CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – General practice – GPR001

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: GPR001

ACRRM Activity Number: GPR001

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1. Can you lift the lid on this diagnosis?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> A 59-year-old woman with poorly controlled hypertension presents with sudden-onset right eyelid drooping lasting one day.She complains of diplopia on left gaze and dull right periorbital pain. Intermittent throbbing headache is also noted.Earlier that day, she visited another hospital, where a non-contrast cranial CT read as negative.On physical examination, doctors observe severe right-sided ptosis, measuring 8mm (see figure 1), and mydriasis of 5mm, with sluggish reaction to light and a downward, lateral deviation of the right eye.She has intact muscular strength and normoreflexia. <ul> <li>a. Oculomotor nerve palsy</li> <li>b. Myasthenia gravis</li> <li>c. Preseptal cellulitis</li> <li>d. Horner’s syndrome</li> </ul> </section> Article reproduced, with permission from BMJ Publishing Group, from Emerg Med J 2022; 16 Dec.

Author

Article reproduced, with permission from BMJ Publishing Group, from Emerg Med J 2022; 16 Dec.

2. Puzzling papules appear on heels

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> Jeremy, a 28-year-old chef, presents with some tender lumps around his heels.He first noticed them six months ago, and reports that over the last few months they have started to cause mild discomfort. He also says the lumps are only visible when he is standing. He does 12-hour shifts and is on his feet all day long. Jeremy has no significant medical history and takes no regular medications.On examination, he has a few compressible papules around both heels. On palpation, the lumps are neither erythematous nor warm. They are mildly tender to touch and disappear upon non-weightbearing or removing downward pressure on the heels. <ul> <li>a. Gouty tophi</li> <li>b. Sebaceous cyst</li> <li>c. Xanthomas</li> <li>d. Peizogenic papules</li> </ul> </section> Photo: DermNet NZ

Author

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

3. Why does this rash keep coming back?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> Arya, a six-week-old infant, presents with a recurrent rash that has been present for the past month. Arya has seen a few other doctors, who have swabbed the rash and treated her accordingly with both oral and topical antibiotics. However, soon after completion of the antibiotics, the rash returns, and her parents are increasingly concerned. The rash is pruritic, and she remains systemically well, with no other clinical findings except for a small abscess developing over her lower occiput. She had no antenatal or birthing complications. <ul> <li>a. Wiskott–Aldrich syndrome.</li> <li>b. Atopic dermatitis.</li> <li>c. Severe combined immunodeficiency.</li> <li>d. Autosomal-dominant hyperimmunoglobulin E syndrome.</li> </ul> </section> Photo: DermnetNZ — Job syndrome

Author

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

4. Why are these gums giving grief?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> Darren, a 70-year-old retired cabinet-maker, presents complaining of enlarged gums that easily bleed.He has already seen his dentist, who advised that he did not seem to have a gum infection and recommended he see his GP.Darren first noticed the enlarged gums two months ago.He reports weight loss of around 10kg, with associated fatigue and easy bruising.He denies fevers, although he has experienced some night sweats, which he relates to his wife leaving the heating on at night.He has a balanced diet and reports no gastrointestinal symptoms.Darren takes olmesartan, 20mg daily, for hypertension — which remains well controlled — but otherwise has no significant medical history.On examination, he is normotensive and apyrexial. Gingival hypertrophy is noted (see picture), and he is also found to have hepatosplenomegaly. The rest of his examination is unremarkable. <ul> <li>a. Scurvy</li> <li>b. Drug-induced reaction</li> <li>c. Fabry disease</li> <li>d. Acute myeloid leukaemia</li> </ul> </section> Photo: DermNet NZ

Author

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

5. Could this be ‘COVID toe’?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> Shari is a 24-year-old ED nurse in Melbourne who sends these images ahead of a telehealth appointment. Her fingers and toes have been slightly itchy and burning for a few days. Erythematous papules developed 2 days ago, which have started to turn purple and erode in the past 24 hours. About a week ago she had a mild diarrhoeal illness with associated fatigue and rhinorrhoea which resolved within 48 hours. She is otherwise well, takes no regular medications and has never had anything like this previously. There was no clear cold exposure precipitant, although it is mid-winter. There is no associated rash or joint pain. <ul> <li>a. Pernio.</li> <li>b. SLE.</li> <li>c. COVID-19.</li> <li>d. Raynaud’s syndrome</li> </ul> </section> Photo: BMJ 2020; Covid-19 associated chilblain-like lesions in an asymptomatic doctor

Author

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

6. What are these chronic blisters on the back of his hands?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> Jurgen, a 55-year-old retired roofer, presents to his GP with painful, photosensitive hands that develop blisters which take a long time to heal. Also, in the past few weeks, his urine has appeared darker, sparking concern.He reports that the issue with his hands has been going on for six months and is increasingly bothersome, as he would like to spend more time on his boat fishing.He denies any changes in diet or cleaning products. However, he does disclose that before his wife passed away 12 months ago, he had been a teetotaller, but now he drinks a few beers before bed, as he finds it to be the only aid to his poor sleep. Jurgen has no significant medical history and takes no medications.Bloods are requested, and these flag moderately deranged liver function tests and elevated serum ferritin.An autoimmune liver screen is negative. Hepatitis serology does not indicate any infective cause. An abdominal ultrasound reveals moderate hepatic steatosis. <ul> <li>a. Epidermolysis bullosa acquisita (EBA)</li> <li>b. Bullous systemic lupus erythematosus (BSLE)</li> <li>c. Porphyria cutanea tarda (PCT)</li> <li>d. Scabies</li> </ul> </section> 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