NR 507
PATHOPHYSIOLOGY
WEEK 6 TD3
Dermatologic and
Musculoskeletal
Disorders Discussion Part
Three
,Week 6: Dermatologic and Musculoskeletal Disorders - Discussion Part Three
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Discussion
This week's graded topics relate to the following Course Outcomes (COs).
1
Discussion Part Three (graded)
Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough
and a fever of about 104 0C, She also has a rash on her face a possibly the beginning of a rash on her
arms. 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?
Responses
Lorna Durfee 6/6/2016 8:33:06 PM
Discussion Part Three
Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and
a fever of about 104.0 C. She also has a rash on her face a possibly the beginning of a rash on her arms.
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 –
The Centers for Disease Control and Prevention explain that Measles is an acute viral respiratory illness.
The prodromal symptoms are that of fever as high as 105.0 F, also cough, coryza, and conjunctivitis (the
three “C”s). There is also the development of Koplik spots and then a maculopapular rash. The rash
appears 14 days after exposure. The incubation period can range from 7 to 21 days. The rash spreads from
the head and trunk and then the extremities (The Centers for Disease Control and Prevention, 2015).
The Centers for Disease Control and Prevention (2015) explain that some of the complications of measles
include otitis media, bronchopneumonia as well as diarrhea and laryngotracheobronchitis (The Centers for
Disease Control and Prevention, 2015). Measles can cause serious illness. The facts are that one out of
every 1,000 cases of measles will develop into acute encephalitis, and that can lead to brain damage. One
or two out of 1,000 children will die from respiratory and neurologic complications (The Centers for
Disease Control and Prevention, 2015).
, Complications: Moss and Griffin (2012) tell us that complications can occur in up to 40 percent of the
patients. Age and undernutrition increase the risk. Fatality is highest in infants and young children.
Pneumonia is the condition most associated with measles-associated deaths. The cause of Pneumonia is a
secondary viral or bacterial infection. In immunocompromised patients, the virus can cause giant cell
pneumonitis. Croup, otitis media, and diarrhea are other problems that can occur. Keratoconjunctivitis can
also develop as a complication of the infection. There are rare complications such as conditions that
involve the central nervous system. Encephalomyelitis can occur in older children and adults.
Periventricular demyelination may also occur. Other CNS complications that occur months later can be
measles inclusion body encephalitis and sclerosing panencephalitis, caused by persistent infection (Moss &
Griffin, 2012, p. 158).
#2: Rubella (German Measles):
Rubella is a communicable disease of children caused by a ribonucleic acid (RNA) virus that enters into the
system through the respiratory route. It is a mild disease, and incubation is from 14 to 21 days. Symptoms
are enlarged lymph nodes, fever (low-grade), sore throat and a runny nose with a cough. There is a faint
pink or red rash that is maculopapular. This rash can develop on the face and then trunk and extremities.
The rash does not present itself on the palms or soles of the feet. The virus causes dissemination of the
skin. Children are not contagious after the development of the rash. There is lifelong immunity to rubella,
along with measles, chickenpox, and roseola if you contact the disease (McCance et al., 2014, p. 1658).
Complications:
The Centers for Disease Control and Prevention (2015) relate that the complications from rubella are not
common, and they occur more in adults than children. Arthralgia or arthritis may occur in 70 percent of
adult women who contract the disease, but it is rare in children and males. Encephalitis can occur in one to
6,000 cases more in adults (females especially) than children. Hemorrhagic manifestations can occur with
children. There are low platelets and vascular damage with thrombocytopenic purpura. There can also be a
gastrointestinal, cerebral and intrarenal hemorrhage. The long term sequelae can last for months. There can
also be neuritis and progressive panencephalitis (The Centers for Disease Control and Prevention, 2015).
#3: Varicella (chickenpox):
Varicella is a disease that is seen in childhood and approximately 90 percent of children develop the disease
during their first decade in life. This virus is very contagious and spreads from person-to-person via
airborne droplets. With infection in the household, there is a 90 percent chance that people who are
susceptible will get the disease within 14 days. Children remain contagious for one day before the rash
develops. Transmission can happen up to 5 to 6 days after onset of lesions in healthy children. There are no
prodromal signs (McCance et al., 2014, p. 1660). The illness may appear with vesicles on the trunk, scalp,
and face. Later on, it spreads to the extremities. The lesions have various stages. They can present as
macules, papules, and vesicles. They rupture easily. They develop a crust. Sometimes they can be found
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:
The Centers for Disease and Control and Prevention (2015) explain that hand, foot and mouth disease is a
common viral illness that affects children younger than 5. It does, however, occur in adults. It usually
starts with a fever, lack of appetite and sore throat and just not feeling well. Once the fever starts, about
two days later, painful sores develop in the mouth. A skin rash with red spots develops that blister. The
blisters can appear on the palms, hand, feet (soles) or the elbow, knees or buttocks. Some people do not
show signs, but they still pass the virus to others. The viruses that belong to the Enterovirus genus
(polioviruses, coxsackieviruses, and echoviruses and enteroviruses. Coxsackievirus A16 is the most
common in the United States, but other viruses that are enterovirus can cause illness. Enterovirus 17 has
been associated with the disease as well. Transmission can occur through close contact, in the air with
coughing and objects contaminated with feces and contaminated surfaces and objects (The Centers for
Disease Control and Prevention, 2015).
#5: Pharyngoconjunctival fever - The Centers for Disease Control state that this condition combines
conjunctivitis as well as fever, and sore throat can also occur with this syndrome. The infection causes 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.
