Question

Sally, age 3 months, has a moist, red, vesicular rash on her cheeks, the backs of her hands, and her arms. Her mother said Sally was constantly trying to scratch the rash and often has difficulty sleeping. Her father has a family history of allergic rhinitis and asthma. Discussion Questions 1. Review atrophic dermatitis from Chapter 3 and discuss the pathophysiology of Sally’s symptoms. 2. Why is the father’s medical history significant, and what can Sally expect as she grows up? 3. Discuss the need to limit scratching, and describe practical methods to achieve this. Case Study 2 Mr. J, age 42, is a construction worker in Las Vegas. He recently noticed that a mole on his face seemed to be getting larger and darker. At first he did not worry because he was in the sun a lot and assumed the change may have been caused by sunburn. After a month, not only was the mole larger and darker, but it appeared to be “bumpy.” His doctor diagnosed a malignant melanoma skin cancer following biopsy of the nevus. Mr. J reports pain in his right shin that does not go away when he puts his feet up or sleeps. Discussion Questions 1. Relate Mr. J’s skin changes to the warning signs for malignant melanoma. (See Malignant Melanoma.) 2. Discuss the normal progression of this malignancy. What is the significance of the bone pain that Mr. J is experiencing? (See Malignant Melanoma.) 3. Discuss the treatment available for this patient and the prognosis for recovery. (See Malignant Melanoma.) Case Study 3 Ms. W, a 21-year-old woman, came into a clinic after suffering a deep laceration on her foot while walking barefoot around her yard. The wound was cleaned, sutured, and bandaged, and she was released to return home after receiving tetanus antitoxoid. Within 72 hours, the wound area was red and swollen, the suture line was dark in color, and it was accompanied by severe throbbing pain. Ms. W had a high fever, her heart felt like it was racing, and she was finding it hard to concentraten even on simple tasks. She returned to the clinic and was immediately taken to the hospital. Following lab tests, a diagnosis of acute necrotizing fasciitis was made. Discussion Questions 1. Explain why Ms. W. received a tetanus antitoxoid before leaving the hospital. (See Chapters 3 and 4, Infection and Passive Immunity.) 2. Explain how acute necrotizing fasciitis developed in this case and the pathophysiology involved. (See Acute Necrotizing Fasciitis.) 3. What is the potential outcome for Ms. W if antibiotic drugs do not reduce the infection quickly?

Answer 1

case study 1
1.Atopic dermatitis pathophysiology-it is a Ig-E mediated hypersensitivity reaction.it is commonly associated with elevated levels of immunoglobulins Ig-E.It oftenly leads to allergic rhinitis and asthma.
2.Atopic dermatitis is genetic,so father's history is significant.As she grows she will develop the condition of complete syptoms of allergic rhinitis and asthma also as per disease development.
3.to minimise scratching ,can use the treatment like moisturizers,topical steroids ,broad immunomodulators and targeted biologic therapies.

case study 2
1.warning signs of Malignant melanoma- warning sign of melanoma is new spot on the skin and changing in size,shape or color.
another rule is ABCDE rule
A-ASYMMETRY- one half of mole or birthmark doesnot match the other.
B-BORDER-edges are irregular
C-COLOR-may include different shades ,brown or black,sometimes patches of pink,red, white.
D-DIAMETER- spot is larger than 6 mm.
E-EVOLVING-mole is changing size ,shape and color.
2.normal progression of the malignancy -tumor progression is third and last phase in tumor development.this is characterised by increased growth and speed and invasion of the tumor cells.
3. treatment- surgical excision is done when mole is less than 1mm.as melanoma is larger, immunotherapy and chemotherapy is preferable.

case study 3
1.tetanus antitoxoid was given for protection for tetanus disease (immunity purpose to prevent lockjoint).
2.infection spreads from the subcutaneous tissue to deep fascial,causes to vascular occlusion,ischemia and tissue necrosis.then superficial nerves are damaged ,producing the characteristic localized anaesthesia.septicemia ensures with systemic toxicity.
3.if antibiotics are not effective surgical excision is made to the involved area of necrosis.