Week 6: Dermatologic and Musculoskeletal Disorders - Discussion Part Three
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This week's graded topics relate to the following
... [Show More] Course Outcomes (COs). 1
Discussion
Discussion Part Three (graded)
Responses
Lorna Durfee 6/6/2016 8:33:06 PM
Discussion Part Three
aK efeisvhear ,o af a1b3o-yueta 1r0-o4l.d0 fCem. aSlhee, haalsso c hoamse a i nratos hy oounr h uerrg feancte c aa rpeo csesinbtleyr .t hSeh eb ehgaisn nreindg c oofn aju rnacstihv ao,n a h ceor uagrhm as.n d About 10 days ago she was around another student who had similar symptoms.
• What is the differential diagnosis?
• What are some of the complications of this disease, assume that the top of your differential is the
definitive?
• Assume that the second item you place on your differential is the definitive diagnosis. What are some
complications of that disease?
Doctor Brown and Class:
13 year-old-female, red conjunctiva, cough, fever 104.0 with a rash.
Differential Diagnosis:
#1: Measles –
TThhee pCreondtreorsm faolr s Dymispeatosme Cs oarnet rtohla at nodf Pferveevre nasti ohnig ehx apsl a1i0n5 t.h0a tF M, aelsaos lceos uisg ha,n c aocruytzea v, iarnadl rceosnpjiurantcotriyv iitlilsn (etshse. tahprpeeea “rsC 1”s4) .d aTyhse arfet eisr eaxlspoo tshuer ed. e vTehleo pinmceunbta otifo nK opperliiko ds pcoatns raanndg eth ferno ma m7 atocu 2l1o pdaapyusl.a rT rhaes hr.a s Thh sep rreaashd s from the head and trunk and then the extremities (The Centers for Disease Control and Prevention, 2015).
iTnhcelu Cdeen otetirtsis f omre Ddiias,e absreo nCcohnotpronle uamndo Pnirae vaesn wtieolnl a(2s 0d1ia5r)r ehxepa laanind tlhaaryt nsogmotera ocfh ethoeb rcoonmcphliitcisa t(iTohnes Cofe mnteearss lfeosr eDviesreya s1e, 0C0o0n ctraosle as nodf Pmreeavselnetsi owni,l l2 d0e1v5e)l. o Mp ienatsol easc uctaen ecnacuespeh saelritiiosu, sa nildln tehsast. c Tanh ele faadc ttso a brrea tihna dt aomnea goeu.t Oofn e oDri stweaos eo uCto onft r1o,l0 a0n0d c Phirledvreennt iwonil,l 2d0ie1 5fr)o. m respiratory and neurologic complications (The Centers for
Complications: Moss and Griffin (2012) tell us that complications can occur in up to patients. Age and undernutrition increase the risk. Fatality is highest in infants and yo 4u0n gp ecrhcielndtr eonf. t he sPenceounmdaornyi av iisra tlh oer c boancdtietriioanl imnfoesct taiossno. c Iinat eimd mwuitnho mcoemaspleros-masisseodc ipaatetide ndtesa, tthhse. v Tirhues ccaauns ec aoufs Pe ngeiuanmt ocneilal is a aplnseou dmeovneiltoips. aCs rao ucpo,m optiltiicsa mtioend ioaf, tahned i dnifaercrthioena .a rTeh oetrhee ar rper roabrlee mcosm thpalitc caatino nosc csuurc.h Kase rcaotoncdoitniojunnsc tthivati tis can iPnevroivlvene ttrhiceu cleanr tdreaml nyeerlvinoautsi osny smteamy .a lEson coecpchuarl.o mOytheelirt iCs NcaSn c oocmcuprl iicna toioldnesr tchhaitl dorcecnu ra nmdo andthuslt lsa. ter can be Gmreiafsfilnes, 2in0c1l2u,s pio. n1 5b8o)d.y encephalitis and sclerosing panencephalitis, caused by persistent infection (Moss &
#2: Rubella (German Measles):
sRyusbteemlla t hisr oau cgohm thmeu rneiscpaibrlaet odriys eraosuet eo.f Icth iisl dar emni lcda udsiseeda bsey, aa nridb oinncuucbleaitcio anc iisd f(rRoNmA 1)4 v tior u2s1 t hdaaty se.n tSerysm inpttoo mthse aprien ke nolra rregde dr alsyhm tphha tn iosd mesa,c fuelvoepra (pluolwar-.g rTahdies) ,r asoshre c tahnr odaetv aenlodp a o rnu nthney fnaocsee a wndit hth ae nc otruugnhk. aTnhde erex tirse ma fiatiienst. sTkhien .r a Cshh idldoreesn n aorte p nroest ecnotn ittasgeilof uosn atfhtee rp tahlem dse ovre slooplems eonft tohfe tfheee tr.a sThh. e T vhierures icsa ulisfeeslo dnigs siemmminuantiitoyn t oof r tuhbee lla, along with measles, chickenpox, and roseola if you contact the disease (McCance et al., 2014, p. 1658).
