Running head: SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 1 SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS 7 Skin Conditions and Differential Diagnosis Adesola Turner Walden University NURS-6512N-17 Advanced Health Assessment. December 22, 2019. Introduction The number 2 graphic (figure below) is characterized as Cherry angiomas that appear in older adults. With time cherry angiomas turn dark, though after infection it is identified by round tiny bright ruby red papules. As age numerically increase Dunphy et al (2015) argues that the disease virtually occurs to everyone above the age of 30 years. One of the ways in which I would perform differential diagnosis is by observing the skin of a patient who is 70 years of age. Graphic #2 Patient Initials: AB                             Age: 70                                 Gender: male  SUBJECTIVE DATA: Chief Complaint (CC): AB comes in clinic complaining about development of hard red bumps on the chest History of Present Illness (HPI): Patient AB who is 70 years old comes in the hospital with complaints of having red bumps on his chest that appeared 2 weeks ago. He states that he wants to be done aa physical examination to be performed. AB says that last year he developed at least 4 new bumps on his chest that formed gradually. He is filled with anxiety because upon doing a Google search about his condition, he found that it could some tumors that are developing on his chest. He deniesrefutes any bleeding, painful and itchy bumps, exudation, or any climate variations. The bumps are located around the chest and the abdomen. AB says he has not come into contact with an irritant, denies having a fever, or does he take medications. Also, he reports he is neither under stress nor lifestyle changes. He claims, no one in his family lineage has ever been diagnosed with skin cancer.  Medications:  none  Allergies: NKDA Past Medical History (PMH):  identified with stage 4 blood pressure Hypertension and the age of 60 which was well managed.  Past Surgical History (PSH): At age 40, his left shoulder was repaired from a torn rotator cuff.  Sexual/Reproductive History: Married and not sexually active.  Personal/Social History: denies smoking, taking alcohol, substance abuse, or under any influence of ETOH  Immunization History: His immunizations are current. In 2017, he got immunized of Pneumococcal vaccines and influenza vaccine Significant Family History: Living with no parents who perished from a car accident. Living with his healthy daughter whom he got at his 30s Social History:  Live with her daughter and his 3 grandchildren. Being a widow for 8 years, he has been working as an engineer before he retired. In his free time, he does light exercises. Every day he attends catholic mass and then joins his 6 friends for breakfast at the local diner.  Review of Systems (ROS):  General: Mr. AB is a well-organized and neat man. He is alert and corporate during the discussion. He responds t ...

1. Running head: SKIN CONDITIONS AND DIFFERENTIAL
DIAGNOSIS 1
SKIN CONDITIONS AND DIFFERENTIAL DIAGNOSIS
7
Skin Conditions and Differential Diagnosis
Adesola Turner
Walden University
NURS-6512N-17
Advanced Health Assessment.
December 22, 2019.
Introduction
The number 2 graphic (figure below) is characterized as Cherry
angiomas that appear in older adults. With time cherry angiomas
turn dark, though after infection it is identified by round tiny

2. bright ruby red papules. As age numerically increase Dunphy et
al (2015) argues that the disease virtually occurs to everyone
above the age of 30 years. One of the ways in which I would
perform differential diagnosis is by observing the skin of a
patient who is 70 years of age.
Graphic #2
Patient Initials: AB Age: 70
Gender: male
SUBJECTIVE DATA:
Chief Complaint (CC): AB comes in clinic complaining about
development of hard red bumps on the chest
History of Present Illness (HPI): Patient AB who is 70 years old
comes in the hospital with complaints of having red bumps on
his chest that appeared 2 weeks ago. He states that he wants to
be done aa physical examination to be performed. AB says that
last year he developed at least 4 new bumps on his chest that
formed gradually. He is filled with anxiety because upon doing
a Google search about his condition, he found that it could some
tumors that are developing on his chest. He deniesrefutes any
bleeding, painful and itchy bumps, exudation, or any climate
variations. The bumps are located around the chest and the
abdomen. AB says he has not come into contact with an irritant,
denies having a fever, or does he take medications. Also, he
reports he is neither under stress nor lifestyle changes. He
claims, no one in his family lineage has ever been diagnosed
with skin cancer.
Medications: none
Allergies: NKDA
Past Medical History (PMH): identified with stage 4 blood
pressure Hypertension and the age of 60 which was well
managed.
Past Surgical History (PSH): At age 40, his left shoulder was
repaired from a torn rotator cuff.
Sexual/Reproductive History: Married and not sexually active.
Personal/Social History: denies smoking, taking alcohol,

