Skin Case Studies PDF

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Skin case studies from in class...

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Skin Case Studies

SP2021 KEY

Highlight or bold the key parts of the passage that helped you to determine the causative agent.

1. You are an oncologist and see one of your favorite patients. As you are discussing the next round of chemotherapy, they show you swollen infection on their lower leg. The patient says it hurts and you notice it is tender and hot to the touch. As you look more closely you see that there are red lines leading away from a centralized area (lymphangitis). It appears that the patient also is running a fever and has a swollen lymph node. You notice the infection has reached down into the dermis of the skin. You find the initial infection site and swab to send it to send a sample off to the lab. You find that there are gram positive cocci that is Beta hemolytic on blood agar. What is this infection? What is the causative agent? a. Cellulitis b. The condition is caused by the fast spreading infection and causes the signs and symptoms bolded above. The most common cause of this condition in healthy individuals are MRSA, Staphylococcus aureus, and Streptococcus pyogenes. In individuals that are immunocompromised, bacteria and some fungi can cause this condition as well. 2. Three young siblings have developed a fever and an abundant centripetal rash that began on their scalps, faces, and trunks that radiated to their extremities. Their skin lesions quickly progressed from macules to papules to itchy vesicles filled with clear fluid. After a few days their lesions crusted over and dropped off, leaving tiny scars. The parents have not vaccinated their children. Their pediatrician diagnosed them based off clinical appearances and warned their parents about the children’s risk of developing shingles later in life. What is the disease? What is the causative agent? a. Chicken pox b. Human herpesvirus 3 (varicella) 3. A postal worker who had possible exposure to a bioterrorism agent is sent to you, a local doctor employed by the CDC, for a full examination. You find several paper cuts on his hands. He explains this is normal because he deals with mail all day and doesn’t like to wear gloves. Upon further examination of his hands, you identify a very small black papule known as an eshar. You decide to send a blood sample and a biopsy of the papule to the CDC lab for culture. What is the disease? Causative agent? a. Cutaneous Anthrax b. It is caused by endospores entering the skin through small cuts in this case. The infection is derived from Bacillus anthracis.

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4. A male patient presents to clinic with a large ulcer on his right calf. In triage, the patient confirms he has recently returned from a trip to Egypt, a country in Northeast Africa near the equator where he was bitten by many flies. Upon examination, you notice a small, red papule in the center of the ulcer near his nose. When you prick the ulcer with a needle, there is clear and water-like drainage. You collect a skin sample from the ulcer for culture and a flagellated protozoan identified as parasitic to humans is detected. What is the disease? Causative agent? a. Leishmaniasis b. Leishmania spp. 5. Jake started fifth grade three weeks ago where he met his first girlfriend. He developed flu-like symptoms, later followed by a confluent reddish rash on his face that spread to the rest of his body within two days. His teacher noticed that the rash gets worse after days where the class plays outside for recess. After talking to Jake’s teacher, his mother learns that his girlfriend had red cheeks a week or so ago. What is the disease? What is the causative agent? a. Fifth Disease b. Parvovirus B19 6. A grandmother takes her three-year-old twin grandsons to play on the Chick-Fil-A playground after lunch. A few days later, both children develop a fever and break-out with painful lesions inside their mouths. Soon, blister-like lesions show up on their palms and soles of their feet. Based on their clinical presentations, their doctor does not fun any additional tests to confirm his diagnosis. What disease to the boys have? What is the causative agent? a. Hand foot and mouth disease (HFMD) b. Enteroviruses (Coxsackle)

7. A 14-year-old patient presents to your clinic with multiple circular skin rashes of dry, scaly lesions about the size of a quarter covering her abdomen. Upon questioning his mother, you find that he has a dog that sleeps with him nightly. Scraping the lesions reveal that the hair fluoresced under ultraviolet light and microscopic views shows hyphae. What is the diagnosis of this boy? What is a causative agent? What is the disease? Causative agent? a. Ringworm b. Trichophyton

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8. A newborn child around 2 days old has swollen eyes and noticeable discharge leaking from around the eyes. The baby was born via a vaginal birth. You swab the discharge and send to the lab for culture. What two STI causing bacteria are you expecting to cause this disease? What is the disease? a. Neisseria gonorrhoeae, Chlamydia trachomatis b. Neonatal Conjunctivitis

9. A 32-year-old female patient presents to clinic with inflammation and clear discharge from the left eye. You notice that the discharge is almost water-like. You decide not to treat with antibiotics. What is the disease? Causative agent? a. Viral Conjunctivitis b. Adenovirus

10. A mother brings her son to the pediatrician due to an itchy lesion near her sons’ mouth. The lesion consists of an area of peeling, crusty, flaking skin and scabs. She says that the scabs sometimes have a yellowish/golden colored crust to them. You gently swab the face of the patient and send it off to the lab. You find that there are gram positive cocci that are coagulase positive. What is the disease? Causative agent? a. Impetigo b. Staphylococcus aureus

