CPD SPOT DIAGNOSIS ,

Spot Dx — A 12-month itch, ocular oddities and an oozing umbilicus

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: GPR005

ACRRM Activity Number: GPR005

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1. Can you scratch beneath the surface of this 12-month itch?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jimmy is a 45-year-old bricklayer who presents with bothersome pruritus that has developed into an overlying rash over the past 12 months. The itch initially developed at the proximal dorsolateral aspect of his right forearm. He is unsure of the trigger as he has not used any new products at home or at work. Jimmy has become increasingly frustrated because he has already seen several GPs, who have given him steroid creams without any success. He has also used permethrin and antihistamines without symptom resolution. So far, the only thing that provides slight relief is applying an ice pack to the proximal forearm.</strong></p></p> <ul> <li>a. Eczema</li> <li>b. Scabies</li> <li>c. Notalgia paresthetica</li> <li>d. Brachioradial pruritus</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.

2. Can you spot the cause of these dry eyes?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Ranjit, a four-year-old boy, recently migrated to Australia from his native India. His parents are concerned as he has been complaining of dry eyes and poor night vision for the past six months. More recently, they have noticed whitish patches in the lateral aspects of both eyes, prompting them to seek medical advice. On examination, Ranjit’s visual acuity is normal. His physical examination is unremarkable except for the ocular abnormality. He is on the fifth centile for height and weight. Ranjit is up to date with all his childhood vaccinations and has no significant medical history, nor does he take any medications.</strong></p></p> <ul> <li>a. Bitot spots</li> <li>b. Keratoconjunctivitis sicca</li> <li>c. Corneal abrasion</li> <li>d. Familial hypercholesterolaemia</li> </ul> </section> <p></p>Reproduced from Abbas A, Firdaus U. Arch Dis Child Educ Pract Ed 2019; 104:99-100, with permission from BMJ Publishing Group Ltd.

Author

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

3. Is this psoriasis or something more sinister?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>An 82-year-old Caucasian woman presents with a six-month history of erythematous pruritic patches and scaly plaques over her legs. These seem to improve with sunlight exposure. A firm nodule has also recently developed on her thigh. She is otherwise well and lives independently at home alone. There is no personal or family history of psoriasis or any skin conditions. She takes aspirin for ischaemic heart disease, and denosumab and vitamin D for osteoporosis.</strong></p><p><strong>On examination, there are erythematous patches over her legs, abdomen and torso (pictured) with some violaceous plaques. On palpation, there are several non-tender subcutaneous nodules on the upper legs. She is afebrile and otherwise well. She has tried an over-the-counter steroid but this hasn’t helped.</strong></p></p> <ul> <li>a. Psoriasis</li> <li>b. Cutaneous T-cell lymphoma</li> <li>c. Erythema multiforme</li> <li>d. Cutaneous metastases of lung cancer</li> </ul> </section> <p></p>

Author

Author: Professor Dédée Murrell is head of dermatology, St George Hospital; professor, faculty of medicine, University of NSW; and honorary professorial fellow, The George Institute for Global Health, Sydney.

4. What’s underlying this swollen eye?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jeremy, a 40-year-old dentist, presents with bilateral diplopia, periocular swelling, irritation and injected conjunctivae. His symptoms have developed over the past 24 hours. He reports a pressure feeling in both eyes but denies any pain or headaches, and there is no history of any recent trauma. He remains systemically well and is apyrexial. He is a light smoker and consumes no alcohol. He takes no regular medications and has no medical history of note.</strong></p></p> <ul> <li>a. Orbital cellulitis</li> <li>b. Scleritis</li> <li>c. Graves’ disease</li> <li>d. Orbital myositis</li> </ul> </section> <p></p>Photo: EyeRounds.org, University of Iowa

Author

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

5. What’s the cause of this knee pain?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Sean, a 16-year-old male, presents with sudden-onset left knee pain while playing soccer. He describes feeling a popping sensation, followed by severe pain, on landing on the left leg after jumping up to attempt a header. He fell to the ground and is now unable to weight bear or extend his left knee, which is swollen and misshapen.</strong></p><p><strong>Sean is generally well. He has a history of Osgood-Schlatter disease in early adolescence, but stopped playing basketball and has not had any knee pain for at least a year.</strong></p><p><strong>On examination he is unable to extend the knee. There is an abnormal contour to the lateral side of the left thigh and a sharp protrusion at the anterior aspect of the left knee. Lateral view X-ray of the left knee is shown.</strong></p></p> <ul> <li>a. Recurrent Osgood-Schlatter disease</li> <li>b. Tibial tubercle avulsion fracture</li> <li>c. Patella tendon rupture</li> <li>d. Quadriceps tendon rupture</li> </ul> </section> <p></p>Photo: Reproduced from EMJ, Liu J; 40:436-470, 2023 with permission from BMJ Publishing Group Ltd.

Author

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

6. What is causing this red and oozing belly button?

What is the most likely diagnosis?

Author

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

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