Complications:
cTohme mCeonnt,e arns dfo trh eDyi soecacsuer C moonrtero iln a anddu Pltrse tvheannt icohni l(d2r0e1n5. ) A rerltahtrea ltghiaat othr ea rctohmritpisli cmaatiyo nosc cfuror min r7u0b eplelarc aernet nooft a6d,0u0lt0 w caosmese nm worheo i cno andturalctst (thfeem daisleesa sees,p beucit ailtl yis) rtahraen i cnh cihldilrderne. n H anemd omrarhleasg. i cE mncaenpifheasltiatitsio cnasn coacnc uorc cinu ro wneit hto cghaisltdroreinnt.e sTtihnearle, acreer elborwal p alnadte lienttsr aarnedn avla hsecmuloarrr dhaamgea.g eT hwei tlho nthgr otemrmbo sceyqtuoepleanei cc apnu rlapsutr fao. r Tmhoenreth csa. n T ahlseore b cea an also be neuritis and progressive panencephalitis (The Centers for Disease Control and Prevention, 2015).
#3: Varicella (chickenpox):
dVuarriincge ltlhae iisr af idrsits edaescea dthea itn i sl isfeee. n Tinh icsh vilidruhso oisd vaenrdy acpopnrtoagxiiomuast ealnyd 9 s0p rpeeardcse nftr oomf c pheirldsorenn-t doe-pveerlsoopn t hveia d isease sauirsbcoerpnteib dlero wpliellt sg.e Wt tihteh dinisfeeacstieo wn iitnh itnh e1 h4o duasyesh.o lCdh, itlhderreen i rse am 9a0in p ceorcnetangt icohuasn fcoer tohnaet pdeaoyp blee fworheo tahree rash dpreovderloopmsa. l Tsirgannss m(MiscsCioann ccaen e th aapl.p, e2n0 1u4p, tpo. 51 6to6 06) .d aTyhse a ifltlenre ossn smeta yo fa lpepseioanr sw iinth h veaelstihcyle csh oinld trheen .t rTuhnekr,e s acrael pn,o amnadc ufalecse,. p Laaptuelre so,n a, nitd s vperseiacdles st.o Tthhee yex rturepmtuirteie esa. sTilhye. lTeshieoyn sd ehvaevleo pv aar icoruuss ts.t a Sgoems. e Ttimheeys cthaney p creasne nbte afso und in the mouth, conjunctiva, and pharynx. There is a fever for 2 to 3 days (McCance et al., 2014, p. 1660).
#4: Hand, foot, and mouth disease:
cTohme mCeonnt evrisr aflo irl lDneissesa tshea ta nadff eCcotsn tcrhoill darnedn P yroeuvnegnetiro tnh a(2n0 51.5 )I te dxopelasi,n h tohwate vhearn,d o, cfcouort iann add mulotsu.t h I td uisseuaaslely i s a tswtaort sd awyist hla ate fre, vpeari,n lfauclk s oofr easp dpeevtietelo apn idn stohree mthoruotaht. a nAd sjkuisnt rnaosth f eweiltihn gre wd eslpl.o tOs ndceev etlhoep fse tvheart sbtlairsttse,r a. bTohuet sbhlioswte rssi gcnans, abpupt etahre yo ns ttihlle ppaaslsm tsh,e h vainruds, fteoe ot t(hseorlse.s )T ohre tvhier ueslebso wth,a kt nbeeelos nogr tbou tthtoec Eksn.t eSroomvier upse goepnleu sd o not (cpoomlimovoinr uisne tsh, ec oUxnsiatcekdi Sevtairtuess,e sb,u at nodth eecrh voivruirsuesse sth aant da reen etenrtoevroirvuisreuss. c Cano xcasaucske iielvlnireusss .A E1n6t eisr othveir umso 1s7t has cboeeung haisnsgo cainadte odb wjeicthts tchoen dtaismeainsea taesd wweiltlh. f Tecraens samndis csioonnt acmanin oactecdu rs uthrrfoacuegsh acnldo soeb cjeocnttsa c(Tt, hine Ctheen ateirr sw fiothr Disease Control and Prevention, 2015).
