Case scenario #1

This wiki is the being used as a housing location for these case scenarios. Each student is to answer each of the case scenarios and turn in for grading as per the course syllabus.

Ms. B. is a 18-year old, white, single female who presents for her three month recare appointment. Upon review of her medical history, Ms. B. discloses she has a sore throat and has had some difficulty swallowing for the last five days. Ms. B. takes phenytoin daily and took it this morning at 8:00 a.m. Her last seizure was eight months ago. Ms. B. also discloses she has been taking acetaminophen 500 mg three times a day for the last five days to address her sore throat that she attributes to being ran down due to “trying to do too much”.

Your E & I exam reveals creamy white lesions on the tongue. You take gauze square and wipe tongue but the white lesion remains. You also note that her free gingiva is generalized erythemic, swollen, scalloped and smooth. You question Ms. B. as to the occurrence of gingival bleeding and she confirms she has experienced this recently. When questioned on what can cause this, you reply “poor oral hygiene, pregnancy, systemic changes”. Ms. B. states that she is pregnant but has not told her patients yet.

What is your overall impression of this case?
Are there any possible drug interactions? If so, what are they? What would you recommend to the patient to address these?
Are there concerns with the drugs being taken and Ms. B. pregnancy status? If so, please explain.