M2 ANATOMY

A 64-year-old woman presents to your clinic with a new rash on her face. She has been a patient of yours for many years and has been in excellent health with the exception of osteoarthritis of the wrists (carpometacarpal joints) as well as mild hypertension. Upon questioning, she tells you that she felt stabbing, electrical pain in the region of her right forehead, right upper eyelid, and the right side of her nose two days previously. She describes the pain as “severe” and “intense” and tells you that there has been a tremendous amount of itching in the area as well. She admits to having had a slight fever, chills, and body aches. After the two days of pain in the aforementioned areas, she reports that when she woke up this morning she first noticed the painful rash on her face. Examination reveals a widely distributed rash over the patient’s right forehead, right upper eyelid and right nose. You specifically notice that the rash has also affected the tip of the patient’s nose. The rash exhibits a red base with vesicular lesions, which are leaking fluid and some regions are beginning to crust over. Your patient denies headaches or nausea, sensitivity to light or fatigue, but says that touching the lesions elicits pain and that the itching is, in her words, “driving her up the wall”. Further physical examination reveals a temperature of 99.7°F with a heart rate of 81 beats per minute, blood pressure of 151/92 mmHg, a respiratory rate of 15 breaths per minute and a pulse oximetry of 99%. After performing the history and physical examination you tell your patient that you are referring her to ophthalmology for emergent care and treatment. As she is leaving your office, you call your colleagues in ophthalmology in order to tell them to expect your patient. You also put in prescription orders for your patient to pick up an anti-viral medication (acyclovir) as well as pain medications from the local pharmacy.