CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – General practice – GPR008

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: GPR008

ACRRM Activity Number: GPR008

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1. Any clue why he’s turning blue?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Sven, a 70-year-old retired English teacher, presents with a blue-grey discolouration to his face. He first noticed this a few months ago, and it has since worsened.</strong></p><p><strong>He feels well otherwise and manages to keep active by playing tennis; he denies any exertional symptoms.</strong></p><p><strong>Sven has had no changes in his bowel habits and reports his urine remains normal in appearance.</strong></p><p><strong>Six years ago he developed a sustained monomorphic ventricular tachycardia after having a myocardial infarction. He was started on amiodarone 300mg daily and has used this ever since. </strong></p><p><strong>He was also noted to have hypercholesterolemia, for which he was commenced on rosuvastatin 5mg daily. </strong></p><p><strong>Sven has no other significant medical history and takes no other medications. He has never smoked and remains a teetotaller.</strong></p></p> <ul> <li>a. Alkaptonuria</li> <li>b. Methaemoglobinaemia</li> <li>c. Iatrogenic hyperpigmentation</li> <li>d. COPD</li> </ul> </section> <p></p>Photo: Blue man syndrome; Umjeet Jolly, George Klein; CMAJ May 2016, 188 (8) 604

Author

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

2. What does this ocular examination reveal

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Pat is a 65-year-old who presents with 24 hours of increasing right eye discomfort and blurred vision. Pat has required refractive correction for hypermetropia since her teens and usually wears daily use contact lenses, but she has not been able insert these today because of pain. Pat has stable hypertension on combination ACEI/hydrochlorthiazide and recently started topiramate for migraine prophylaxis. On examination, she appears uncomfortable. Vital signs are normal. Corrected visual acuity is Corrected visual acuity is 6/6 left and 6/15 right. The gross ocular examination findings are pictured.</strong></p></p> <ul> <li>a. Contact lens overwear.</li> <li>b. Glaucoma.</li> <li>c. Episcleritis.</li> <li>d. HSV keratitis.</li> </ul> </section> <p></p>Photo: BMJ 2014

Author

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

3. Can you name this cystic lump?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Brian is a 32-year-old who presents with a four-week history of a soft lump on the inner aspect of the right lower lip. The lesion is not painful and fluctuates in size. Brian recalls accidentally biting the area before the swelling appeared. There is no past history of note, he is a non-smoker and consumes one beer most days. Intraoral examination reveals a 9 x 8mm diameter fluctuant dome-shaped swelling with a bluish appearance (pictured). Extraoral examination is unremarkable, and there is no regional lymphadenopathy.</strong></p></p> <ul> <li>a. Fibroepithelial polyp</li> <li>b. Calibre persistent labial artery</li> <li>c. Venous lake</li> <li>d. Mucocoele</li> </ul> </section> <p></p>

Author

Author: Dr Jacinta Vu is an oral medicine specialist and clinical senior lecturer at the University of WA Dental School, who practises in Perth, WA.

4. Is an office accessory to blame for this elbow pain?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Gianfranco, a 35-year-old bank manager, presents complaining of pain at his left elbow for several months. He believes it has been caused by leaning on his arm rest while talking to customers and has since removed the arm rests from his chair. While this measure initially provided some relief, over the past two months, he reports waking at night with numbness and pain in an ulnar distribution through his left forearm, ring and little finger. He reports he just “shakes it off” and goes back to sleep. The symptoms are now occurring daily and triggered whenever his left arm is flexed. He has no medical history of note and cannot remember any significant trauma to his left arm. Nerve conduction studies reveal ulnar motor nerve conduction velocity is slowed across the left elbow. An MRI of the left elbow is requested (pictured).</strong></p></p> <ul> <li>a. Medial epicondylitis</li> <li>b. Myosarcoma</li> <li>c. Haematoma</li> <li>d. Anconeus epitrochlearis</li> </ul> </section> <p></p>Photo: Eurorad 2009; 20 May

Author

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

5. Can you net this diagnosis?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jasmin, a 30-year-old chef, presents with a net-like pattern rash on her leg that started a few weeks ago. The rash has a few broken and irregular circles. She is quite distressed as she cannot think of a reason as to why it has appeared. She is systemically well, and her bloods are unremarkable except for a mild thrombocytopenia. Jasmin is a mother of one and takes no regular medications. She experienced an adjustment disorder with associated depression after recurrent miscarriages but otherwise has no medical history of note.</strong></p></p> <ul> <li>a. Pancreatitis</li> <li>b. TB</li> <li>c. Buerger disease</li> <li>d. Antiphospholipid syndrome</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. What’s behind this sudden hair loss?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 30-year-old woman presents with sudden-onset hair loss that began as a small round patch on the back of her head.</strong></p><p><strong>The patch has gradually increased in size, with additional patches appearing on other areas. There is no redness, itching or pain.</strong></p><p><strong>The hair loss began three weeks after she lost her job. She reports feeling self-conscious and experiencing distress because of the hair loss.</strong></p><p><strong>On examination, the affected areas are smooth and non-uniform and the remaining hair is easily pulled. There are no signs of inflammation or scarring in the patches, and the remaining scalp hair appears healthy.</strong></p><p><strong>There is no hair breakage or thinning elsewhere on the body and no evidence of underlying systemic or infectious causes. Investigations — including FBC, thyroid function and iron studies — are normal.</strong></p></p> <ul> <li>a. Trichotillomania</li> <li>b. Alopecia areata</li> <li>c. Telogen effluvium</li> <li>d. Traction alopecia</li> </ul> </section> <p></p>

Author

Author: Professor Dedee Murrell is head of dermatology at St George Hospital, Sydney, and conjoint professor at UNSW Sydney. This article was co-authored by Henry Tseng, a medical student at UNSW Sydney; and Dr Corey Stone, a dermatology research fellow at Premier Specialists and St George Hospital, Sydney.

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