3. substance abuse, or under any influence of ETOH
Immunization History: His immunizations are current. In 2017,
he got immunized of Pneumococcal vaccines and influenza
vaccine
Significant Family History: Living with no parents who
perished from a car accident. Living with his healthy daughter
whom he got at his 30s
Social History: Live with her daughter and his 3 grandchildren.
Being a widow for 8 years, he has been working as an engineer
before he retired. In his free time, he does light exercises. Every
day he attends catholic mass and then joins his 6 friends for
breakfast at the local diner.
Review of Systems (ROS):
General: Mr. AB is a well-organized and neat man. He is alert
and corporate during the discussion. He responds to the
question correctly and in-depth as he is a historian.
Comment by Kristin Curcio: These are objective findings.
ROS is for subjective information – what the patient tells you.
HEENT:
Eyes: clear vision and wears no glasses, and his last eye check-
up was done six months ago. He refutes having any
photophobia, excessive tearing, floaters, diplopia, and
glaucoma.
Ears: his ears are fine because he reports noDenies recent ear
infection, discharge or tinnitus.
Nose: intact smell. No history of polyps, epistaxis or recent
sinus infection. Nasal mucosa with rhinorrhea. Comment by
Kristin Curcio: Exam finding.
Mouth: chews and swallows food with no difficulty. AB has
healthy dental hygiene and did his last check-in in 2018.
Neck: No carotid bruits. No tracheal deviation noted. No masses
palpated. No thyromegaly. Supple, full range of motion.
Comment by Kristin Curcio: Exam findings.
Breasts: Refutes Denies any form of rashes, masses or lesions.
Respiratory: No breathing difficulty. Symmetrical diaphragm
excursion Comment by Kristin Curcio: Exam finding.

4. CV: No history of arrhythmias, palpitations, edema, paroxysmal
nocturnal dyspnea, chest discomfort, or murmur.
GI: has controlled reflux, no vomiting or nausea. The
bladder/bowel pattern has not changed. No abdominal pain.
GU: His urinary pattern, incontinence, and dysuria have not
changed. Since he lost his spouse in his heterosexual
relationship, he has been sexually inactive.
MS: The report shows he does not have arthritis, gout or
limitation of limb movement. History of rotator cuff repair due
to injury.
Psych: He denies suicidal history. No history of depression or
anxiety.The report shows he is not insomniac, psychological
disorders or delusions.
Neuro: No falls or seizure history. His range of motions and
coordination are not limited. No history of abnormal muscle
twitch; plus memory or thinking patterns, has not changed.
Integument /Lymph: 32 1-3 mm hard, raised papule bright red
in color, scattered over the chest and abdomen, they do not
blanch with pressure. Comment by Kristin Curcio: This
would be your exam.
Endocrine: no history of hormonal therapies or endocrine
symptoms
Allergic/Immunologic: the report indicate a history of allergic
arthritis
OBJECTIVE DATA:
Physical Exam:
Vital signs: Temperature 95.4, orally; BP 133/78, pulse 68, R
19 and regular. He weighs176 pounds and is 5’7” with a BMI of
23.6
General: looks organized and well-groomed.
HEENT:
Neck: supple, full ROM. No JVD or bruit
Chest/Lungs: Breath sounds clear and regular bilaterally
Heart/Peripheral Vascular: pulses+2 bilat pedal and +2 radial.
RRR without murmur, rub or gallop
ABD: Soft, nontender. No distension, masses, or organomegaly;

