CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER007

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: DER007

ACRRM Activity Number: DER007

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1. Can you crack the case of this web-space lesion?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Maryanne, a 68-year-old retired nurse, presents with a three-month history of a moist red area between the middle and ring fingers of her right hand. This has been itchy but not painful. Maryanne had been washing her hands more regularly in the preceding months to minimise the risk of contracting COVID-19. She has never had any skin problems, including with regular handwashing when nursing. Maryanne has typically enjoyed excellent health, although, in lockdown, her good lifestyle habits slipped significantly, and she has recently been diagnosed with diabetes, for which she is taking metformin and addressing lifestyle factors. There is no other past history of note and no other medication use. Examination is unremarkable apart from the lesion shown.</strong></p></p> <ul> <li>a. Interdigital candidiasis</li> <li>b. Erythrasma</li> <li>c. Inverse psoriasis</li> <li>d. Irritant contact dermatitis</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

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

2. What is the cause of this alarming ulcer?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jeziah, a seven-month-old, presents with his concerned parents, who noticed a lesion on his right cheek three days ago. His mother reports that it started as a small red patch that became a bloody spot with pus in it before rapidly developing the black eschar with surrounding ulcer. She is anxious that Jeziah has also had a fever of around 38°C for the past two days. He was born at full term without any ante- or postnatal complications. He is up-to-date with the vaccination schedule and has no history of foreign travel.</strong></p></p> <ul> <li>a. Pyoderma gangrenosum</li> <li>b. Cutaneous leishmaniasis</li> <li>c. Ecthyma gangrenosum</li> <li>d. Syphillis</li> </ul> </section> <p></p>Photo: BMJ, 2014

Author

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

3. What does this palpable purpura point to?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Rani is a 16-year-old girl who presents with one week of rash affecting both legs. In the past two days, she has had bilateral knee pain and generalised abdominal pain. Rani had a COVID-negative URTI with rhinorrhoea and sore throat for a few days two weeks ago, which resolved with symptomatic treatment. She is usually well, with no past history of note, regular medications or allergies. On examination, she appears well, vital signs are normal and there are no focal findings apart from the non-blanching palpable papules pictured.</strong></p></p> <ul> <li>a. IgA vasculitis</li> <li>b. Epstein–Barr virus</li> <li>c. Meningococcal sepsis</li> <li>d. Idiopathic thrombocytopenia</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

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

4. What’s this ‘warty-looking’ worry?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Tina, a 49-year-old accountant, presents for review of a lesion on the second toe. She has been self-treating a ‘warty-looking’ lesion for the past six months, using topical salycilic acid and OTC liquid-nitrogen. Another GP reviewed her three weeks ago and suggested stopping the topical treatment and prescribed a course of oral antibiotics. Neither has helped, and if anything, the toe now looks worse. Tina is generally well, with no medical history of note. On examination, the lesion feels firm and is tender. There are no other significant findings.</strong></p></p> <ul> <li>a. Plantar wart</li> <li>b. Invasive SCC</li> <li>c. Carcinoma cuniculatum</li> <li>d. Tinea pedis</li> </ul> </section> <p></p>Photo: BMJ 2013

Author

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

5. What’s driving this pruritic rash?

What is the most likely diagnosis?

Author

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

6. What is the cause of these pale patches?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Prem is a 46-year-old accountant who presents with a two-year history of spreading mildly itchy hypopigmented patches. Initially, the left elbow only was affected, but it has now extended to involve the back and trunk. He has seen a number of doctors and trialled eczema skin care measures, topical and oral antifungals, and topical corticosteroids with no benefit. Prem is of South Asian descent, born and raised in Australia. He is diligent with sun protection, wearing a brimmed hat and long-sleeve shirt when outdoors. He is otherwise well, with no past history of note. Examination is unremarkable apart from the hypopigmented lesions shown, some of which contain subtle telangectasia.</strong></p></p> <ul> <li>a. Pityriasis versicolor</li> <li>b. Discoid eczema</li> <li>c. Vitiligo</li> <li>d. Hypopigmented mycosis fungoides</li> </ul> </section> <p></p>Photo: BMJ 2014

Author

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

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