PATHOPHYSIOLOGY
WEEK 6 TD3
Dermatologic and
Musculoskeletal
Disorders Discussion Part
Three
,Week 6: Dermatologic and Musculoskeletal Disorders - Discussion Part Three
Loading...
Loading...
Discussion
This week's graded topics relate to the following Course Outcomes (COs).
1
Discussion Part Three (graded)
Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough
and a fever of about 104 0C, She also has a rash on her face a possibly the beginning of a rash on her
arms. 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?
Responses
Lorna Durfee 6/6/2016 8:33:06 PM
Discussion Part Three
Keisha, a 13-year-old female, has come into your urgent care center. She has red conjunctiva, a cough and
a fever of about 104.0 C. She also has a rash on her face a possibly the beginning of a rash on her arms.
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 –
The Centers for Disease Control and Prevention explain that Measles is an acute viral respiratory illness.
The prodromal symptoms are that of fever as high as 105.0 F, also cough, coryza, and conjunctivitis (the
three “C”s). There is also the development of Koplik spots and then a maculopapular rash. The rash
appears 14 days after exposure. The incubation period can range from 7 to 21 days. The rash spreads from
the head and trunk and then the extremities (The Centers for Disease Control and Prevention, 2015).
The Centers for Disease Control and Prevention (2015) explain that some of the complications of measles
include otitis media, bronchopneumonia as well as diarrhea and laryngotracheobronchitis (The Centers for
Disease Control and Prevention, 2015). Measles can cause serious illness. The facts are that one out of
every 1,000 cases of measles will develop into acute encephalitis, and that can lead to brain damage. One
or two out of 1,000 children will die from respiratory and neurologic complications (The Centers for
Disease Control and Prevention, 2015).
, Complications: Moss and Griffin (2012) tell us that complications can occur in up to 40 percent of the
patients. Age and undernutrition increase the risk. Fatality is highest in infants and young children.
Pneumonia is the condition most associated with measles-associated deaths. The cause of Pneumonia is a
secondary viral or bacterial infection. In immunocompromised patients, the virus can cause giant cell
pneumonitis. Croup, otitis media, and diarrhea are other problems that can occur. Keratoconjunctivitis can
also develop as a complication of the infection. There are rare complications such as conditions that
involve the central nervous system. Encephalomyelitis can occur in older children and adults.
Periventricular demyelination may also occur. Other CNS complications that occur months later can be
measles inclusion body encephalitis and sclerosing panencephalitis, caused by persistent infection (Moss &
Griffin, 2012, p. 158).
#2: Rubella (German Measles):
Rubella is a communicable disease of children caused by a ribonucleic acid (RNA) virus that enters into the
system through the respiratory route. It is a mild disease, and incubation is from 14 to 21 days. Symptoms
are enlarged lymph nodes, fever (low-grade), sore throat and a runny nose with a cough. There is a faint
pink or red rash that is maculopapular. This rash can develop on the face and then trunk and extremities.
The rash does not present itself on the palms or soles of the feet. The virus causes dissemination of the
skin. Children are not contagious after the development of the rash. There is lifelong immunity to rubella,
along with measles, chickenpox, and roseola if you contact the disease (McCance et al., 2014, p. 1658).
Complications:
The Centers for Disease Control and Prevention (2015) relate that the complications from rubella are not
common, and they occur more in adults than children. Arthralgia or arthritis may occur in 70 percent of
adult women who contract the disease, but it is rare in children and males. Encephalitis can occur in one to
6,000 cases more in adults (females especially) than children. Hemorrhagic manifestations can occur with
children. There are low platelets and vascular damage with thrombocytopenic purpura. There can also be a
gastrointestinal, cerebral and intrarenal hemorrhage. The long term sequelae can last for months. There can
also be neuritis and progressive panencephalitis (The Centers for Disease Control and Prevention, 2015).
#3: Varicella (chickenpox):
Varicella is a disease that is seen in childhood and approximately 90 percent of children develop the disease
during their first decade in life. This virus is very contagious and spreads from person-to-person via
airborne droplets. With infection in the household, there is a 90 percent chance that people who are
susceptible will get the disease within 14 days. Children remain contagious for one day before the rash
develops. Transmission can happen up to 5 to 6 days after onset of lesions in healthy children. There are no
prodromal signs (McCance et al., 2014, p. 1660). The illness may appear with vesicles on the trunk, scalp,
and face. Later on, it spreads to the extremities. The lesions have various stages. They can present as
macules, papules, and vesicles. They rupture easily. They develop a crust. Sometimes they can be found
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:
The Centers for Disease and Control and Prevention (2015) explain that hand, foot and mouth disease is a
common viral illness that affects children younger than 5. It does, however, occur in adults. It usually
starts with a fever, lack of appetite and sore throat and just not feeling well. Once the fever starts, about
two days later, painful sores develop in the mouth. A skin rash with red spots develops that blister. The
blisters can appear on the palms, hand, feet (soles) or the elbow, knees or buttocks. Some people do not
show signs, but they still pass the virus to others. The viruses that belong to the Enterovirus genus
(polioviruses, coxsackieviruses, and echoviruses and enteroviruses. Coxsackievirus A16 is the most
common in the United States, but other viruses that are enterovirus can cause illness. Enterovirus 17 has
been associated with the disease as well. Transmission can occur through close contact, in the air with
coughing and objects contaminated with feces and contaminated surfaces and objects (The Centers for
Disease Control and Prevention, 2015).
#5: Pharyngoconjunctival fever - The Centers for Disease Control state that this condition combines
conjunctivitis as well as fever, and sore throat can also occur with this syndrome. The infection causes 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.
