Biomedical Science: Diagnosis and Treatment of Skin Conditions, Rheumatoid Arthritis, Iron Deficiency Anemia, and Type 2 Diabetes

Running head: BIOMEDICAL SCIENCE 1
BIOMEDICAL SCIENCE
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BIOMEDICAL SCIENCE 2
Question 1
a) In the history and examination, some of the key points to consider for proper
diagnosis include; location of lesions, family history, and a genetic tendency of
development of allergic condition such as asthma. One should also consider the place
of residence of the client, gender, and socioeconomic status. Some of the conditions
or diseases are influenced by family history meaning that they run across the family
lineage. Place of residence influences the development of certain allergic diseases and
the presence of pets in a family may lead to allergies which may lead to the
development of a particular disease (Arkwright et al, 2013).
It is also important to consider the history of allergies to medications and foods. Some
diseases are associated with allergies to different nutrients such as proteins,
carbohydrates or vitamins. It is also essential to consider the type and location of
flexures or other patient manifestations. Nature and location of lesions help in making
a diagnosis since certain different diseases affect different parts of the body. For
example, in a condition like eczema the lesions are usually located on flexural
surfaces while in psoriasis they tend to be on extensor regions (Arkwright et al.,
2013).
b) The main diagnosis for this case is atopic dermatitis.
c) The most possible differential diagnoses are scabies, pemphigus foliaceus and contact
dermatitis. In atopic dermatitis, the levels of immunoglobulin E (IgE) are usually
normal to high while in contact dermatitis and pemphigus are usually normal and
slightly elevated in scabies. Eosinophilia is very common in scabies and atopic
dermatitis but very rare and uncommon in contact dermatitis and pemphigus foliaceus
(Arkwright et al., 2013).

BIOMEDICAL SCIENCE 3
In atopic dermatitis, the eczema has a typical distribution and morphology, often
excoriated and pruritic while in contact dermatitis eczema is often localized. In
pemphigus foliaceus the eczema is superficial and atypical in seborrheic areas while
in scabies it involves the genitalia, finger webs and flexor wrists with typical burrows.
White dermographism is very common in atopic dermatitis and very rare in all the
three differential diagnoses. Pruritis is typical in both atopic dermatitis and scabies
and uncommon in contact dermatitis and pemphigus foliaceus. Additionally, atopic
dermatitis involves food and respiratory allergies but they are uncommon in the three
differential diagnoses (Katayama et al, 2014).
d) A blood test would be a recommendable laboratory test for atopic dermatitis whose
expected results would be high levels of immunoglobulin E (IgE) and eosinophils.
The second test is buccal swabs which should show mutations of Filaggrin gene
which leads to eczema. The third test would be a skin biopsy which would help in the
detection of other similar skin conditions such as psoriasis (Katayama et al, 2014).
e) The commonly used pharmacological agent for atopic dermatitis is tacrolimus
ointment whose adverse effects include; flu-like symptoms, headaches, itching,
redness, hypersensitivity, and burning. Its contraindications include allergies to
macrolide immunosuppressant and conditions like shingles, swollen lymph nodes,
malignant lymphoma, herpes simplex infection, incompatibility reaction after Bone
Marrow Transplant and skin conditions due to Herpes Simplex Virus (Arkwright et
al., 2013).
f) Atopic Dermatitis is attributed to complex interactions of environmental triggers,
genetic predispositions, and immune dysregulation. Disturbed epidermal barrier
causes dryness of the skin following high trans-epidermal loss of water hence
enhancing penetration of allergens and initiative substances into the skin. Allergies,

BIOMEDICAL SCIENCE 4
deviation of immune responses and impairment of the innate immunity may also
contribute to development of atopic dermatitis (Katayama et al, 2014).
g) Contraindications to assessment findings include; placebo, age, genetic profile, and
environmental exposures.
Question 2
a) The key points to consider in history taking and examination include; signs and
symptoms, family history, social history particularly smoking, age and gender. There
are certain signs and symptoms which are specific to a particular condition. There are
some medical conditions which are common in a particular gender within a particular
age bracket. Social history like smoking is a risk factor for various health conditions.
Family history is also important since some of the health conditions are genetically
inherited and run across a family lineage (Gibofsky, 2012).
b) The main diagnosis is Rheumatoid Arthritis.
c) The most possible differential diagnoses include osteoarthritis, fibromyalgia and
systemic rheumatic disease. The common joints affected by rheumatoid arthritis
include metacarpophalangeal (MCP) and proximal interphalangeal (PIP) hand joints
at the base and middle of the finger, wrists (ulnar-styloid articulation), ankles,
shoulders, knees, elbows and the metarsophalangeal (MTP) joints at the toes
(Gibofsky, 2012).
Morning joint stiffness lasting for more than one hour is the hallmark of rheumatoid
arthritis. Osteoarthritis affects the distal interphalangeal joints and carpometacarpal
joint (at the thumb) and involves the Heberden’s nodes. Joint swelling in osteoarthritis
is bony and hard while in rheumatoid arthritis involves warm, soft, tender and boggy