c#o5n: j uPnhcatirvyintigs oacso wnjeulln acst ifveavle fre, vaenrd -s o Treh eth Croeantt ecrasn f aolrs Do ioscecausre wCiothn ttrhoils s staytned trhoamt eth. i sT choen idnifteioctni ocno mcabuisneess it with adenovirus serotypes3, 4 and 7 (The Centers for Disease Control and Prevention, 2014).
References
Moss, W. J., & Griffin, D. E. (2012). Measles. The Lancet, 379(9811), 153-64.
Nicole, N. H. (2014). Alterations of the Integument in Children. In McCance, K. L., Huether, S. E.,
Brashers, V. L. (Eds.), Pathophysiology: The biologic basis for disease in adults and children
(7th ed., pp. 1656, 1658, 1660). St. Louis, MO: Mosby.
The Centers for Disease Control and Prevention. (2014). Conjunctivitis. Retrieved from
http://www.cdc.gov/conjunctivitis/about/diagnosis.html
The Centers for Disease Control and Prevention. (2015). Hand Foot and Mouth Disease. Retrieved from
http://www.cdc.gov/hand-foot-mouth/
The Centers for Disease Control and Prevention. (2015). Measles. Retrieved from
http://www.cdc.gov/measles/hcp/index.html
The Centers for Disease Control and Prevention. (2015). Rubella. Retrieved from
http://www.cdc.gov/vaccines/pubs/pinkbook/rubella.html
Instructor Brown reply to Lorna Durfee 6/9/2016 5:42:01 PM
RE: Discussion Part Three
Lorna,
What is going on from a patho standpoint to cause conjunctivitis?
Lorna Durfee reply to Instructor Brown 6/10/2016 3:15:49 PM
RE: Discussion Part Three
What is going on from a pathophysiological standpoint to cause conjunctivitis?
Doctor Brown:
pAaltthhoopuhgyhs tihoilso gteixcat li sp rnoocte csus rtrheantt ,i sI ifne lqt utheastt iiotn w. o uld provide a necessary understanding of the
cEonndseirsst s( 1o9f 9th6r)e eex gpelanienrsa :t hPaatr athmey mxoeavsirleuss ,v wirhuisc bhe ilnocnlgusd etos tthhee pfaamraiilnyf lPuaernazma yvxioruvsierisd aaned. mThuims fpasm; ily bPenleounmg otov i(rBusa,r ownh i&ch N inatciloundaels C reesnpteirra ftoorr yB sioytneccyhtniaoll ovgiryu sI nafnodr mMaotirobnil,l 1iv9i9ru6s, ,p w. 1h)ic.h the measles virus
iPsa ara mheylxicoavlliyru ssyems amree ternicvaell toupbeed- lpikaert inculecsle tohcaat pasried atphpatr ocxoinmtaaitnesly a 1s5in0g tloe -3s0tr0a nndme di,n n deigaamtievtee–r.s eTnhsee re pRrNotAei ng ewnohmiche aisn adt RthNeA b-adsier eocft ethde R dNouAb lpeo-llyaymeerreads eli.p Tidh ee nnvueclloepoec.a pTshide issp aiksseos coinat ethde w eintvhe tlhoep em haatrviex tpwaroa mglyyxcoopvrirouteseinss h. a Oven ea igse an evriarla lo ardttearc hfomr ethnet pvrioratel ipnr oantedi nths ea nodth beiro ac hfuemsioicna pl rportoepiner. t iTesh efo r viral avtitraucsh lmaceknst nperoutreaimnsin (iBdaarsoen b &ut Nhaast ihoenmala Cggelnutteirn afotirn Bg iaobteilcithineso.logy Information, 1996, p. 1). Measles
fEunsdioenrs o (f1 t9h9e6 e) nrvelealtoepse t haantd a cttyatcohpmlaesnmt iocf m peamrtibcrlaens eosf atnhde vpiernuest rtaot ethse i ncteol lt hsuer nfauccel eios cfaopllsoidw iendt ob yth e cRyNtoAp.l a Msma.t u Trahteio vni roiof nth Re NviAru iss taa kteems ppllaactee fwoirt hth teh ep rbouddudcitniogn o of ft hmeR vNirAus afnrodm al tshoe f coer lrle (pBliacraotnio &n of National Center for Biotechnology Information, 1996, p. 26).
