CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – General practice – GPR002

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: GPR002

ACRRM Activity Number: GPR002

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1. Can you nail the next best step?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>This case involved a 15-year-old boy, who slipped and impaled his left hand on a wooden beam.</strong></p><p><strong>An initial anterior–posterior radiograph was obtained prior to referral to plastic surgery for further management. Clinical examination was restricted due to access.</strong></p><p><strong>The patient reported general pain on limited movement of all digits but normal neurology.</strong></p><p><strong>He received appropriate initial treatment of broad-spectrum antibiotics and tetanus care in the ED.</strong></p><p><strong>His medical and social history were unremarkable.</strong></p></p> <ul> <li>a. Immediate removal of the impaled structure under tourniquet control in an operating theatre.</li> <li>b. Immediate removal of the impaled structure in the ED under nerve block.</li> <li>c. Further imaging is needed.</li> <li>d. Urgent surgical consultation.</li> </ul> </section> <p> </p> <p></p>Photo: Reproduced from Emerg Med J, Teoh V, Shariff Z. An image is worth a thousand words, 36:65-71, 2019 with permission from BMJ Publishing Group Ltd.

Author

Reproduced from Emerg Med J, Teoh V, Shariff Z. An image is worth a thousand words, 36:65-71, 2019 with permission from BMJ Publishing Group Ltd.

2. Can you work out the cause of this fluctuant mass?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Felicity, a 25-year-old teacher, presents complaining of a tender swelling over her frontal bone with associated fever for the past two days. She reports that she had a telehealth consult seven days ago where she described a persistent phlegmy cough and frontal sinus tenderness with no history of fever. She had a negative COVID-19 swab at her local drive-through pathology testing centre. The GP suspected a viral URTI and provided Felicity with general symptomatic advice and safety netted her. She is currently febrile with a tender fluctuant mass. The rest of her physical examination is unremarkable. There is no history of recent trauma, and Felicity has no significant medical history.</strong></p></p> <ul> <li>a. Periorbital cellulitis</li> <li>b. Inflammatory cutaneous TB</li> <li>c. Pott’s puffy tumour</li> <li>d. Haematoma</li> </ul> </section> <p></p>Photo: CMAJ 2019; 11 Feb.

Author

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

3. What are these problematic papules?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Loretta, a 33-year-old hairdresser, presents complaining of new-onset “bumps” on her forehead. She reports that they are multiplying, and the existing ones are enlarging. The lesions are not itchy or painful. She has not recently used any new hair or skin products. She has not developed any lesions or rashes elsewhere. She is feeling well otherwise, takes no medications and has no significant past medical history. Of note, she has started a new relationship and wants the lesions gone by “hook or by crook”.</strong></p></p> <ul> <li>a. Tuberous sclerosis complex.</li> <li>b. Brooke–Spiegler syndrome.</li> <li>c. Birt–Hogg–Dubé sydrome.</li> <li>d. Familial multiple discoid fibromas.</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.

4. Is this a suspicious streak?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Kennedy, a 13-year-old boy, presents to his GP alongside his worried mother.</strong></p><p><strong>The mother reports that, over the past year, she has noted an area of hyperpigmentation on the left side of her son’s forehead. And in the past few months, she has become increasingly anxious that the underlying skull appears to be indented with associated linear hair loss.</strong></p><p><strong>Kennedy denies any visual problems but does disclose new-onset left frontal headaches. There is no associated nausea or vomiting. He has also become increasingly self-conscious of his facial appearance as some other children have been teasing him about it.</strong></p><p><strong>The patient has no significant medical history. He interacts well with his mother and reports he has experienced no injuries to the area of concern. </strong></p><p><strong>Neurological examination and the remainder of his physical examination are unremarkable.</strong></p></p> <ul> <li>a. Non-accidental injury</li> <li>b. Focal dermal hypoplasia (Goltz syndrome)</li> <li>c. Lupus profundus</li> <li>d. En coup de sabre</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.

5. Why is this young man's hair falling out in patches?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Mark, a 22-year-old full-time student and part-time waiter, presents with two months of hair loss. He has been feeling ‘run down’, with low energy and appetite, which he attributes to exam stress and working nights. He initially also had a non-itchy rash affecting his torso and extremities, but this resolved after a few weeks. He typically enjoys excellent health and has no past history of note. On examination, he is febrile, has disseminated non-tender lymphadenopathy in the posterior cervical chain, axxilae, groin and epitrochlear regions. Examination is otherwise unremarkable apart from the scalp.</strong></p></p> <ul> <li>a. Trichotillomania.</li> <li>b. Alopecia areata.</li> <li>c. Syphilitic alopecia.</li> <li>d. Tinea capitis.</li> </ul> </section> <p></p>Photo: BMJ 2019

Author

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

6. What's causing this crop of papules?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Tristan, a 34-year-old optician, presents with a recent onset of a pruritic, yellow and erythematous rash on his left shoulder. It began two weeks ago with a crop of lesions (see picture) and has not progressed further since then. He has been taking a daily antihistamine as he believed them to be insect bites. This has helped calm the itching sensation. Tristan has no medical history of note. His physical examination is otherwise unremarkable. He takes no medications and has no known allergies. He is keen for the rash to settle quickly as he wants to travel interstate to visit his father, who had a recent MI at the age of 57. Tristan attributes this to his father’s poor lifestyle choices.</strong></p></p> <ul> <li>a. Fibroblastic rheumatism</li> <li>b. Pityrosporum folliculitis</li> <li>c. Eruptive xanthomas</li> <li>d. Molluscum contagiosum</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