CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – General practice – GPR009

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: GPR009

ACRRM Activity Number: GPR009

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1. Is this irregular rapid pulse an ominous sign?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jeremy, a 72-year-old retired bank manager, presents to his GP with a history of fever and cough with heavy sputum production. Jeremy is a lifelong smoker with known severe COPD. He has done a negative COVID-19 PCR test prior to his attendance. Aside from his COPD, he is also known to have hypertension.</strong></p><p><strong>His medications include two inhalers: combination fluticasone furoate/umeclidinium/vilanterol, and salbutamol, plus oral olmesartan 20mg daily.</strong></p><p><strong>On examination, he is noted to be afebrile and normotensive. However, he is tachycardic with an irregularly irregular pulse, so an ECG is performed (see photo).</strong></p></p> <ul> <li>a. Sinus tachycardia with frequent premature atrial complexes (PACs) or ventricular premature beats (VPBs)</li> <li>b. Atrial flutter with variable AV conduction</li> <li>c. Atrial fibrillation</li> <li>d. Multifocal atrial tachycardia</li> </ul> </section> <p></p>Photo: Jer5150/CC BY

Author

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

2. What's causing this hard palate lesion?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jack, a 45-year-old carpenter, presents with a swollen upper lip and an ulcerative lesion that has been enlarging for six months over his hard palate. He recently developed a low-grade fever and general malaise. He has also been experiencing copious nasal discharge for several months and has seen multiple GPs who have given him antibiotics and steroid nasal sprays. It has not responded to any of the treatments given thus far. Jack is otherwise generally well, is a non-smoker and consumes 2-3 standard drinks a week.</strong></p></p> <ul> <li>a. Sarcoidosis</li> <li>b. Mycobacterium ulcerans infection</li> <li>c. Oral squamous cell carcinoma</li> <li>d. Extranodal natural killer/T-cell lymphoma</li> </ul> </section> <p> </p> <p> </p> <p></p>Photo: BMJ Case Reports — 2011

Author

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

3. Can you diagnose this sore shoulder, based on the history?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Ralph, 41, presents with a painful right shoulder. He is struggling with daily tasks as he is unable to externally rotate the shoulder. He was discharged from hospital last week following a three-week admission after collapsing with a subarachnoid haemorrhage. The causative aneurysm was successfully clipped and recovery has been exceptional. He has become increasingly aware of the shoulder symptoms after starting outpatient rehabilitation. His only other residual symptoms are fatigue and memory disturbance. He remains on an anticonvulsant, having had a seizure on arrival in ED, with no recurrence. His shoulder at review is pictured.</strong></p></p> <ul> <li>a. Anterior shoulder dislocation</li> <li>b. Full thickness infraspinatus tear</li> <li>c. Undisplaced fracture distal clavicle</li> <li>d. Posterior shoulder dislocation</li> </ul> </section> <p></p>

Author

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

4. What's this unusual growth during pregnancy?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Amy is a 22-year-old primigravida who presents at 28 weeks’ gestation with a rapidly enlarging painless mass affecting the middle finger of her dominant hand. She first noticed a small red papule about six weeks ago. She had sustained a small superficial laceration at the site two weeks before that and initially thought this was healing scar tissue. However, the redness spread, leading her to present to another GP who prescribed a course of flucloxacillin, followed by cefalexin, with no effect. Finger flexion and hand function are now affected. Amy is otherwise well, with no past or family history of note.</strong></p></p> <ul> <li>a. Pyogenic granuloma gravidarum</li> <li>b. Amelanotic melanoma</li> <li>c. SCC</li> <li>d. Glomus tumour</li> </ul> </section> <p> </p> <p> </p> <p></p>Photo: reproduced from BMJ Pyogenic granuloma, Stephen Key et al, 346, e8499 2013; with permission from BMJ Publishing Group Ltd.

Author

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

5. Why has this tongue turned white?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Kevin is a 27 year old office worker who is concerned about his tongue. In recent weeks, it has looked white. He is concerned he has a yeast infection. </strong></p><p><strong>Kevin has a background of allergic rhinitis for which he takes oral antihistamines as needed. He had a mild URTI about a month ago, from which he has completely recovered.</strong></p><p><strong>He has no other past medical history of note. He does not smoke and drinks alcohol socially on weekends.</strong></p><p><strong>Examination findings are unremarkable apart from white tongue discolouration, pictured, which cannot be removed with a gauze wipe.</strong></p></p> <ul> <li>a. Oral candidosis</li> <li>b. Hairy tongue</li> <li>c. Leukoplakia</li> <li>d. Psoriasis</li> </ul> </section> <p></p>

Author

Author: Dr Tami Yap is an oral medicine specialist who practises in Melbourne, Victoria.

6. What on earth is this foot lesion?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jason, a 30-year-old plumber, attends his GP regarding a lesion on his left foot. He says it started a week ago, shortly after he returned from Thailand.</strong></p><p><strong>The lesion began as an itchy red spot, and one week later has developed into the serpiginous lesion seen in the picture below.</strong></p><p><strong>Jason reports feeling otherwise well. He has no medical history of note, and the remainder of his physical examination is unremarkable.</strong></p><p><strong>He denies having any unprotected intercourse while away and reports no sexual health concerns or symptoms.</strong></p><p><strong>Temporary relief from the associated pruritus has been provided by using antihistamines.</strong></p></p> <ul> <li>a. Scabies</li> <li>b. Cutaneous larva migrans</li> <li>c. Erythema chronicum migrans</li> <li>d. Dracunculiasis</li> </ul> </section> <p></p>Photo: Dermatology Atlas

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