CPD SPOT DIAGNOSIS ,

Self-recorded CPD: Spot Dx — Dermatology – DER006

You can self-report this CPD/PDP activity by logging it online with the RACGP/ACRRM. The activity has been allocated 1 hour (0.5 hour EA and 0.5 hour RP). Certificates are not available for this CPD.

Test your clinical knowledge by taking the 6 quizzes below. If you select the wrong answer, have another go — you can try as many times as you like.

RACGP Activity Number: DER006

ACRRM Activity Number: DER006

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1. What is causing this painful pinna?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Mark is a 44-year-old banking executive who presents with a painful, tender nodule on the right ear (pictured). It developed a few months ago. The lesion typically crusts in the centre, and the crust is then usually knocked off when he uses his headphones, which he wears regularly for work calls and meetings while working from home during the pandemic. It is starting to become uncomfortable when he wears headphones and sleeps on the right. And a similar lesion is now developing on the left ear. Mark is generally well, with no past history of note. Examination is unremarkable apart from the lesion shown.</strong></p></p> <ul> <li>a. Chondrodermatitis nodularis helicis</li> <li>b. Keratoacanthoma</li> <li>c. BCC</li> <li>d. Gouty tophus</li> </ul> </section> <p></p>Photo: DermnetNZ

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

2. What’s driving this rash and excoriated nodules?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 49-year-old man presents with several months of pruritic rash and progressive excoriated nodules affecting his torso and upper and lower limbs (pictured). His hands, face, neck and genitals are spared. The rash developed over summer after he started working as a gardener. He has been in contact with invasive bamboo and various herbicides and pesticides, although he usually wears protective clothing. Occasionally, the rash is so intensely pruritic that he scratches to the point of bleeding and pain. He is systemically well, with a past history of mild atopic eczema, which usually flares in winter and responds to general skin care and low-potency topical steroids.</strong></p></p> <ul> <li>a. Lichen simplex chronicus</li> <li>b. Epidermolysis bullosa</li> <li>c. Prurigo nodularis</li> <li>d. Nodular scabies</li> </ul> </section> <p></p>

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital and conjoint professor at UNSW. This article was co-authored by Dave Wi, a fourth-year medical student at UNSW and Dr Anna Wilson, a dermatology research fellow at St George Hospital.

3. What’s behind these spreading white patches?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Cherie, a 30-year-old woman, presents for review of progressive white patches affecting her skin. She first noticed patches over both wrists a few months ago, which have progressed to involve her neck, back and the dorsal surface of her hands (pictured). Cherie is six months post-partum, following an uncomplicated pregnancy and delivery. She has no significant past medical history. Clinical examination reveals depigmented patches on her chest, neck, back, dorsal hands and distal forearms. A halo naevus is noted on her torso. Wood’s lamp examination reveals the depigmented patches fluoresce bright blue and have sharp borders.</strong></p></p> <ul> <li>a. Acanthosis nigricans</li> <li>b. Idiopathic guttate hypomelanosis</li> <li>c. Vitiligo</li> <li>d. Lichen sclerosus et atrophicus</li> </ul> </section> <p></p>

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at the University of NSW, Sydney.This article was co-authored by Henry Lee, a medical student at UNSW and Dr Timothy Cowan, a dermatology registrar at St George Hospital.

4. Can you detect the source of this head scratcher?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Lee is a 74-year-old retiree who presents with a three-day history of an itchy rash on the forehead. She tried some of her partner’s topical steroid, which made the rash worse. Lee has generally enjoyed good health until three weeks ago when she was diagnosed with primary lung adenocarcinoma following an episode of haemoptysis. She is booked for a lobectomy next week, with likely subsequent chemotherapy. She is up to date with flu and pneumococcal vaccination. On examination, vital signs are normal. In addition to the forehead, there are also 15-20 urticated plaques, with some blistering, on the left chest and abdomen. There is no mucosal involvement.</strong></p></p> <ul> <li>a. Cellulitis</li> <li>b. Irritant contact dermatitis</li> <li>c. Paraneoplastic pemphigus</li> <li>d. Disseminated herpes zoster</li> </ul> </section> <p></p>Photo: BMJ 2020

Author

Author: Dr Kate Kelso is a GP and medical editor at Australian Doctor.

5. Can you pick what’s causing this interdigital itch?

What is the most likely diagnosis?

Author

Author: Professor Dedee Murrell is head of the department of dermatology, St George Hospital; and conjoint professor, University of NSW, Sydney. Dr Timothy Cowan is a dermatology registrar, St George Hospital. Joy Wong Lynn is a medical student at UNSW

6. What’s this dark lesion that’s doubled in size?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Damien, a 55-year-old golf coach, presents with an enlarging lesion over the medial canthus of his right eye. He noticed it two months ago and is worried that it has nearly doubled in size in that time. Damien reports that the lesion is not sore to touch and feels his vision is entirely normal. He does not wear any spectacles and has no significant medical history, nor does he take any regular medications.</strong></p></p> <ul> <li>a. Epidermal naevus</li> <li>b. BCC</li> <li>c. Hidrocystoma</li> <li>d. Milia</li> </ul> </section> <p></p>Photo: Dermnet NZ

Author

Author: Dr Paul Muthiah is a GP and a former medical co-editor of Australian Doctor.

References on request from kate.kelso@adg.com.au