Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every spring and fall.
- Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
- Skin: Flaking erythematous rash on the flexor surfaces of both arms
- Head, Eyes, Ears, Nose, and Throat:Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)
- Lungs: Clear to auscultation and percussion
Initial Post: Answer the following questions about Anna Sanchez and her condition.
- What evidence suggests that Anna does not have an acute severe infection?
- If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
- A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
- What class of antibodies bind to the mast cells?
- What physiological mechanisms caused the redness of Anna’s nasal mucosa?
- What mechanisms caused Anna’s clear postnasal drainage?
Response # 1: Carefully read the initial posts made by the other students in your small group.
- Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.
Response #2: Go back into your own initial post.
- Identify what diagnostic testing or additional information you might need to establish a diagnosis.
- Identify what you believe is the correct diagnosis for the patient in the case study with the rationale for your response.
- Identify why the differential diagnoses left by your peers are or are not the correct diagnosis and support this with evidence from research and from the case posted by your peers.