iWnveo klvneo wth eth laytm mpehaastliecs a insd a rseyssptiermatoicr yv isryasl tienmfesc, tsioknin. aTnhde brer aairne. m Tahnei fveisrtuast icoanns eonft tehre t hdeis heoasste tthhraotu gh tnhoed neso siet caannd spporsesaidb ltyo tthhee creosntj uonf cthtiev are. t iOcunlcoee tnhdeo vthireulisa ml suylstitpemlie ws ihne rthe et hree srpeipralitcoartyio tnra scet qaunedn lcyem tapkhe s place (Baron & National Center for Biotechnology Information, 1996, p. 27).
USC Roski Eye Institute and Keck Medicine of USC, explains that some of the seen with eye problems with measles have lost vision because it caused damage ptoat itehnet cs othrneeya h. a ve tMhee aesylee sa knedr caatinti sc aisu sae c ionnfldaimtiomna tthioant roefs ualntys fpraormt o mf tehaes lbeas cikn foefc ttihoen e. y Te,h ien vcilruudsi ncga nr eatfinfeac, tb tlhoeo db ack of svceasrsreilnsg, a(nUdn itvheer osipttyi co nf eSrovuet.h eTrhne Crea ilsif sowrneilal,i n2g0 1o6f )t.h e eye from measles infection that can result in
bDeefvorriee sth, eDyu cparnex s parneda dD teoS wthaer et p(2it0h1e5li)u emx,p elanidno tthhaetl imumor boirl lnievuirruosneasl icneflelcs t( cDeell sV orife tsh, eD iumpmreuxn, e& s yDsete m Swart, 2015, p. 703).
nMeogsasti avned-s eGnrsieff i Rn N(2A01 v4i)r utes lalsn du sm theamt bthere omf etahsel eMs ovribruilsl iivsi rsupsh egreincuals, ienn tvheel oPpaerda manydx osivnigrildea-set rfaanmdielyd. hTaheem RaNggAlu gteinnionm bein fdosr tmo eraescleepst ohrass ianb coeultl s1 a6n, d0 0w0o nrkusc lweoitthid tehse t hfuast ieonnc pordoet eeiing htot pmroedteiiantes. f uTshioen into tehliec ivti aranl iemnvmeulonpee r easnpdo tnhseen. cTohnen eccetl lw reitche pthtoer hs ofsotr cmelela msleems ibsr aCnDe.4 6T ahnisd hCaDem15a0g,g wluhtiincihn apcrtoivteaitne sw tihlel lnyumclpehaotecdy tcee lmlso. l eScLuAleM (S iLs AacMti)v.a tBedec oanu sTe aCnDd 4B6 liysm a pchoomcpylteems aenndt manotliegceunl-ep, rtehsaetn itsin egx pcerellsss e(Md oons sa &ll tGhriisf fviinr,u 2s 0s1p2re, apd. s1 t5o5 l)y. m Tphhea tvicir tuiss srueep.l i cTahteio rne polciccuatriso inn ienp tihthee tliisaslu ceesl liss iwnh tahte c raeusspeirsa tthoer y tract, and sdyismsepmtoimnast.i o nT hoef madeaapstlievse tiom mmaunnye o rregsapnosn. sHeso satr eim vmiruusn sep reecsipfoicn hseusm aorera rle asnpdo ncseilblulela fro rre tshpeo snisgenss. aTnhde ovicrcuusr ,c aann de nitt ecra nth croauusgeh bthacet ceorinajlu inncfeticvtaio ann idn t thheen eiyt ebse c (oMmoesss s&ys Gtermififci.n ,T 2h0e1 2im, pm. u1n5e6 )r.e s Wpoinths em ceaans les i&n fGecrtiifofinn, ,t 2h0er1e2 c, apn. 1b5e7 d)e. c Kreearsaetdo cloynmjupnhcotciyvtieti sr ecsapno oncsecsu ra nind cihmilpdarierned w diethn dVriittiacm cienl lA f udnecftiicoinen (cMy oasnsd lcoaonk cinaugs feo br ltihned nIgeGss a(nMtiobsosd &y aGnrdi fIfginM, 2a0n1ti2b,o pd.i e1s5 8(M). o Dssia &gn Gosriisff oinf, m20ea1s2l,e ps .c 1a5n8 b)e. mMaedaes lbeys csaenro bloeg y, diagnosed with a conjunctival swab (Moss & Griffin, 2012, p. 159).
