CPD SPOT DIAGNOSIS ,

Self-Recorded CPD: Spot Dx – Radiology – RAD001

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: RAD001

ACRRM Activity Number: RAD001

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1. What does this head CT show?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>An adult patient with arterial hypertension had a witnessed loss of consciousness and a fall from a height of approximately 1.5 metres with head trauma; the patient was thus referred to the ED in an unconscious state.</strong></p><p><strong>A head CT scan was obtained.</strong></p></p> <ul> <li>a. Subarachnoid haemorrhage</li> <li>b. Epidural haematomapustulosis</li> <li>c. Subdural haematoma</li> <li>d. All of the above</li> </ul> </section> <p></p>

Author

Article reproduced from Emergency Medical Journal, Bernardi E, 7 Nov. 2022, with permission from BMJ Publishing Group.

2. What’s behind this swollen toe?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Trent, a 21-year-old truck driver, presents with a persistently swollen and painful left second toe.</strong></p><p><strong>This has been present for at least 12 months. He can’t recall any preceding trauma or injury.</strong></p><p><strong>The swelling is more pronounced with prolonged walking and driving and doesn’t resolve with rest or elevation. The pain is rapidly relieved by NSAIDs and is much worse at night.</strong></p><p><strong>There is no associated fever, systemic symptoms or other joint involvement.</strong></p><p><strong>The only significant finding on examination is the minimally tender swelling, with no palpable mass. Blood tests including CRP are normal. Xray shows a radiolucent lesion in the plantar cortex of the neck of the proximal phalanx.</strong></p></p> <ul> <li>a. Osteoid osteoma</li> <li>b. Acute osteomyelitis</li> <li>c. Osteosarcoma</li> <li>d. Simple bone cyst</li> </ul> </section> <p></p>Photo: Reproduced from BMJ, Lui TH et al. 378:e069082, 2022 with permission from BMJ Publishing Group Ltd.

Author

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

3. Is Skippy to blame for this shoulder pain?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A fit and well 30-year-old woman attended her local ED 24 hours after being bitten on the right index finger while feeding a kangaroo at a petting zoo.</strong></p><p><strong>On review, the bite was small and the wound looked clean. She was given a tetanus booster, as per local guidelines, with safety-net advice to return if symptoms worsened. She returned 24 hours later with worsening severe right shoulder pain radiating to her elbow joint.</strong></p><p><strong>Clinically, she was tender all over the shoulder, with pain on movement in all directions. Her temperature was 36.7°C. The injection site did not have any surrounding erythema or induration.</strong></p><p><strong>A point-of-care ultrasound image of the proximal humeral head is shown.</strong></p></p> <ul> <li>a. Supraspinatus tear</li> <li>b. Shoulder injury related to vaccine administration</li> <li>c. Frozen shoulder</li> <li>d. Wound infection with proximal lymphatic tracking</li> </ul> </section> <p></p>Photo: Reproduced from Emergency Medicine Journal, Deol P;38:829-841, 2021 with permission from BMJ Publishing Group Ltd

Author

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

4. Why was the breath knocked out of this footballer?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>A 26-year-old man presents to ED with dull, pleuritic chest pain after being hit in the chest by a soccer ball during a match. The pain radiates to the back and is exacerbated by coughing. Shortness of breath is noted. On examination, the patient has a high-pitched voice and crepitus over the neck and clavicles. Chest expansion is symmetrical and the lungs are clear bilaterally. There is no hyper-resonance on percussion. A crunching sound during systole is auscultated over the precordium. The ECG is normal. A chest radiograph is ordered.</strong></p></p> <ul> <li>a. Pneumopericardium</li> <li>b. Pneumomediastinum</li> <li>c. Pneumothorax</li> <li>d. Pneumoperitoneum</li> </ul> </section> <p></p>

Author

Reproduced from Emergency Medicine Journal, Chiang C et. al., 2019;36:564-578 with permission from BMJ Publishing Group Ltd

5. What’s causing this periumbilical pain?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Matt, a 42-year-old lawyer, presents with periumbilical pain and discharge draining from the umbilicus. He first noticed redness and pain one day prior. Matt is otherwise well with no past history of note. On examination, vital signs are normal, there is periumbilical redness, tenderness and a positive Carnett’s sign (tenderness on palpation at the site of maximal pain is made worse when the patient is asked to raise his head and shoulders). Pathology reveals only an elevated CRP of 25mg/L (normal: less than 5), with normal WCC and urinalysis. Contrast-enhanced CT is requested.</strong></p></p> <ul> <li>a. Diverticulitis</li> <li>b. Cellulitis</li> <li>c. Metastatic carcinoma</li> <li>d. Urachal remnant abscess</li> </ul> </section> <p></p>

Author

6. Can you detect the cause of this pain in the neck?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p><strong>Jess is a 43-year-old office worker who presents with a seven-day history of progressive neck pain. Over the past 24 hours, the pain has become severe and associated with bilateral arm numbness, neck stiffness and fever. Jess is generally well. She takes doxycycline periodically for cystic acne and restarted this about a month ago for a flare-up, along with a short course of oral prednisone 25mg for seven days, as prescribed by her dermatologist. There is no history of trauma, cervical injury or surgery. On examination, her temperature is 39°C, and there is globally limited range of neck motion, bilateral shoulder weakness and altered sensation across the collar region. There is no evidence of trauma initially or bruising to the neck. Jess is referred to ED, where a plain X-ray of the neck is requested.</strong></p></p> <ul> <li>a. Fracture of the cervical spine</li> <li>b. Cervical spine malignancy</li> <li>c. Cervical osteomyelitis</li> <li>d. Prevertebral haematoma</li> </ul> </section> <p> </p> <p></p>Photo: Emergency Medicine Journal, 2021; Aug. 2021; Aug.

Author

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

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