**Patient:** Victoria Lewis
**Age:** 25 years
**Chief Complaint:** "I have an itchy rash on my inner thighs and left
forearm."
---
### 1. History of Present Illness (HPI)
Victoria presents with a rash that began roughly 24-48 hours after
returning from a trip to Napa Valley. The rash started as itchy red
bumps on the inner thighs and later appeared as linearly distributed
blisters on her left forearm. The affected areas feel tender and swollen,
with intense itching that disrupted her sleep. She reports possible
exposure to poison ivy/oak during a hike ("bushwhacking") where she
wore shorts and a tank top, as well as soaking in a hot tub and using a
, new scented lotion. She denies any systemic symptoms like fever, chills,
or shortness of breath .
### 2. Review of Systems (ROS)
All systems are negative except for the skin findings. She specifically
denies fever, chills, night sweats, breathing difficulty, chest pain,
nausea, vomiting, or joint pain. She also notes no swelling of the face,
lips, or tongue .
### 3. Past Medical History (PMH)
- **General Health:** No chronic illnesses or prior dermatologic
conditions (eczema, psoriasis).
- **Immunizations:** Up to date.
- **Allergies:** Allergic to Cefaclor (Ceclor) - developed hives as a child.
- **Medications:** None regularly; occasional OTC acetaminophen or
ibuprofen .
### 4. Family History (FH)
- No family history of skin diseases or allergic contact dermatitis.
- Mother has hypertension; father has coronary artery disease .
### 5. Social History (SH)
- **Occupation:** College student and part-time barista.
- **Lifestyle:** Physically active; no smoking; occasional alcohol.
**Age:** 25 years
**Chief Complaint:** "I have an itchy rash on my inner thighs and left
forearm."
---
### 1. History of Present Illness (HPI)
Victoria presents with a rash that began roughly 24-48 hours after
returning from a trip to Napa Valley. The rash started as itchy red
bumps on the inner thighs and later appeared as linearly distributed
blisters on her left forearm. The affected areas feel tender and swollen,
with intense itching that disrupted her sleep. She reports possible
exposure to poison ivy/oak during a hike ("bushwhacking") where she
wore shorts and a tank top, as well as soaking in a hot tub and using a
, new scented lotion. She denies any systemic symptoms like fever, chills,
or shortness of breath .
### 2. Review of Systems (ROS)
All systems are negative except for the skin findings. She specifically
denies fever, chills, night sweats, breathing difficulty, chest pain,
nausea, vomiting, or joint pain. She also notes no swelling of the face,
lips, or tongue .
### 3. Past Medical History (PMH)
- **General Health:** No chronic illnesses or prior dermatologic
conditions (eczema, psoriasis).
- **Immunizations:** Up to date.
- **Allergies:** Allergic to Cefaclor (Ceclor) - developed hives as a child.
- **Medications:** None regularly; occasional OTC acetaminophen or
ibuprofen .
### 4. Family History (FH)
- No family history of skin diseases or allergic contact dermatitis.
- Mother has hypertension; father has coronary artery disease .
### 5. Social History (SH)
- **Occupation:** College student and part-time barista.
- **Lifestyle:** Physically active; no smoking; occasional alcohol.