References
De Vries, R., Duprex, W., & De Swart, R. (2015). Morbillivirus Infections: An Introduction.
Viruses, 7(2), 699-706. doi:10.3390/v7020699
Enders, G. (1996). Paramyxoviruses. In Baron, S., & National Center for Biotechnology
Information (U.S.) Medical microbiology. (pp.1-36). Galveston, Tex.: University of Texas
Medical Branch at Galveston. Chapter 59.
Moss, W. J., & Griffin, D. E. (2012). Measles. The Lancet, 379(9811), 153-164.
doi:10.1016/s0140-6736(10)62352-5
University of Southern California. (2016). Measles and the Eye | USC Roski Eye Institute.
Retrieved from http://eye.keckmedicine.org/measles-and-the-eye
Lanre Abawonse 6/9/2016 9:50:46 PM
Discussion Part Three
What is the differential diagnosis?
Measles
Measles is a disease caused by a virus. Hard measles, or 7-10 day measles (rubeola) is a
communicable viral disease caused by the morbillivirus. Sometimes it begins on the face and spreads to the
appendages (or outgrowth). Before the rash begins, fever, conjunctivitis and cough are present (Watkin,
2013). There are koplik spots (small, irregular red with bluish white speck in the center) on the buccal
mucosa, and mild to severe photosensitivity. The rash can become severe in nature, becoming more
apparent as a maculopapular eruption on the face and into the skin tissue or to another body surface
Roseola
Roseola (Exanthem Subitum) is caused by herpesvirus (human) type 6, is mostly limited to age
6months to 3 years and is incubated 5-15 days. The rash in this disease is composed discrete rose-pink
macules appearing first around the trunk, then spreading to neck, face and extremeities. This can lead to
recurrent febrile seizures from latent infection of nervous system that is reactivated by fever. The fever lasts
3-5 days; then a tiny, erythematous, raised papule rash appears (O’Grady, 2014).
Fifth Disease
Erythema Infectiosum (Fifth disease) is caused by parvovirus B19 (Human parvovirus). This is
mostly transfer from an infectious person with an incubation period a 4-21 days. It usually begins with
fever, headache, sore throat, pruritus coryza, abdominal pain and arthralgias. 7-10 days after the symptoms
go away, the rash begins as a slapped cheek appearance The rash associated with this disease appears in
three stages. After the rash appears, the patient is no longer contagious (O’Grady, 2014).
Rubella
Rubella is a viral infection caused by a rubivirus that occurs in childhood. There are two types know
as 3 day measles and German measles,. Its diffuse punctate, macular rash begins on the trunk and spreads to
the arms and legs. The child might also present with cold-like symptoms (cough). The virus might be
present in the blood, stool, and urine. Patient is contagious a week before symptoms start and 4 days after
the rash starts (Watkin, 2014).
What are some of the complications of this disease, assume that the top of your differential is
the definitive?
Measles is more severe in malnourished children and it can lead to complications which include
diarrhea, pneumonia, otitis media, and acute encephalitis (rare), corneal ulcers and sub-acute sclerosing
anencephalitis (Haq, Masood, Sharif, & Asghar, 2015). It is usually benign but the greatest danger is
teratogenic effect of the fetus.
Assume that the second item you place on your differential is the definitive diagnosis. What
are some complications of that disease?
Roseola is a contagious viral disease that affect children younger than 4 with a rapid rise in
temperature up to 105 f. This can make this disease to be mis-interpreted or mistaken for rubella. Some
complications seen are recurrent febrile seizures, which develop from latent infection of central nervous
system that is reactivated by the fever and encephalitis (rare). Long term complications include
developmental disorders and autism spectrum disorders (O’Grady, 2014).
Reference
Haq, M. Z., Masood, N., Sharif, M., & Asghar, R. M. (2015). Measles. Professional Medical Journal, 22
(9), 1116-1121. doi:10.17957/TPMJ/15.2841
O'Grady, J. S. (2014). Fifth and sixth diseases: More than a fever and a rash. Journal of Family Practice, 63
(10), E1-E5.
Watkins, J. (2014). Rubella: An overview of the symptoms and complications. Britis [Show Less]