11. Your diabetic father had a puncture wound on his toe that became infected. You noticed the infection was spreading quickly to his foot and lower leg. He has pain, edema, and bloody exudate in the lesion along with fever. His foot started to turn black and fill with little bubbles, and you decide to rush him to the emergency room. The doctor swabs his lesion and the result showed he has a gram-positive, endospore-forming bacterial infection. What is the disease? What is the causative agent? a. Cellulitis b. This disease is caused by fast-spreading infection in the dermis and subcutaneous tissues. The most common cause of this condition in healthy individuals are MRSA, Staphylococcus aureus , and Streptococcus pyogenes. It is very common on the lower leg, and it is thought the bacteria can enter through breaks in the skin between the toes caused by fungal infection. 3

Skin Case Studies

SP2021 KEY

12. A pregnant 16-year-old female is brought into the hospital in labor. The mother has a lowgrade fever, maculopapular rash and lymphadenopathy during her second month of pregnancy. The infection resolved on its own, so she was not worried. She does not know her vaccination history. Upon examination of the baby after birth you notice the baby has a blueberry muffin like rash and cataracts. Further, the loud sounds of the hospital appear to have no effect on the infant. What did mom contract during her pregnancy? a. Rubella virus 13. A 15-year-old girl presents to you with multiple hypopigmented lesions on her chest and back. Upon examination, the lesions have a dry scaly appearance. A direct microscopic KOH preparation reveals yeast with hyphae. What is the causative agent of his infection? What is his infection called? a. Malassezia b. Superficial Mycosis 14. A 12-year-old patient presents to clinic with noticeable inflammation, milky discharge, and redness in and around the right eye. The patient informs you that when they woke up this morning it felt like their right eye was glued shut. You give them a ceftriaxone 1g injection (antibiotic shot) and prescribe ciprofloxacin eye drops (antibiotic eye drops). What is the disease? Causative agents? a. Bacterial Conjunctivitis b. Bacterial conjunctivitis is most commonly caused by Staphylococcus aureus or Streptococcus pneumoniae, Haemophilus influenzae and Moraxella species. N. gonorrhoeae and C. trachomatis can also cause conjunctivitis in adults. These infections may result from autoinoculation from a genital infection or from sexual activity. 15. You’re a doctor at Children’s Emergency Department, and your first patient of the night is a three-week-old infant that was brought in by ambulance because of a seizure. After speaking with the parents, you learn that the baby has had a high fever (between 103105°F) for three days despite having no other symptoms. You admit the infant for observation overnight, and infant’s fever disappears on day four. He has no more seizures and no new symptoms, so you discharge him. What disease do you diagnose him with? What is the causative agent? a. Roseola b. Roseola is caused by a human herpesvirus called HHV-6. This disease is common in young children and babies and is sometimes known as “sixth disease.”

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16. Your sister calls you, a doctor, with a question about a rash her newborn has developed. Your niece has itchy, flaky lesions with yellow crust around her mouth, face, and extremities. Following your advice, she takes your niece to the pediatrician where they gently swab the area for a bacterial culture. The results were positive for a gram-positive coccus in Lancefield group A that is beta-hemolytic on blood agar. What is the disease? What is the causative agent? a. Impetigo b. Streptococcus pyogenes 17. In 1953, a doctor in a hospital developed a high fever, malaise, and a macular rash on her pharynx, face, and extremities. The rash developed into papular, vesicular, and pustular appearance that eventually crusted over. She was left with nonpigmented, pitted sited of scar tissue. His physician diagnosed him based on clinical appearance. What is the disease? What is the causative agent? a. Smallpox b. Variola virus 18. A 4-year-old boy presents to your eye clinic located in Kenya. He complains of a swollen left eye for the past 2 weeks. When you examine the eye, you notice small bumps on the inner upper eyelid and a pseudo membrane of exudates and inflammatory leukocytes have formed over his cornea. You decide to take a scraping of the bumps on the inner eyelid and send them to the lab for staining. The stains come back positive for inclusion bodies. You treat your patient with azithromycin, an oral antibiotic, and tell his parents to follow up in a week to check for any long-term eye damage. What is the disease? Causative agent? a. Trachoma b. Chlamydia trachomatis 19. You are a podiatrist and a patient has come to you complaining of a painful bump on the sole of the left foot. What is your diagnosis? What is the causative agent? a. Plantar wart b. Human papillomavirus

20. A man enters your eye clinic complaining of a swollen eye and that he is unable to take his contact out. When asking about his medical history and contact care, the man notes that he often rinses his contacts out in the sink at work if he gets dust in them. You are

