What five conditions would be considered as
What five conditions would be considered as differential diagnoses with most likely listed first (with rationale included and how would you eliminate or narrow down this list)? CASE STUDY CC: “I have a rash.” HPI: S.M. is a 59-year-old female who presents with a complaint of itching and soreness in her right side and upper back. She felt an “irritation” 3 days ago with intermittent itching. She now complains of intermittent “shooting pain” and “tingling” sensations. She is not aware of any recent trauma to the chest or back. PMH: Reports history of hypertension, osteoarthritis (primarily of the knees and fingers), osteoporosis, gout, and polymyalgia rheumatica. Medications: Lisinopril 10 mg PO daily, Alendronate 70 mg, PO, once per week, Allopurinol 200 mg PO daily, Omeprazole 20 mg PO daily, and Prednisone 7.5 mg PO daily. FH: Osteoarthritis, hyperlipidemia, or hypertension. SH: Lost her husband of 25 years 1 year ago. Denies current or past smoking. Works as a teacher in middle school. ROS: Skin, hair, and nails: See HPI. Head and neck: Denies dizziness, syncope, brain injuries. Eyes: Denies double vision, pain, redness, discharge. Ears, nose, and throat: Denies ear pain, runny nose, or nasal congestion. Lymph nodes: Denies enlargement or tenderness. Chest and lungs: Denies cough, dyspnea, or wheezing. Heart and blood vessels: Denies chest pain, palpitations, or edema. Gastrointestinal: Denies abdominal pain, vomiting, or constipation. Neurologic: see HPI. Objective Data Vital Signs: BP = 128/86 mm Hg, P = 90, R = 18, T = 98.0 F, O2 saturation = 99% RA. Weight 160 pounds, Height 63 inches, BMI 28.3. General appearance: Alert, pleasant, overweight, well-groomed female. Speech is appropriate and clear. No obvious deformities. She is in no apparent distress. Skin: Multiple scattered, small, bright – red, pinpoint papules over the right upper back, as well as several irregularly shaped, flat, brownish red macules. No obvious insect bite or entry wound. HEENT: Head: normocephalic and nontender with no scalp lesions or apparent alopecia. Eyes: PERRLA, extraocular movements intact. Ears: Tympanic membranes clear bilaterally. Oropharynx: pink and moist with no lesions or exudate. Tonsils pink 2+ equal bilaterally with no exudate. Lymph nodes: No palpable lymphadenopathy in head, neck, thorax, or axilla. Neck: Supple. No thyromegaly. Heart: RRR. S1S2 audible. No murmurs. Thorax: Exquisite tenderness on palpation in the right subscapular area, extending to the anterior axillary line, lateral to the right breast. Lung sounds are clear throughout with no rhonchi, crackles, or wheezes. Abdomen: Round and soft. Normoactive bowel sounds. Negative tenderness, masses, or organomegaly. Neurologic: CN II-XII grossly intact. Psychiatric: Mood and affect appropriate. SCIENCE HEALTH SCIENCE NURSING NURS 703
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