Patients initials: Mike Jack Age: 68 Gender: Male
SUBJECTIVE DATA:
Chief Complaint: Patient-reported of annual multiple and physically hard red bumps on his chest
HPI: Mike Jack is a 68 years old Caucasian male presented for annual physical and needed to address the multiple hard red bumps on his chest. His main concern is tumor, which he came to understand after conducting a Google search. However, there is no family or personal history of skin cancer.
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Medications: Metoprolol 50mg
Allergies: No Known Drug Allergies
PMH: Hypertension diagnosed at the age of 54 and it is well managed
PSH: Underwent surgery to repair a torn rotator on his left shoulder
Sexual Reproductive History: Not sexually active
Immunization History: Got immunized with influenza and pneumococcal vaccine in January 2019
Significant Family History: He has a son in the thirties.
Lifestyle: He is a retired engineer. He has been windowed for the last ten years and lives at his home with his son’s family. He walks 2 miles daily and is a practicing catholic. No history of recreational drug use
REVIEW OF SYSTEMS:
General: Mr. Jack is a well-nourished and developed male who is cooperative and generally alert. He has a perfect memory too.
HEENT: Vision appears normal; his last eye check-up was six months ago. He reported no ear discharge, tinnitus, or ear infections. Had his last dental check-up was in June 2018 is healthy.
Neck: No tracheal deviation, carotid bruits, thyromegaly and he is full of motion
Breast: No rashes, masses or lesions
Respiratory: No problem noted
CV: No chest discomfort
GI: No change in bladder and bowel movement
GU: No change in dysuria and urinary pattern
MS: No report of myalgia/arthralgia, gout or arthritis to limit movement but has a history of rotator cuff repair
Neuro: No report dizziness, headaches, or paresthesia. He has a perfect memory
Lymph: 32 1-3 mm hard, raised papule bright red, scattered over the chest and abdomen, they do not blanch with pressure.
Endocrine: No hormonal therapy
Allergic: None
OBJECTIVE:
Physical Assessment: B/P 110/75; Temperature 98.3; Ht. 6 ’5’; Wt. 184 lbs. The abdomen has benign, mild suprapubic tenderness, no organomegaly. Skin/Lymph 32 1-3 mm hard, raised papule bright red, scattered over the chest and abdomen, they do not blanch with pressure.
ASSESSMENT:
Diagnostic : Deferred
Differential Diagnosis:
1. Angiokeratoma corporis diffusum: shows histologically superficial ecstatic vessel which ranges from purple to red. It occurs on the lower part of trunk, thighs and buttocks. The disease is closely linked to lysosomal storage diseases (Diffusum et al., 2015).
2. Glumeruloid hemangioma: A condition exhibit signs small firm reddish-purple dome-shaped papules. These are located on proximal limbs and the lower trunk (Gupta et al., 2013).
3. Cherry angioma: cutaneous vascular papules that grow as a single or serve la spots and occur on the arms and upper trunk. They appear to be dome-shaped and vary in diameter. Research shows that cherry angiomas prevalence tends to increase with age, with 75% of those diagnosed are aged above 75 years (Kim, Park and Ahn, 2009).
REFLECTION OF GRAPHIC 2:
As the care provider, I would diagnose Mr. Jack with cherry angioma since the disease occurs to virtually all people above 30 years (Ball et al., 2015). To determine if Mr. Jack is having cherry angioma, I would do a biopsy, which involves removal and examination of a small sample to diagnose and rule out conditions such as skin cancer. Some of the common procedures that I can explain to the patient are include: electro-cauterization, cryosurgery, laser surgery or shave excision (Delgado, 2017).
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Neurologic system. Seidel's Guide to Physical Examination. 8th ed. St Louis, MO: Elsevier Mosby .
Delgado, A. (2017).How to get rid of Cherry Angiomas. See https://www.healthline.com/health/cherry-angioma
Diffusum, A. C., Jayavardhana, A., Balasubramanian, P., & Vijayalakshmi, A. M. (2015). Copyright 1999-2015 Indian Pediatrics. Indian Pediatr , 52 , 175.
Gupta, J., Kandhari, R., Ramesh, V., & Singh, A. (2013). Glomeruloid hemangioma in normal individuals. Indian journal of dermatology , 58 (2), 160.
Kim, J. H., Park, H. Y., & Ahn, S. K. (2009). Cherry angiomas on the scalp. Case reports in dermatology , 1 (1), 82-86.
