Squishy Case Studies

The patient was referred for a new itchy and tender bilateral groin lesions that the patient says will drain pus. He also has multiple other complaints. He gives a history of being allergic to DOXYCYCLINE. As previously stated, he has tender sites which can drain pus off and on in his groin for years. There is also history of facial acne and scalp acne since his late teens. He took Accutane during his 20s with improvement by history. He flared and repeated Accutane about one year after completing the first course by his history. He is bathing with unscented Dove and uses cocoa butter lotion. He also has a second problem of itching over his back, shoulders, and arms, and legs

Ms. C. is a 53 y/o female with admitted to 2A with complaints of severe right abdominal pain. She is a pleasant lady with a friendly demeanor and asks for very little assistance. Mrs. C is morbidly obese which makes it difficult to get out of bed without assistance but for the most part, she can ambulate and walk around on her own once she is out of the bed with the assistance of a walker. Because of her obesity, Ms. C has several skin folds throughout her body, which make a great medium for fungal infections. The area underneath her skin folds is red and irritated. Ms. C has had oliguria for the past several days and is outputting very little to no urine. A foley catheter has been placed in order to remove any

Per the medical report dated 03/29/2016 by Dr. Waghmarae, the patient believes that her left buttock pain has increased over the last month. She describes her pain as aching, throbbing and stabbing. She rates her pain symptoms as 8/10. Pain is relieved by medication, heat, ice and use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit, and is increased by movement and standing for long periods of time. She states that her bilateral legs have also increased in pain severity over the last month. She believes because she is doing a lot of standing and trying to clean up her house. She states that pain is increasing in her left buttock. She is not involved in physical therapy, chiropractic, massage therapy or acupuncture. Palpation of the lumbosacral spine reveals abnormalities along the bilateral facet joints. There is pain in her axial lower back in all planes of lumbar motion that is

According to R.P. she is allergic to sulfa (thrush), eggs, Allegra (cramps) and Penicillin (GI upset. Her past medical history consists of hypothyroidism, chronic sinusitis, endometrial cancer and a mitral valve prolapse. The conditions that required hospitalization was a surgical removal of the ovaries and a hysterectomy in year of 2006. R.P. also had surgery on the right elbow and an appendectomy, but was unable to recall the year. The medications that she is currently taking are levothyroxine, Claritin, Singular, Prilosec and propranolol. R.P. is currently up-to-date with immunizations of Td/Tdap in 2016 and vaccinations of pneumococcal 11/2016. Client refused influenza vaccine.

The patient that will be discussed is going to be referred to as “Ms. W.” She is a forty nine year old woman who is divorced, has three children, and does not work due to her behavior. Twelve years ago she began thinking she had a bug infestation in her skin. She says that although she has never actually seen the bugs, she can feel them under her skin. Ms. W claims that, they also cause her pain. She was referred by a dermatologist after there was no physical evidence of a medical skin condition.

Then there is generalized erythema rapidly followed by the development of flaccid blisters and desquamation, as seen in this patient. The mucous membranes are not involved, which is also consistent with our patient. The surrounding areas of her face were involved, but the mucous membranes were spared. This condition is also associated with a positive Nikolsky sign. A Nikolsky sign is the ability to extend the area of superficial sloughing by applying gentle lateral pressure on the surface of the skin at an apparently uninvolved site. This was found incidentally in our patient when the adhesive tape of an IV line was removed resulting in sloughing off of the skin below it. Furthermore, due to the sloughing off of skin with pressure, there tends to be increased desquamation in areas of mechanical stress like the flexural areas, buttocks, hands, and feet. If SSSS is suspected, cultures should be obtained from the blood, the urine, the nasopharynx, the perianal area, and any other abnormal skin or suspected focus of infection. The intact bullae are sterile and will come back without growth. In this patient, blood cultures had no growth to date and the pan-cultures from the mouth, nares, eyes, and anus were non-specific. Diagnosis for SSSS is usually clinical, although it may be confirmed with skin biopsy that shows a cleavage plane in the lower stratum