5. benign, nabs x 4, no organomegaly
Genital/Rectal: Postponed
Musculoskeletal: fully weight-bearing. Full ROM in all
extremities
Neuro: A&O x3, cooperative. CN II-XII is intact. DTRs 2+ and
symmetrical bilaterally
Skin/Lymph Nodes: 32 1-3 mm hard, raised papule bright red in
color, scattered over the chest and abdomen, they do not blanch
with pressure.
ASSESSMENT:
Lab Tests and Results: SAO2 – 98%
Diagnostics: DEFERRED
Differential Diagnosis:
1.) Cherry angioma- Cutaneous vascular proliferation which
predominantly occurs on the upper trunk and arms is manifested
with single or multiple spots. Measuring up to several
centimeters in diameter, they appear as a red, dome-shed,
round-to-oval, bright red papules and pinpoint macules. Cherry
angioma forms in the papillary dermis whereby histopathologic
findings show that they appear as true capillary hemangioma
with tapered lumens and protruding endothelial cells arranged
in lobular fashion (Dunphy et al., 2015). Research has
documented little information about cherry angioma etiology.
But, as the patient ages, the risk of developing the disease
increases by 75% in adults who are above 75 years of age, and
the aging process may play a role in the pathogenesis of cherry
angioma (Ball et al., 2017).
2.) Glomeruloid hemangioma- is small dome-shaped papules,
red in color or wine-red sessile or pedunculated papules, firm,
papulonodules, subcutaneous bluish compressible tumors, or
lesions with cerebriform morphology. They are located in
proximal limbs and the truck, which range in size, measuring
few millimeters to a centimeter in diameter, and is manifested,
by a single or multiple blue-red papules (Kim, Park & Ahn,
2009).
3.) Angiokeratoma corporis diffusum- Red to purple,

6. hyperkeratotic and coalescing papules form most typically on
the lower region of the trunk, buttocks, and thighs and is
usually associated with Lyosomal storage diseases (Dunphy et
al., 2015). The disease is identified by Ball et al (2017) as
superficial ectatic vessels with epidermal proliferation.
Diagnoses/Client Problems of Image #2:
1.) Cherry angioma- People above the age of 30 are vulnerable
to getting infected with cherry angioma disease and the risk
increases numerically with age (Kim, Park & Ahn, 2009). As it
forms in the lower papillary dermis, the Glomeruloid
hemangioma is ruled out because it is vascular proliferation
which occurs suddenly on the neck, head, extremities, and trunk
region (Helm et al., 2017). Also, Angiokeratoma corporis
diffusum was ruled out because all lab work enzymes were
normal for the patient’s Lysosomal storage disease.
PLAN: No intervention is necessary. It could be removed for
cosmetic reasons.
Conclusion
Cherry angioma is the most common dermatosis of vascular
cause in the individual. Its rate in the scalp is extremely high,
including men and women and it is progressively more in men
over 30 years old. This soap note differential diagnosis has
affirmed graphic #2 is cherry angiomas.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2017). Seidel's Physical Examination
Handbook-E-Book: An Interprofessional Approach. Elsevier
Health Sciences.
Dunphy, L. M., Winland-Brown, J., Porter, B., & Thomas, D.
(2015). Primary care: Art and science of advanced practice
nursing. FA Davis.
Helm, K. F., Marks, J. G., & Foulke, G. T. (2017). Differential
Diagnosis in Dermatology. JP Medical Ltd.
Kim, J. H., Park, H. Y., & Ahn, S. K. (2009). Cherry angiomas
on the scalp. Case reports in dermatology, 1(1), 82-86.

7. Episodic/Focused SOAP Note Template
Patient Information:
Initials, Age, Sex, Race
S.
CC (chief complaint) a BRIEF statement identifying why the
patient is here - in the patient’s own words - for instance
"headache", NOT "bad headache for 3 days”.
HPI: This is the symptom analysis section of your note.
Thorough documentation in this section is essential for patient
care, coding, and billing analysis. Paint a picture of what is
wrong with the patient. Use LOCATES Mnemonic to complete
your HPI. You need to start EVERY HPI with age, race, and
gender (e.g., 34-year-old AA male). You must include the seven
attributes of each principal symptom in paragraph form not a
list. If the CC was “headache”, the LOCATES for the HPI might
look like the following example:
Location: head
Onset: 3 days ago
Character: pounding, pressure around the eyes and temples
Associated signs and symptoms: nausea, vomiting, photophobia,
phonophobia
Timing: after being on the computer all day at work
Exacerbating/ relieving factors: light bothers eyes, Aleve makes
it tolerable but not completely better
Severity: 7/10 pain scale
Current Medications: include dosage, frequency, length of time
used and reason for use; also include OTC or homeopathic
products.
Allergies: include medication, food, and environmental allergies
separately (a description of what the allergy is ie angioedema,
anaphylaxis, etc. This will help determine a true reaction vs

