PART 2: Case Study
Select one of the following case studies and corresponding Differentials Table to complete. In the subject line of your post, please identify which case study you are responding to.
- Select one of the following case studies.
- Complete the corresponding “Differentials Table” to align your clinical reasoning – include 5 differentials (excluding example provided).
- In SOAP format, discuss what questions you would ask the patient (Review of Systems), what physical exam elements you would include, what further testing you would want to have performed (if any), differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
- Upload your Differentials Table and SOAP note to the Discussion Board.
Note: Document at least one scholarly source to connect your response to national guidelines and evidence-based research in support of your ideas.
In your peer replies, please reply to at least one peer who chose a different case study.
***Important Considerations – As you dive deeper into your clinical practice, challenge yourself to formulate well thought-out differentials prior to arriving at your final diagnosis. Diseases, despite their common features, can become unique and dynamic. This means that symptomatology can easily be affected by different modifying factors such as age, co-morbid conditions, environmental factors and the like.
Case Studies
- Jenny, a 66-year-old retired cook, presents with a vesicular rash on the right side of her face. She experienced pain on that side 2 days ago, but thought it was just a headache. She has been under a lot of stress lately because she is caring for her husband who has Alzheimer’s disease.
- Sally is a 22-year-old female who recently became bothered by a rash that is itchy, red, inflamed, and dry. She also has scaly areas that she says are getting worse. The rash is only around her umbilicus and on her elbows. Both of her parents have psoriasis, but she doesn’t believe this is the problem, because it appears to be different from her parents’ lesions. She is living in Florida, is under a lot of stress in high school, and just recovered from a lingering upper respiratory infection (URI).
- A 48-year-old male presents with a two-month history of nighttime headaches that are becoming more frequent. The pain awakens him at night. He has no other somatic complaints and no other significant medical history.
If you chose case study 1 or 2, complete the below Differentials Table
| Differential | Signs/Symptoms | Gold Standard Diagnostics | Gold Standard Treatment |
| Ex: Actinic Keratosis | Scaling, dry, round, flesh-colored lesions on skin that do not heal; usually sunexposed areas; sizes range from microscopic to several centimeters. |
Clinical diagnosis |
For patients with multiple thin lesions on the face or scalp, treatment with topical fluorouracil cream is first-line therapy.
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If you chose case study 3, complete the below Differentials Table.
| Differential | Signs/Symptoms | Gold Standard Diagnostics | Gold Standard Treatment |
| Ex: Temporal arteritis (giant cell arteritis/GCA) | Unilateral pain, temporal area with scalp tenderness, skin over artery is indurated, tender, warm and reddened; amaurosis fugax (temporary blindness). |
Medical urgency – refer to ED or Ophthalmologist |
High dose steroids * Dose and route of administration of glucocorticoids for newly diagnosed GCA varies depending on whether patient presents with or without threatened or established visual loss at diagnosis. |
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