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confident in your diagnosis based upon clinical presentation and the patient’s hygiene practices. What is the disease? Causative agent? a. Bacterial Conjunctivitis b. Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella, Neisseria gonorrhoeae, or Chlamydia trachomatis 21. A 38-year-old man comes into your clinic with a raised, red, tender lesion on his beard. The lesion has pus and is warm to the touch. Your patient admits he shaves his face almost every day for work. You swab the lesion and send it off for further testing in the lab, and the results show there are gram-positive cocci that are coagulase positive. You also learn that the bacteria are resistant to multiple antibiotics. What is the disease? What is the causative agent? a) Methicilin- resistant Staphylococcus aureus (MRSA) b) Staphylococcus aureus

22. An eight-year-old boy was brought into his pediatrician’s office when he became sick after they traveled to India. He symptoms began with a dry cough, headache, fever, and sore throat, and he shortly developed slightly raised colored bumps around his mouth. The maculopapular rash spread to the rest of his body within a week. The mother admits that she never had her son vaccinated due to fear of him developing autism. While the pediatrician is sure of his diagnosis based on clinical presentation, she orders an ELISA test to test the boy for IgM to the suspected disease’s antigen. What is the disease? What is the causative agent? a) Measles b) Measles virus (Moribillivirus)

23. A 41-year old women walks into your ophthalmology clinic complaining of unusual eye redness and sharp pain. Upon your physical examination, left eyes exhibit corneal inflammation, tearing, discharge, and sensitivity to light. She also appears to have opaque corneal lesions. You notice that she currently has a fever blister on her mouth and think you may know the causative agent of her discomfort? a) Herpes Simplex Virus (HSV-1) (Keratitis)

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24. A three-week-old baby girl in the NICU (neonatal intensive care unit) is in obvious discomfort and has been very irritable (and not sleeping well). As you change her diaper you notice a severe rash forming near her belly/button umbilical cord area. A quick temperature check alerts you the child has a fever. You take a sample from the red blistered area and notice that some of the layers of skin look like they are peeling off. The sample reveals desquamation at the epidermal layer. What is this condition? Causative agent? a) Staphylococcal Scalded Skin Syndrome (SSSS) b) Staphylococcus aureus

25. A father takes his 3-year-old child to the clinic after he notices she is running a fever and is generally unwell for a couple of days. You perform an exam and notice several red vesicular spots in the mouth and blisters on the palms of her hands and soles of her feet. The father confirms that his child attends daycare regularly where the children share toys and play together. You are confident in your diagnosis based on the clinical presentation and the patient’s history. What is the disease? Causative agent? a) Hand, foot, muscle disease b) Enteroviruses, usually coxsackle

26. A patient presents to your clinic in Ethiopia for a routine eye exam. When you examine the eye, you notice microfilariae wiggling in the anterior chamber of the eye. You ask your patient if they have ever been caught in a black fly swarm and they state yes and have been bitten hundreds of times. Based on this finding, you prescribe ivermectin. You also strongly advise the patient to avoid the black fly swarms that are common in the area. What is the disease? Causative agent? a. The disease is river blindness. b. The causative agent is Onchocerca volvulus and Wolbachia living inside the Onchocerca worms. This organism is a filarial helminthic worm that is transmitted by small biting vectors called black flies.

27. 37-year-old man comes into clinic complaining of a large sore on his upper lip that is painful to the touch. After examining the sore, you decide to prick the blister with a needle to swab it for a PCR test. Based on the PCR results and clinical presentation, you decide to prescribe acyclovir to prevent any future outbreaks for the patient. What is the disease? Causative agent? a. The disease is chicken pox. b. The causative agent is Human Herpesvirus 3 (varicella-zoster virus). 7

Skin Case Studies

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28. A teenage patient comes into your dermatology clinic complaining of puberty painpimples. When you examine the skin on her face, you notice several small, red bumps, some with pustules, on the forehead, cheeks, and chin. You provide education to the patient on helpful skincare routines and products. What is the disease? Causative agent? a. The disease is acne. b. The causative agent is Propionibacterium acnes. 29. You are an oncologist and see one of your favorite patients. As you are discussing the next round of chemotherapy, they show you a swollen infection on their lower leg. The patient says it hurts and you notice it is tender and hot to the touch. As you look more closely you see that there are red lines leading away from a centralized area (lymphangitis). It appears that the patient also is running a fever and has swollen lymph nodes. You notice the infection has reached down into the dermis of the skin. You find the initial infection site and swab to send it to send a sample off to the lab. You find that there are gram positive cocci that are coagulase positive. What is this infection? What is the causative agent? a. The infection is cellulitis. b. The causative agent is Staphylococcus aureus, since it produces coagulase. This disease is caused by fast-spreading infection in the dermis and subcutaneous tissues. 30. A 9-year-old boy comes to the clinic with a chief complaint of multiple lumps on his face that have persisted for 2 weeks. Physical examination reveals multiple painless, flesh colored, umbilicated nodules on the face and trunk without signs of inflammation. You perform a squash test of the pus from inside the fluid inside the lesion and see characteristic inclusion bodies. What is the causative agent of this disease? What is your diagnosis? a. The causative agent is Molluscusm contagiosum viruses. b. The diagnosis is Pox Virus.

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