Upon inspection the contour of the patients abdomen was rounded, symmetric, color appropriate to genetic background, striae present, 6 to 8 round bruises from subcutaneous injections. No apparent pulsations, masses, lesions, rashes, wounds, ascites, scars, or hernias present. Auscultated bowel sounds in all four quadrants; hyperactive sounds heard in lower right quadrant, hyperactive sounds heard in upper right quadrant, normoactive bowel sounds in upper left quadrant, and hyperactive bowel sounds heard in lower left quadrant. Auscultated the aorta, renal arteries, and iliac arteries for vascular sounds, no bruits heard. Lightly palpated the abdomen in all four quadrants, patient felt tenderness on bruised areas, no masses present, abdomen distended. Percussed the abdomen in all four quadrants noting the predominately tympanic in all four quadrants and minimum dullness. The patient’s last bowel movement was around 0830, loose, with no pain. The patient stated having three to five loose bowel movements daily and that, “several bowel movements a day was common for her.” The patient describe the characteristics of her bowel movement as “watery, stinky, and not a large amount”. No prescription medication related to the abdomen. However, patient takes over the counter medication for frequent bowel movements at home. No surgeries related to the abdomen. No laboratory data related to the

A 25-year-old female presents to your clinic for evaluation of a mass in the vulvar area. This has been present for the last 1 week and tender to touch, there is no fever and no chills. Upon exam, you noticed that there is a medially protruding mass in the introitus area around a radius of 1.5 cm and tender to touch with some induration around the area. You advised the patient that the most likely diagnoses in this case are:

What are some differential diagnoses to consider? Based upon Mrs. S’s clinical presentation, what is the most likely diagnosis?

Skin:color consistent with ethnicity, dry, smooth, soft and warm to touch. No rashes or bruises present, nailbeds were pink. Temperature was 99.0F. No edema, jaundice or milia on her nose but a little peeling off her legs. No abnormal moisture or turgor

Patient Amy Ford has come into the office complaining of abdominal pain, increasing amounts of diarrhea and has been dehydrated. Amy is a very active 30-year-old with no children and travels all over the United States and stays at camp grounds in her RV. Amy has said that she previously bathed in a nearby lake at her camp site and has poor hand hygiene. Amy also enjoys hiking and traveling to different State land marks. Her overall health has been very good until approximately a month ago when the symptoms started. Her family history has no signs of heart disease or canner. She has come to the doctors because she thinks that something is wrong with her stomach or intestines.

A 29-year-old male comes from segregation and is shackled. Patient is seen today for concerns about swollen lymph node on left-side of his neck. He said it is painful with turning his neck and with palpation. He denies having pain with swallowing. Has not had chills, fever, change in appetite. Says he has partially been baseline due to his anxiety. He also continues to complain of generalized rash. He states that he has had this rash and swelling for the past four weeks. Rash kind of moves around different spots of his body. Currently, the only spot that the rash is present in is on the tip of his penis. Currently, does not have any swelling but states he has had swelling of joints

Skin- she has some mild equimosis on her skin and some anathema. She has patches but no obvious skin breakdown. She has no fissuring in the buttocks crease.

Patient is a 63-year-old right-hand white male who states that since April when he was in rehab for his left total knee replacement he has been having pain along his abdomen. He describes this as a band of numbness and dysesthesia. He outlines a strip involving T9-T11. He states this is mostly on the right. It does extend past the midline a little to the left, but is not significantly disturbing on the left. He gets spontaneous stabbing pain, tingling and dysesthesias in that area. Also, he is extremely sensitive to touch, more so anteriorly and laterally than posteriorly. Posteriorly, it goes to the mid-axillary line on the right and again it just extends past the midline to the left. He states that he did have a fall 12 years ago with a coccyx fracture. He has not had any recent injuries or recent x-rays. He does have some numbness and tingling in his feet, but it is not significant. He did not notice any vesicular rash on his torso at any time since the onset of these symptoms. He is unable to give any further history.

Mrs C.P. is a 54-year-old Caucasian female came to the clinic with complaints of abnormal vaginal bleeding associated with abdominal bloating, swelling, painful bowel movements, pelvic pain during the menstrual cycle, painful intercourse, pain in the lower back, breast tenderness, nausea and vomiting. She is married, lives with her husband, and has no children. She does work for Lee County School Board at Lee County in Florida. She is an established patient at Millennium Physician Group. Today, she came to the office for her annual gynecologic care visit. She didn’t take any medication for her symptoms. Her past medical history includes depression, headache/ migraines, osteopenia/osteoporosis, Chronic kidney disease stage 4, and allergic rhinitis.