ChestLungs Chest wall symmetrical Respirations even and unlabored CTA APL

Chestlungs chest wall symmetrical respirations even

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Chest/Lungs: Chest wall symmetrical. Respirations even and unlabored. CTA AP&L Heart/Peripheral Vascular: RRR without murmur, rub, or gallop; pulses+2 bilateral pedal and +2 radial. No edema. ABD: Abdomen obese. Bowel sounds active and normal x 4. No tenderness, organmegaly, masses, or hernia.
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Genital/Rectal : External genitalia intact, no cervical motion tenderness, no adnexal masses. Musculoskeletal: Symmetric muscle development. Muscle strengths 5/5 all groups Neuro: Speech clear, good tone. Posture erect. Gait normal. CN II – XII grossly intact. No focal neurological deficits. DTRs intact in upper and lower extremities. Skin/Lymph Nodes: Lesions on bilateral elbows consists of erythematous, silvery white scaly, sharply demarcated borders, indurated plaques, distributed symmetrically. No edema present. No history of skin cancer removal. No excessive bruising. No history of blood transfusions. Endocrine: No endocrine symptoms. Allergic/Immunologic: No history of allergies. No immune deficiencies. ASSESSMENT: Diagnostics: Dermoscopy Differential Diagnosis (DDx): 1 Plaque Psoriasis 2 Tinea Corporis 3 Lichen Planus Plaque psoriasis is a chronic inflammatory skin condition that is an autoimmune disorder. In psoriasis, new skin proliferation turns over every three to four days, which causes the skin to not mature. The presentation is excessive erythematous scaly papules and plaques. The most common areas affected are extensor surfaces of the elbows, knees, scalp, and lumbosacral area. Typical plaques are elevated above the skin two to three millimeters with well-defined borders. Obesity has been linked to psoriasis (Philipp, Sabat, & Sterry, 2014). Tinea corporis is a dermatophytosis that causes red to pink round lesions. The borders are raised and have white scaly patches with characterizations of inflammatory glabrous skin lesions. It mostly occurs in hot humid climates (El-Zawawu & Ali, 2016). Lichen planus is an inflammatory skin condition affecting the mucous membranes, skin, nails, and hair. It appears purple in color with flat bumps and white scaly patches. It is often painful and itchy. Sometimes blisters appear and burst causing crusting. It often affects middle aged adults (Mayo Clinic, 2015). Plaque psoriasis is the
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most likely diagnosis because the patient is obese. Obesity is a risk factor for the development of psoriasis. In addition to obesity, the patient has erythematous white scaly patches on the elbows which is the hallmark sign (Phillip et al., 2014). References El-Zawawy, N. A., & Ali, S. S. (2016). Pyocyanin as anti-tyrosinase and antitinea corporis: A novel treatment study. Microbial Pathogenesis, 100(2), 213. doi:10.1016/j.micpath.2016.09.013 Goman, T. (2017). Identifying the different clinical presentations of psoriasis. Journal of Community Nursing , 31 (2), 57-60. Retrieved from Walden University Library databases. Mayo Clinic. (2015). Lichen planus. Retrieved from - conditions/lichen-planus/symptoms-causes/syc-20351378 Philipp, S., Sabat, R., & Sterry, W. (2014). Psoriasis : Diagnosis and Management . Chichester, West Sussex: Wiley-Blackwell. Retrieved from Walden University Library databases.
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