Question

A 33 year old female patient comes to the clinic with complaints of an irregular skin lesion that is under her right brow. She has no significant past medical history. The nurse practitioner notes that the plaques are raised and yellow-colored. She diagnoses the patient with xanthelasma. What should the next step be?

a. Order steroid topical to be applied twice daily for 5 days.
b. Refer to dermatology
c. Order TSH, T3, and T4
d. Order Salicylic acid to be applied twice daily for 5 days.

Answer 1

The next step for a patient with xanthelasma is to order TSH, T3, and T4 to assess thyroid function as it can indicate underlying lipid metabolism issues. Further testing or referral for abnormalities may follow.

Step-by-step explanation:

A 33-year-old female patient with xanthelasma beneath her right brow should undergo the appropriate next steps for treatment and diagnosis. Since xanthelasma can sometimes be associated with hyperlipidemia and liver diseases, and considering her age and the absence of significant past medical history, it would be prudent to perform a lipid profile screening before considering referral to a specialist or prescribing treatments. Thus, the next appropriate step in this clinical scenario would be:

c. Order TSH, T3, and T4

This step is taken to check for any underlying thyroid disorders that can be associated with lipid abnormalities, as thyroid hormones can influence lipid metabolism. If thyroid function tests are normal, further assessment with a lipid profile should be considered. In case any abnormalities are detected, the patient may be referred to endocrinology or cardiology for further assessment and management.