,Patient Information
Name: Sarah Mitchell
Age: 36 years old
Gender: Female
Chief Complaint: Itchy rash
Informant: Patient (Sarah Mitchell)
Case Overview
Sarah Mitchell, a 36-year-old female, presents to the primary care clinic
with a new, intensely pruritic rash on her arms and torso for five days.
The i-Human simulation for NRNP 6512 (Week 4) is designed to develop
advanced health assessment skills, requiring learners to conduct a
detailed history, perform a focused dermatologic and systemic physical
exam, formulate a differential diagnosis for the itchy rash, order
appropriate diagnostic tests, and develop an evidence-based, patient-
centered management plan. The case emphasizes clinical reasoning,
accurate rash characterization, patient communication, and integration
of 2025 healthcare technologies (e.g., AI-driven skin analysis,
telehealth) to optimize care. The goal is to identify the underlying cause
,of the rash, distinguish benign from potentially serious etiologies, and
address Sarah’s concerns about discomfort and cosmetic appearance.
Step 1: History of Present Illness (HPI)
Chief Complaint: “I’ve had this really itchy rash on my arms and
stomach for a few days, and it’s getting worse.”History-Taking (i-Human
Interface Description):
Interface Description: The i-Human history-taking interface
displays a virtual patient (Sarah, a 36-year-old female) seated in a
clinic exam room, appearing mildly distressed and scratching her
arm. A text input field allows free-text questions, and a dropdown
menu offers categories like “Chief Complaint,” “Associated
Symptoms,” “Past Medical History,” and “Social History.” Patient
responses appear in a dialogue box, with keywords (e.g., “itchy,”
“rash”) highlighted in red to guide differential diagnosis
development. A progress bar tracks history completeness (e.g.,
“History: 90% complete”), and a sidebar suggests follow-up
questions (e.g., “Have you used new soaps or detergents?”). Real-
time feedback notes strengths (e.g., “Good question: Explores
environmental triggers”) or errors (e.g., “Missed asking about
systemic symptoms”).
, Process: The learner uses the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating
factors, Related symptoms, Treatment, Severity) to gather a
comprehensive history. Open-ended questions (e.g., “Can you
describe the rash?”) encourage detailed responses, while targeted
questions (e.g., “Have you been exposed to new plants or
chemicals?”) clarify potential triggers. The learner creates a
supportive environment to address Sarah’s concerns about itching
and appearance.
HPI Details:
Onset: Rash began 5 days ago, noticed after gardening in her
backyard. Onset was gradual, starting with mild itching and
progressing to visible lesions.
Location: Bilateral forearms (extensor surfaces), upper arms, and
anterior torso (abdomen, lower chest). No involvement of face,
scalp, palms, soles, or mucous membranes.
Duration: Persistent for 5 days, with worsening pruritus and slight
increase in lesion number.
Characteristics:
Name: Sarah Mitchell
Age: 36 years old
Gender: Female
Chief Complaint: Itchy rash
Informant: Patient (Sarah Mitchell)
Case Overview
Sarah Mitchell, a 36-year-old female, presents to the primary care clinic
with a new, intensely pruritic rash on her arms and torso for five days.
The i-Human simulation for NRNP 6512 (Week 4) is designed to develop
advanced health assessment skills, requiring learners to conduct a
detailed history, perform a focused dermatologic and systemic physical
exam, formulate a differential diagnosis for the itchy rash, order
appropriate diagnostic tests, and develop an evidence-based, patient-
centered management plan. The case emphasizes clinical reasoning,
accurate rash characterization, patient communication, and integration
of 2025 healthcare technologies (e.g., AI-driven skin analysis,
telehealth) to optimize care. The goal is to identify the underlying cause
,of the rash, distinguish benign from potentially serious etiologies, and
address Sarah’s concerns about discomfort and cosmetic appearance.
Step 1: History of Present Illness (HPI)
Chief Complaint: “I’ve had this really itchy rash on my arms and
stomach for a few days, and it’s getting worse.”History-Taking (i-Human
Interface Description):
Interface Description: The i-Human history-taking interface
displays a virtual patient (Sarah, a 36-year-old female) seated in a
clinic exam room, appearing mildly distressed and scratching her
arm. A text input field allows free-text questions, and a dropdown
menu offers categories like “Chief Complaint,” “Associated
Symptoms,” “Past Medical History,” and “Social History.” Patient
responses appear in a dialogue box, with keywords (e.g., “itchy,”
“rash”) highlighted in red to guide differential diagnosis
development. A progress bar tracks history completeness (e.g.,
“History: 90% complete”), and a sidebar suggests follow-up
questions (e.g., “Have you used new soaps or detergents?”). Real-
time feedback notes strengths (e.g., “Good question: Explores
environmental triggers”) or errors (e.g., “Missed asking about
systemic symptoms”).
, Process: The learner uses the OLDCARTS framework (Onset,
Location, Duration, Characteristics, Aggravating/Alleviating
factors, Related symptoms, Treatment, Severity) to gather a
comprehensive history. Open-ended questions (e.g., “Can you
describe the rash?”) encourage detailed responses, while targeted
questions (e.g., “Have you been exposed to new plants or
chemicals?”) clarify potential triggers. The learner creates a
supportive environment to address Sarah’s concerns about itching
and appearance.
HPI Details:
Onset: Rash began 5 days ago, noticed after gardening in her
backyard. Onset was gradual, starting with mild itching and
progressing to visible lesions.
Location: Bilateral forearms (extensor surfaces), upper arms, and
anterior torso (abdomen, lower chest). No involvement of face,
scalp, palms, soles, or mucous membranes.
Duration: Persistent for 5 days, with worsening pruritus and slight
increase in lesion number.
Characteristics:
