Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Rest home resident with itching and rash

Clinical Discipline(s)/Organ System(s)
Dermatology, General Practice, Infectious Diseases
Progress Test Topic(s)
You have been asked to visit an 81 year old NZ European man with dementia in hospital level care. The nursing staff report that he has become agitated in the last 3 months and has developed an extensive rash that is most severe on the trunk and in the inguinal flexures.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Microbiology and histology of tinea and scabies
   - Pharmacology of the topical treatments for scabies and tinea; topical antifungal; azoles (miconazole etc); topical antiscabetics (permethrin, malathion)
   - Pharmacology of the systemic treatments for scabies and tinea; systemic antifungals (terbinafine, itraconazole); systemic antiscabetics (ivermectin)
Clinical and Communication Skills 
   - Establish the history from nursing staff and family/whānau and take a careful drug history
   - Communication and examination of a patient with dementia
   - Undertake a careful examination of the skin; identify scabies burrows and mites (using dermoscopy, if available); differentiate usual scabies from crusted scabies
   - Describe the clinical features observed using dermatological terminology
   - Take a skin scrape and nail clipping for mycological microscopy and culture
   - Identify other affected residents
   - Discuss and institute appropriate therapy, topical and systemic
   - Liaise closely with nursing staff and family/whānau members; describe expected response to treatment and follow-up arrangements
   - Provide the rest home with written information about institutional scabies and its management
Personal and Professional Skills 
   - Display respect and empathy for the patient with dementia
   - Awareness of the vulnerability of an patient with dementia in long-term residential care for older people and in hospitals.
   - Patient rights and safety
   - Code of Rights, Health and Disability Commissioner
Hauora Māori 
   - Culturally safe engagement with this patient and his whānau
Population Health 
   - Awareness of the difficulties in eradicating scabies from institutions
   - Appropriate and sensitive communication with contacts; contact tracing
Conditions to be considered relating to this scenario
scabies, tinea cruris/corporis/onychomycosis, intertrigo, asteototic eczema, discoid eczema, drug eruption, bullous pemphigoid
prebullous pemphigoid
Related Scenarios
[Itching child]