Subjective portion
The extent of the spread of the bumps
Has the patient noticed the bumps in any other place in the body or is it only around the genitals? Is it possible to know if they are internal or external?
Are they painless or do they feel rough?
Has the patient experienced any burning sensations or itching at the moment or before finding out about the bumps? How do the bumps react do they crust over, weep or accelerate? Have they changed appearance over the course o0f the week or are they still the same? And if they have changed how?
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Can the patient tell if the bumps come and go or are they present at all times?
A-is the patient aware of anything that aggravates the bumps? For instance, warm water or tight garments or any type of soap? Is it possible that the patient has changed detergents?
R-is the patient aware of anything that can decrease the number of the bumps or maybe alter their shape or texture?
T-has the patient tried any home remedies? If so have they helped in any way to reduce the bumps?
S- The patient acknowledged that they were painless.
Can they rank the effect of the bumps on their daily life on the scale of one to ten with 10 being the greatest effect?
Objective Portion
Physical exam
General
Illustrate stature, priming, hygiene touch and eye contact.
HEENT
Any lacerations, edema, enlarged tonsils, drainage, cold sores, assess throat for redness. Checking for systematic infection from another virus or HSV?
Chest
No enflamed ancillary nodes. Nipples discharge or tenderness, breast assessment no inflammations, non-labored breathing.
Lungs
CTA, Chest wall symmetrical, but is there any wheezing, any nasal flaring or retractions.
Neck
Check the neck area for any apparent nodules, nodal tenderness, clavicular nodes, ROM any jvd or bruit?
Genitals
The patient has not had a pap for three years and only had ahx of chlamydia? This calls for v a pap smear test where the cervix gets inspected, the uterine size and presentation gets checked, any ovary palpable, motion tenderness, any discharge noted, foul odor or bleeding from the vaginal area?
Rectal exam
Check out for any masses, trauma, hem occult stool, hemorrhoids and lesions.
Skin
Assess the skin for any discoloration, patches or scaling, any lesion or redness in other areas. Check if the skin is pink, dry or warm.
Is the assessment supported by the subjective and objective information? Why or why not?
The assessment has not been fully supported by the subjective and objective data since most of the essential parts from both sides are missing from the examination.
Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?
Diagnostics would be very appropriate for this case since they will help the assessor identify the microorganism causing the bumps.
Would you reject/accept the current diagnosis? Why or why not? Identify three possible conditions that may be considered as a differential diagnosis for this patient. Explain your reasoning using at least three different references from current evidence-based literature.
I would accept the current diagnosis since it tests for the HSV viral culture which could be the most probable cause of the bumps.
Differential diagnosis
Insect bites
Although it is very unlikely due to the position of the bumps, she may have been camping or using an outdoor bathroom where she was prone to an insect bite. According to Domachowske (2019) , bites from insects cause typical pruritic wheel and urticarial which develops at the site of the bite.
Syphilis
The position of the inflammations on the labia permits contact with a direct syphilis sore ( Karki et. al. 2015). The patient is at risk due to her past STI experience and multiple sex partners within a short period of a year. The fact that the bumps are painless, that is, they do not burn or itch and there are no reports of the same upon eruption indicates a syphilis rule before any other diagnosis ( Chang, 2019).
Lesions
The genital warts are rough suggesting verrucous lesion. The painless bumps appearing could be single lesions but it could also be more may be syphilis ( Yussman&Urbach, 2020) Vesicles normally point out herpes and they exist on the external labia presenting with sweltering and irritating.
Reference
Chang, J. S. (2019). Ocular Syphilis: Clinical Manifestations and Treatment Course. WMJ , 192.
Domachowske, J. (2019). Introduction to Clinical Infectious Diseases . Springer International Publishing.
Karki, A., Shrestha, R., &Parajuli, N. (2019). Pattern of sexually transmitted infections in a tertiary care hospital: A five-year retrospective study. Grande Medical Journal , 1 (2), 84-87.
Yussman, S. M., &Urbach, K. (2020). 243. Universal Chlamydia and Gonorrhea Screening in an Urban School-Based Health Center 2016-2019. Journal of Adolescent Health , 66 (2), S123.