8. intolerance).
PMHx: include immunization status (note date of last tetanus
for all adults), past major illnesses and surgeries. Depending on
the CC, more info is sometimes needed
Soc Hx: include occupation and major hobbies, family status,
tobacco & alcohol use (previous and current use), any other
pertinent data. Always add some health promo question here -
such as whether they use seat belts all the time or whether they
have working smoke detectors in the house, living environment,
text/cell phone use while driving, and support system.
Fam Hx: illnesses with possible genetic predisposition,
contagious or chronic illnesses. Reason for death of any
deceased first degree relatives should be included. Include
parents, grandparents, siblings, and children. Include
grandchildren if pertinent.
ROS: cover all body systems that may help you include or rule
out a differential diagnosis You should list each system as
follows: General:Head: EENT: etc. You should list these in
bullet format and document the systems in order from head to
toe.
Example of Complete ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, double vision or
yellow sclerae. Ears, Nose, Throat: No hearing loss, sneezing,
congestion, runny nose or sore throat.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest
discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
GASTROINTESTINAL: No anorexia, nausea, vomiting or
diarrhea. No abdominal pain or blood.
GENITOURINARY: Burning on urination. Pregnancy. Last
menstrual period, MM/DD/YYYY.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia, numbness or tingling in the extremities. No change in

9. bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain, joint pain or
stiffness.
HEMATOLOGIC: No anemia, bleeding or bruising.
LYMPHATICS: No enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat
intolerance. No polyuria or polydipsia.
ALLERGIES: No history of asthma, hives, eczema or rhinitis.
O.
Physical exam: From head-to-toe, include what you see, hear,
and feel when doing your physical exam. You only need to
examine the systems that are pertinent to the CC, HPI, and
History. Do not use “WNL” or “normal.” You must describe
what you see. Always document in head to toe format i.e.
General: Head: EENT: etc.
Diagnostic results: Include any labs, x-rays, or other diagnostics
that are needed to develop the differential diagnoses (support
with evidenced and guidelines)
A.
Differential Diagnoses (list a minimum of 3 differential
diagnoses).Your primary or presumptive diagnosis should be at
the top of the list. For each diagnosis, provide supportive
documentation with evidence based guidelines.
P.
This section is not required for the assignments in this course
(NURS 6512) but will be required for future courses.
References
You are required to include at least three evidence based peer-
reviewed journal articles or evidenced based guidelines which
relates to this case to support your diagnostics and differentials
diagnoses. Be sure to use correct APA 6th edition formatting.
© 2019 Walden University

10. Page 1 of 3
Imagine not being able to form new memories. This is the
reality patients with anterograde amnesia face. Although this
form of amnesia is rare, it can result from severe brain trauma.
Anterograde amnesia demonstrates just how impactful brain
disorders can be to a patient's quality of living. Accurately
assessing neurological symptoms is a complex process that
involves the analysis of many factors.
In this Case Study Assignment, you will consider case studies
that describe abnormal findings in patients seen in a clinical
setting.
· By Day 1 of this week, you will be assigned to a specific case
study for this Case Study Assignment. Please see the “Course
Announcements” section of the classroom for your assignment
from your Instructor.
· Also, your Case Study Assignment should be in the
Episodic/Focused SOAP Note format rather than the traditional
narrative style format. Refer to Chapter 2 of the Sullivan text
and the Episodic/Focused SOAP Template in the Week 5
Learning Resources for guidance. Remember that all
Episodic/Focused SOAP notes have specific data included in
every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources, and consider the
insights they provide about the case study.
· Consider what history would be necessary to collect from the
patient in the case study you were assigned.
· Consider what physical exams and diagnostic tests would be
appropriate to gather more information about the patient's

11. condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be
considered in a differential diagnosis for the patient.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create an
episodic/focused note about the patient in the case study to
which you were assigned using the episodic/focused note
template provided in the Week 5 resources. Provide evidence
from the literature to support diagnostic tests that would be
appropriate for each case. List five different possible conditions
for the patient's differential diagnosis, and justify why you
selected each.
A 47-year-old obese female complains of pain in her right wrist,
with tingling and numbness in the thumb and index and middle
fingers for the past 2 weeks. She has been frustrated because the
pain causes her to drop her hair-styling tools.