3. Towards the end of your visit,

3. Towards the end of your visit, your patient remembers that he noticed a rash on his arm. Using the transcript below, how would you document this symptom in his ROS? Patient: “Hey, sorry – I forgot. I have one more thing. About a week ago, I noticed this red spot on my arm (points to reddened area on flexor surface of right elbow). What do you think that is? You: “Have you ever had a rash like this before?” Patient: “No.” You: “Tell me how it showed up – was it all of a sudden like this, or did it get worse over time?” Patient: “Well, I didn’t notice anything there at all until about a week ago. Since then it has gotten really itchy and more like a bright red. It’s a lot worse at the end of the day when I get home from work.” You: “How bad is the itching, on a scale from 1-10 with 1 being not itchy and 10 being the itchiest thing you’ve ever felt?” Patient: “It’s hardly anything, like a 1, when I first wake up. But when I get home from work it’s like a 5 or 6.” You: “Is there something at work that you think might be aggravating it? Any new chemicals or materials that you are coming into contact with?” Patient: “Let me think. No, the only thing that’s changed at work is that the air conditioning went out and it’s always like 100 degrees at my desk. I sweat all the time, especially when the afternoon sun comes in my window.” You: “Do you tend to flex your elbows most of the day, like from typing on a keyboard?” Patient: “Yeah, especially in the afternoons.” You: “Does that inner elbow get pretty sweaty most of the time then?” Patient: “Definitely.” You: “Okay, how about other things you might have been exposed to. Have you been doing any yard work, camping, hiking, handling livestock or pets?” Patient: “No, none of that.” You: “Does anything make the itching and redness feel better?” Patient: “Taking a shower helps. Maybe because I’m able to get this sweat off of me. I haven’t put any creams or anything on it.” You: “Is there anyone else you know with the same rash?” Patient: “No, I think I’m the only one.” You: “I know you said you don’t have any allergies to things like dust or tree nuts, but can you think of anything else you might be allergic to?” Patient: “Not really.” You: “OK, have a seat and I’ll take a closer look at your rash.” SCIENCE

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