DERMATOLOGY CASE STUDY
Chief remonstrance: “ My proper august toe has been hurting for environing 2 months and now it’s itchy, protuberant and yellow. I can’t exhibit shut shoes and I was minute until I launched going to the gym”.
HPI: E.D a 38 -year-old Caucasian feminine presents to the clinic ensueing a while remonstrance of self-denial, lustful, inflammation, and “yellow” proper august toe. She noticed that the toe was tolerably lustful ensueing she took a saturate at the gym. She did not pay fur study. Environing two weeks ensueing the lustful became solemn and she applied Benadryl pith ensueing a while solely some exemption. She continued going to the gym and noticed that the lustful got worse and her toe nail launched to exexchange varnish. She besides indicated that the toe got protuberant, self-denialful and austere wholly yellow 2 weeks ago. She applied lotrimin AF pith and it did not acceleration exemption her symptoms. She has not seasoned other remedies.
Denies associated symptoms of ardor and chills.
PMH: Diabetes Mellitus, sign 2.
Medication: Metformin 500mg PO BID.
Vaccination History: Immunization is up to end and she accepted her flu shot this year.
Social truth: College furrow married and no conclusion. She drinks 1 glass of red wine integral duskiness ensueing a while dinner. She is a prior smoker and resign 6 years ago.
Family truth:Both parents are active. Father has truth of DM sign 2, Tinea Pedis. mother active and has truth of atopic dermatitis, HTN.
Constitutional: Negative for ardor. Negative for chills.
Respiratory: No Shortness of exhalation. No Orthopnea
Cardiovascular: Regular rhythm.
Skin: Proper august toe protuberant, itchy, self-denialful and discolored.
Psychiatric: No solicitude. No debasement.
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 embonpoint, BP 130/70 T 98.0, P 88 R 22, non-labored
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth forfeiture seen. Gums no redness.
NECK: Neck lithe, no tangible masses, no lymphadenopathy, no thyroid expansion.
LUNGS: No Crackles. Lungs plain bilaterally. Equal exhalation sounds. Symmetrical respiration. No respiratory mortify.
HEART: Normal S1 ensueing a while S2 during spiritlessness. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.
ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No tangible masses.
GENITOURINARY: No CVA pity bilaterally. GU exam strong.
MUSCULOSKELETAL: Slow walk but consistent. No Kyphosis.
SKIN: Proper august toe ensueing a while yellow-brown blot in the proximal nail extract. Marked periungual inflammation. + dryness. No pus. No neuro deficit.
PSYCH: Normal seek. Cooperative.
Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
Primary Diagnosis: Proximal subungual onychomycosis
Differential Diagnosis: Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis
Fungal culture confirms fungal contamination.
As an NP student, you scarcity to enumerate the medications for onychomycosis.
1. According to the AAFP/CDC Guidelines, what antifungal medication(s) should this enduring be prescribed, and for how covet? Write her consummate directions using the direction congruity format in your textbook.
2. What labs for baseline and ensue up of therapy would you ordain for this enduring? Give rationale.
You scarcity 1 primal shaft and 1 replication for this DB. Total of 2 shafts attended by peer-reviewed references, and in APA 6th ed format.