms of illness. He states he has had this problem twice before, however the lesions went away in the course of a few weeks and he did not seek medical treatment. The patient’s vital signs are stable and he is afebrile. He has not medical history and admits to smoking one pack of cigarettes per day. On exam, you note large, plaque-like lesions over his elbows and forearms. You also observe one similar lesion to his scalp. This patient’s fingernails also appear discolored and pitting is noted. The lesions are covered with loose, flaky dry skin. They are non-tender and are not warm to the touch. Based on the appearance of these lesions, you quickly diagnose this patient with psoriasis. You elect not to confirm your diagnosis with a skin biopsy as based on the typical presentation of this case, you are certain of your diagnosis.

1. Why are you so sure of your diagnosis?
2. What things or events could have triggered this patient’s outbreak?
3. Why shouldn’t a topical medication be an option for treatment in some cases?
4. What is the preferred treatment for Psoriasis?
5. Identify 7 clinical manifestations that are identifiable in this disorder

2. Case studies on Impetigo

Case One: While working at XYZ Pharmacy, VM, a pharmacist, is approached by a mother and a 5-year-old boy, DS. The mother asks VM for his opinion on how to treat her son because the skin on his hands, feet, elbows, and knees is peeling. She denies that her son has recently had a sunburn or been exposed to irritating chemicals.

After further questioning, VM learns that DS was diagnosed with “strep throat” 2 weeks ago. A few days after starting treatment for his infection, his tongue was coated white. He also developed a rash on the trunk of his body. The rash was worse under his arms and between his legs. The mother described the rash as “feeling like sandpaper.”

On examination, VM notes peeling skin on the boy’s hands, feet, elbows, and knees. VM sees that the skin on the boy’s face also is starting to peel. VM tells the mother that he suspects that the boy is recovering from a mild case of scarlet fever. Scarlet fever is a complication associated with streptococcal infections. It often develops after a strep throat infection. VM assures the mother that scarlet fever is not contagious.

The mother wants to know whether she needs to take her son to the pediatrician or if there is an OTC treatment. Is treatment necessary for the boy’s peeling skin? Why?

Case Two: While working at a missionary clinic in an underdeveloped country, a pediatrician is assisting in examining patients who come for treatment. OB, a 3-year-old boy, is brought to the clinic with a facial rash. According to OB’s mother, the rash started 4 days ago as little red bumps below his nose. The rash has spread around his mouth and chin. The rash also has changed in appearance to flat, reddened areas with fluid-filled pustules.

On physical examination, the pediatrician finds OB to be a content and alert child in no acute distress. His vital signs are stable and within normal limits. The pediatrician notes that some of the pustules have ruptured, leaving weepy, red lesions and honey-colored crusts. The affected area is not excessively warm or swollen.

The pediatrician suspects that OB has impetigo. He explains to the mother that impetigo is a contagious condition that requires treatment with antibiotics. He knows that the most common pathogen causing impetigo is Staphylococcus aureus, with possible group A streptococcal co-infection. The pediatrician is aware that impetigo was traditionally treated with penicillin, but resistance has limited the usefulness of this antibiotic. Instead he hopes to use an antibiotic that effectively will cover staphylococci and streptococci.

As the pediatrician checks the supplies of medications available in the clinic, the mother comments that OB will not take any medications by mouth. She asks whether there are any medications that can be applied to the rash, rather than given by mouth.

Are there any topical options available to treat OB’s impetigo? Name a few of them and give your recommended one and why.

3. The Case of the Aging Surfer

Seth, a thirty-eight year-old white male of Scandinavian descent, has lived his entire life in Southern in Florida. He is very concerned with maintaining a “healthy” appearance. Seth is very athletic and especially enjoys surfing. He has been surfing since the age of twelve and he started making surfboards while he was in high school. After obtaining a college degree in marketing Seth decided to start his own business making surfboards and giving surfing lessons for a local resort near his home. During a routine physical examination the physician assistant that Seth sees commented on the presence and appearance of a small growth (approximately 2-cm in diameter) above Seth’s right eyebrow. This growth was shiny with a pearly border, a central ulcer and engorged surface blood vessels. The physician assistant was concerned that this might be a tumor and asked Seth a number of questions to aid in the diagnosis. Seth reported that he noticed this growth approximately six months ago but thought nothing about it since he often developed “pimples” when he was working on surfboards because of the heat and dust. Seth noticed that the growth would occasionally bleed, but he thought the bleeding most often occurred when he absently scratched above his eyebrows when he was working. Seth also reported that after bleeding the growth would “crust over” and appear to heal, but not disappear. Seth also thinks the lesion has increased in size, but he can’t be certain.

The physician assistant asks Seth to come back in two days to visit with the attending physician and encourages Seth to be sure to use sunscreen whenever possible, especially when he is surfing or teaching surfing classes. Upon returning to see the physician, Seth is told that he probably has a basal cell carcinoma. This, the physician explains, is a cancer that while not benign, rarely metastasizes and grows very slowly. This type of cancer usually occurs in areas that have the greatest exposure to the sun (i.e. the face, head, and neck). While this cancer would probably not metastasize, the physician suggests surgical removal to minimize damage to any underlying tissues and a histological examination of the excised tissue to confirm the diagnosis.

Seth is concerned that if this is indeed cancer he will have to undergo radiation and/or chemotherapy and suffer from both hair loss and nausea like his mother did when she was being treated for breast cancer 10 years ago. The physician assures Seth that these treatments are not required for basal cell carcinoma and explains that this cancer usually remains localized to the specific area of the skin and does not usually spread to other tissues, so radiation and chemotherapy would not be necessary. Seth then asks why it is necessary to remove the tumor if it will not spread and is told that while the tumor does not spread to other body areas it will continue to grow and also invade deeper layers of the skin, such as the dermis, and destroy normal tissues. Seth agrees to the procedure and schedules a follow-up appointment to discuss the results of the biopsy the following week. At the follow-up appointment, Seth is told that the lesion was indeed a basal cell carcinoma. He is told that it will be important for him to try to use both sunscreens, specifically those containing para-amino benzoic acid or PABA, and protective clothing as much as possible to minimize the effects of the ultraviolet (UV) rays of the sunlight. Seth is also told that while he should not be overly concerned, he should also pay close attention for similar lesions in the future, since a person with a single basal cell carcinoma is likely to develop additional basal cell carcinomas in the future.

1. Define those unfamiliar terms (to you) in the text.

1. How are benign and malignant tumors similar and different from each other?

1. Describe the anatomy of the skin and the relationship of these layers to the type of cancer that Seth presents with.

1. What are oncogenes and how are they believed to be related to cancer?

1. Identify both the primary risk factors that Seth presents with and other risk factors that may or may not be related to Seth’s case.

1. How do chemotherapy and radiation therapy act as treatments for cancer?

1. Why does chemotherapy cause the side effects of hair loss and nausea?

4. CASE on melanoma

A 10 year old boy who lived in Florida all of his life was diagnosed with melanoma. The boy previously had a mole that was ignored.

1. Why is melanoma the deadliest type of skin cancer?
2. List the methods that may be used to reduce the likelihood of developing melanoma
3. How is melanoma differentiated from the other types of skin cancer? What are the possible treatments?