CPD SPOT DIAGNOSIS ,

Spot Dx — Sudden sores, a swirling rash and fundoscopic findings

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: GPR006

ACRRM Activity Number: GPR006

View Course details

1. Can you flush out the cause of this unilateral hidrosis?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Matt is a 23-year-old university student who presents with a six-month history of left-sided facial flushing and sweating after exercise, hot showers or eating spicy foods. The symptoms typically resolve about an hour after removal of the stimulus. He brings a photo to demonstrate. Matt is usually very well, with no past or family history of note and no regular medications. There are no associated focal neurological symptoms or signs, and the remainder of the examination is unremarkable. FBC, EUC, inflammatory markers and thyroid function tests are normal, as are chest X-ray, brain MRI and CT angiography.</strong></p></p> <ul> <li>a. Idiopathic Horner syndrome</li> <li>b. Rosacea</li> <li>c. Idiopathic harlequin syndrome</li> <li>d. Atypical migraine</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

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

2. What’s causing this progressive rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jane is a 62-year-old fitness instructor who presents with four months of mildly painful, progressive rash involving the feet, legs (pictured) and hands. There is also a similar brownish pigmented band around the collar region. She is fatigued and has recently developed intermittent watery diarrhoea. Jane has been unemployed for the past eight months as a result of staff layoffs during the pandemic. In this context, she has been drinking more, up to a bottle of wine, most nights. Jane has a longstanding history of restrictive eating, particularly in times of stress and/or excess alcohol use. This had been well managed in recent years with psychological strategies but has also relapsed. Jane’s BMI has dropped from 20 to 18 in the past six months.</strong></p></p> <ul> <li>a. SLE</li> <li>b. Pellagra</li> <li>c. Atopic dermatitis</li> <li>d. Porphyria</li> </ul> </section> <p></p>Photo: BMJ 2019

Author

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

3. What caused this swirling rash in a breathless nurse?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Janet, a 50-year-old Caucasian nurse, presents with a spreading, very itchy rash. It started two months ago as a small red itchy patch on the trunk and has since spread to involve most of her trunk and upper and lower limbs. The rash has a swirling pattern that resembles a wood-grain surface. There is a trailing collarette of scale in parts. She has tried worming treatment and a topical steroid/antifungal to no effect. Janet has had several courses of antibiotics in recent months for a productive cough and exertional dyspnoea that have still not completely resolved. She is an ex–heavy smoker and social drinker, with no other medical history of note.</strong></p></p> <ul> <li>a. Drug eruption</li> <li>b. Bronchogenic cancer</li> <li>c. Cutanea larvae migrans</li> <li>d. Tinea imbricata</li> </ul> </section> <p></p>Photo: BMJ 2021

Author

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

4. Can you pick these fundoscopic findings?

What is the most likely diagnosis?

Author

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

5. Skater boy still feeling the burn

What is the most likely diagnosis?

Author

Author: Dr Ash Chehata is an orthopaedic surgeon specialising in upper limb surgery, based in Melbourne, Vicoria.

6.Why are these sores suddenly appearing?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jerome, a 45-year-old bank manager, presents for the second time this year with a few sores on the dorsum of his right wrist. He reports that he went to bed feeling fine and developed these lesions overnight. The lesions are painless, non-pruritic and there is no history of trauma reported. Jerome feels systemically well and is apyrexial, with an otherwise normal clinical examination except for the lesions. He takes no medications and has no significant medical history. He presented in the same manner six months ago and was prescribed cefalexin by a colleague. A swab of the wounds was taken to check for infection and was negative. Those lesions eventually healed within one week.</strong></p></p> <ul> <li>a. Pyoderma gangrenosum</li> <li>b. Scabies</li> <li>c. Buruli ulcer</li> <li>d. Dermatitis artefacta</li> </ul> </section> <p></p>Photo: Science Photo Library

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