CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Paediatrics – PAE001

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: PAE001

ACRRM Activity Number: PAE001

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1. What’s behind this child’s rash and case of ‘the runs’?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jackson, a 13-month-old boy, is brought in by his foster carers with a rash on his face (see picture). They are concerned about the rash, adding that he has a similarly affected area in between his buttocks. The carers became Jackson’s legal guardians a few days ago, after he was removed from his biological parents’ custody because of neglect in the setting of parental drug and alcohol misuse. They have limited medical history about Jackson but have been instructed by social services to get his weight monitored as it has been faltering and to get his mild diarrhoea checked out also. He is not on any medications and has no known allergies. He is afebrile, with growth parameters under the fifth centile. Examination findings are otherwise normal apart from the rash.</strong></p></p> <ul> <li>a. Psoriasis</li> <li>b. Seborrheic dermatitis</li> <li>c. Epidermolysis bullosa</li> <li>d. Acrodermatitis enteropathica</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. What is causing this scrotal pain?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Hunter is a 10-year-old boy who presents with acute right scrotal pain of 20 hours’ duration. There is no associated fever, vomiting or history of trauma and no past history of note. On examination, vital signs are normal. The scrotum shows no swelling or erythema, and the cremasteric reflex is normal. Both testes demonstrate normal vertical lie and softness on palpation. A tender area of subtle blue discolouration is observed near the upper pole of the right testis (pictured) that moves when the testis is manipulated. An ultrasound is requested, which shows both testes and epididymal blood flow are normal.</strong></p></p> <ul> <li>a. Testicular torsion</li> <li>b. Epididymitis</li> <li>c. Torsion of appendix testis</li> <li>d. Incarcerated inguinal hernia</li> </ul> </section> <p></p>Image and answer reproduced from Movable discoloration in the scrotum with attendant pain; Emergency Medicine Journal 2021;38:578-586: with permission from BMJ Publishing Group Ltd.

Author

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

3. Do you recognise this ‘smiley’ rash?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Hunter is a five-year-old brought in by his father with a four-day history of an itchy patch on his left shoulder blade. Hunter’s parents have tried calamine and a mild topical steroid for the itch, with no effect. Hunter is generally well with normal milestones and no past history of note. He is a thriving kindy kid who chats garrulously during the consult about how much he loved home schooling during lockdown with his parents; younger brother, Ollie; their dog, Pebbles; and new kitten, Bam Bam. Hunter’s dad noticed that, this morning, Ollie also had a small itchy scaly patch on his leg, although this did not have the same ‘smiley’ appearance. There are no examination findings of note apart from the lesion (pictured).</strong></p></p> <ul> <li>a. Discoid eczema</li> <li>b. Dermatitis artefacta</li> <li>c. Tinea corporis</li> <li>d. Pityriasis rosea</li> </ul> </section> <p></p>Photo: BMJ 2021; 7 Sept.

Author

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

4. What’s the cause of this painfully swollen eye?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Tim, eight years old, is brought in by his father after waking this morning with painful purplish-red swelling affecting both eyes. There was no preceding history of trauma. Tim has been off school for the past few days with fatigue and a sore throat. He started complaining of leg pain yesterday. He has some similar looking tender lumps on both shins. On examination, he has a fever of 380C. He has an erythematous, exudative oropharynx and tonsils, and tender cervical lymphadenopathy. The eye lesions are tender and feel firm, warm and indurated, and he has several similar areas of tender erythema of up to 4cm in diameter on the shins.</strong></p></p> <ul> <li>a. Erythema nodosum</li> <li>b. Allergic conjunctivitis</li> <li>c. Periorbital cellulitis</li> <li>d. Idiopathic angioedema</li> </ul> </section> <p></p>Photo: BMJ 2019

Author

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

5. Should you be suspicious of this child’s fundal findings?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jemima, a seven-month-old, is brought into her local ED by her distraught parents. They report that she was well in the morning, fed normally and was put down in her cot for her usual mid-afternoon sleep. When they tried to wake her a few hours later, she was unresponsive. Her parents did not witness seizures or signs of tongue biting. Jemima is apyrexial and has a normal pulse, blood pressure and blood glucose. Of note, there are no signs of external injury. Urgent bloods, a CT head and an ECG are ordered. The bloods and ECG are normal, but the CT reveals a small subdural haematoma in her left occipital region. As a result of the findings on fundal examination (see image), which display retinal nerve fibre layer haemorrhages, a coagulation screen is requested; the results of this are also normal.</strong></p></p> <ul> <li>a. Leukaemia</li> <li>b. Sepsis</li> <li>c. Coagulopathy</li> <li>d. Non-accidental injury</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.

6. What is behind this newborn’s nodular skin?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Wilbur is a two-week-old who has been brought in for review of a rash on his back. Mum noticed the new raised, red area when changing him that morning. Wilbur was born at 39 weeks’ gestation after induction of labour for pre-eclampsia, with delivery via emergency caesarean section for prolonged labour with fetal distress. Birth weight was 4.1kg, Apgars 5, 9, 9. He did not require additional nursing care, was discharged on day three and has been well since. The only clinical finding of note is a firm, nodular, non-pitting, erythematous area on the back that seems to cause Wilbur discomfort when palpated.</strong></p></p> <ul> <li>a. Meningococcaemia</li> <li>b. Subcutaneous fat necrosis of the newborn</li> <li>c. Sclerema neonatorum</li> <li>d. Erythema nodosum</li> </ul> </section> <p></p>Photo: BMJ 2018

Author

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

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