CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Dermatology – DER008

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: DER008

ACRRM Activity Number: DER008

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1. What’s behind this suddenly bruised finger?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Anna, a generally well 45-year-old receptionist, presents with spontaneous bruising affecting her left ring finger. This was preceded by acute pain 12 hours previously. She recalls several episodes of similar symptoms affecting the digits. These typically settle within a few days with no treatment. Anna has no systemic symptoms or past history of note and takes no regular medications. There is no history of recent trauma or cold exposure. Physical examination is unremarkable apart from the well-demarcated and limited ecchymosis shown. Vascular, joint and skin examination is normal as are inflammatory, autoimmune and coagulation studies.</span></p></p> <ul> <li>a. Chilblains</li> <li>b. Raynaud’s syndrome</li> <li>c. Achenbach’s syndrome</li> <li>d. Upper-limb ischaemia</li> </ul> </section> <p></p>Photo: BMJ 2014

Author

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

2. Is this rash par for the course?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Geoff, a 55-year-old pest controller, presents with a prominent rash on his shins. The rash developed a few days ago and is associated with a mild burning sensation. He denies any trauma and always wears fully protective clothing at work. He also reports that no new products have been used at work or at home recently. He takes no medications and has no significant past medical history. Geoff declares that he feels very well and played a near perfect round of golf at an event a few days ago despite challenging hot and muggy summer conditions. He is systemically well, and his physical examination is unremarkable except for the purpuric rash, as shown, which delineates above his ankles. No abnormalities are noted on a urine dipstick.</span></p></p> <ul> <li>a. Henoch–Schönlein purpura</li> <li>b. Scurvy</li> <li>c. Ehlers–Danlos syndrome</li> <li>d. Exercise-induced vasculitis</li> </ul> </section> <p></p>Photo: DermNetNZ

Author

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

3. What’s behind this woman’s intimate irritation?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Monique is an 18-year-old who presents with a three-month history of anogenital rash. This is minimally itchy and was initially noted by her beautician when she attended for a bikini wax. She has not changed any skin care or laundry products, clothing or activity patterns. She is generally very well, BMI is normal and she has no other rash currently. She had quite bad bouts of nappy rash as an infant but no skin issues since. She has stopped waxing and getting her nails done because they have been quite brittle and pitted, which her beautician said was due to the shellac.</span></p></p> <ul> <li>a. Lichen simplex</li> <li>b. Candidiasis</li> <li>c. Contact dermatitis</li> <li>d. Psoriasis</li> </ul> </section> <p></p>Photo: BMJ 2020

Author

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

4. Was this rash caused by something she ate?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Janice is a 47-year-old businesswoman who presents with a mildly itchy, red linear eruption affecting the back, trunk and lower extremities for the past 24 hours. She is typically very well, with no past medical history of note and no regular medications. She reports having diarrhoea and mild fever three days ago, which she attributed to undercooked meat in a beef, shiitake and bok choy stir-fry the night before. She took a single dose of loperamide and paracetamol that morning with effect. She has no known sick contacts and hasn’t been to any COVID-19 hotspots. She now feels well apart from the rash, which she denies scratching.</span></p></p> <ul> <li>a. Escherichia coli food poisoning</li> <li>b. Drug eruption</li> <li>c. COVID-19</li> <li>d. Shiitake dermatitis</li> </ul> </section> <p></p>Photo: BMJ 2020

Author

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

5. Can this concern be alleviated?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Frank, a 20-year-old tennis coach, attends his GP regarding a recently discovered skin lesion on his right foot. He rarely checks his skin and only noticed this lesion within the past two weeks. He does not feel it has changed since he noticed it and reports it is neither painful nor pruritic. He cannot remember any recent trauma to his foot. He has tried scratching the edge of the lesion, and some of the discolouration lifted off and has not recurred. He is a non-smoker, has minimal alcohol consumption and no significant medical history. He admits to spending lots of his youth in the sun. He has always used sunscreen but rarely applies it to the soles of his feet. Unfortunately, Frank’s mother was recently diagnosed with a metastatic melanoma, and this is his primary concern. Dermoscopically, the border appears regular, with a uniform reddish-brown hue and an ordered parallel pattern.</span></p></p> <ul> <li>a. Acral lentiginous melanoma</li> <li>b. Viral wart</li> <li>c. Talon noir</li> <li>d. Traumatic tattoo</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.

6. Do these lesions seem a bit fishy?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><span style=”font-size: 14px”>Jeremy, a middle-aged pet shop owner, presents complaining of a nodule on his left hand that has been present for the past six weeks. Jeremy took a picture a few weeks ago of a separate papular lesion, distal to the initial nodule, which had developed into a shallow ulcer. This has since healed. He denies any constitutional symptoms, and his examination is otherwise normal. He incurs the occasional nick on his hand while feeding the fish at work, but he denies any other injuries. Jeremy is a little annoyed now as doctors keep giving him antibiotics (cephalosporins and penicillins), which have not helped. He is hoping for a “stronger one” this time around.</span></p></p> <ul> <li>a. Cutaneous leishmaniasis</li> <li>b. Staphylococcus aureus infection</li> <li>c. Mycobacterium marinum</li> <li>d. Basal cell carcinoma</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