GU: No change in urinary system. Denies dysuria, frequency, or urgency. She is heterosexual. No history of STDs. Denies having recent sexual intercourse. MS: Denies arthralgia/myalgia, gout, trauma, or fractures. Active and passive range of motion within normal limits. No history of fractures or osteoporosis. Psych: No history depression or psychiatric disorders. No complaints of insomnia. Denies suicidal/homicidal ideations. Neuro: No episodes or syncope or fainting. Denies dizziness or headaches. No change in memory. No history of seizures Integument/Heme/Lymph: No rashes, itching, or bruising. + red skin lesions that are on the chest, abdomen, and axillae. Denies pain or itching with lesions. Uses lotion daily.
She has no history of skin cancer or lesion removal. She has no bleeding disorders, clotting difficulties, or history of transfusions. Denies anemia and frequent bruising. Endocrine: No endocrine symptoms. Allergic/Immunologic: No history of allergies. No immune deficiencies. OBJECTIVE DATA Physical Exam: Vital signs: B/P 124/62, right arm, sitting, regular cuff; P 64 and regular; T 97.0 orally; RR 17; non-labored; Wt: 146 lbs; Ht: 5’6; BMI 23.6 General: BB is well developed and well-nourished Caucasian female. A&O x3 and answers questions appropriately. No acute distress. Appears comfortable. HEENT: Normocephalic, atraumatic and without lesions, hair evenly distributed. PERRLA, EOMs intact. Ear canals patent. Nasal mucosa pink, normal turbinates. No septal deviations. Oral mucosa pink and moist. Pharynx is nonerythematous and without exudate. Teeth in good repair. Neck: Supple. Full ROM, no cervical lymphadenopathy, no occipital nodes, no thyomegaly or nodules. Chest/Lungs : Symmetric chest wall. Respirations regular and easy. CTA AP&L Heart/Peripheral Vascular: RRR without murmur, rub, or gallop; pulses+2 bilateral pedal and +2 radial. ABD: Bowel sounds normal x 4. No tenderness, organmegaly, masses, or hernia. Genital/Rectal: Intact, no masses. Musculoskeletal: Full ROM in all 4 extremities. Moves about exam room freely. Symmetric muscle development. Muscle strengths 5/5 all groups Neuro: CN II – XII grossly intact. No focal neurological deficits. DTRs intact in upper and lower extremities. Speech clear and good tone. Skin/Lymph Nodes: Skin intact. Turgor good. No ecchymosis or edema. Red, tiny smooth papules scattered on the abdomen, chest, and axillae. Some appear darker red and brown in color. The size is 0.25 cm-0.5 cm in diameter. Some papules protrude from the skin where as some are smooth. ASSESSMENT: Lab Tests and Results: Diagnostics: Unnecessary Differential Diagnosis (DDx): 1.) Cherry angiomas 2.) Petechiae
3.) Glomeruloid hemangiomas Cherry angiomas occur in adults, over the age of thirty, and increase with age (Ball. Dains, Solomon, & Stewart, 2015). Cherry angiomas are a common vascular skin lesion that are described as polypoid lesions with an epidermal collarette, and multiple lobules of dilated capillaries. In most cases the etiology is unknown except for chemical exposure including mustard gas and bromides (Ingram et al., 2013). They appear bright red in color and can turn purple over time (Brown, 2016). The average size of cherry angiomas are pinpoint to 0.5 centimeters in diameter (United States Department of Health and Human Services, 2017).
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- Summer '15