CPD SPOT DIAGNOSIS ,

Spot Dx — A post-FOOSH injury, palpitations, and red-flag rashes

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: GPR011

ACRRM Activity Number: GPR011

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1. Can you pick this post-FOOSH injury?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Ollie is an eight-year-old boy who is brought in by his father with left elbow pain after falling off his scooter, landing on his outstretched left hand.</p><p>He is now guarding the elbow and is reluctant to allow examination because of the pain.</p><p>Ollie is generally well, with no past history of note.</p><p>The elbow appears swollen, but there is no apparent deformity and no evidence of neurovascular compromise.</p><p>Ollie is referred for X-rays of the left elbow (pictured).</p></p> <ul> <li>a. Lateral humeral condyle fracture</li> <li>b. Medial humeral condyle fracture</li> <li>c. Supracondylar fracture of humerus</li> <li>d. Olecranon fracture</li> </ul> </section> <p></p>

Author

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

2. What's this ECG showing?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 45-year-old man with a history of unspecified intermittent arrhythmia presents with palpitations and dizziness.</p><p>He is conscious with systolic blood pressure of 90mmHg and a heart rate of 180-220 bpm. The remaining physical examination is unremarkable.</p><p>His initial ECG is pictured.</p><p><a target=”_blank” rel=”noopener noreferrer nofollow” href=”https://images.media.ausdoc.com.au/wp-content/uploads/2026/01/06124453/Spot-Dx-Whats-this-ECG-showing.jpg”>View an expanded version of the ECG here.</a></p></p> <ul> <li>a. Ventricular tachycardia</li> <li>b. Pre-excited AF</li> <li>c. Antidromic atrioventricular re-entrant tachycardia</li> <li>d. Aberrant conduction during AF</li> </ul> </section> <p></p>

Reproduced from Emergency Medicine Journal, Vol. 39, Pages 99-158, 2022 with permission from BMJ Publishing Group Ltd.

Author

Author: Emergency Medicine Journal is a global medical journal covering pre-hospital, hospital emergency medicine and critical care.

3. What are these painless plaques post-shingles?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Glen is a 48-year-old IT professional who presents with a two-week history of painless scaly erythematous plaques on the lower back (pictured).</p><p>He has psoriasis, which has been stable on monthly subcutaneous secukinumab 300mg for several years.</p><p>Glen was treated with antivirals for shingles in the same distribution one month ago. The blisters dried and crusted off over 10 days, and two days later, red lesions with white scale developed, overlying the healing zoster lesions. He has no associated neuralgia.</p><p>The lesions are confined to the area pictured. Dermoscopically, diffusely distributed white scales on a bright red background pattern are seen, as well as regularly arranged dotted globules and hairpin-like vessels.</p></p> <ul> <li>a. Post-herpetic psoriasis</li> <li>b. Zosteriform pityriasis rosea</li> <li>c. Zosteriform lichen planus</li> <li>d. Lupus erythematosus</li> </ul> </section> <p></p>

Photo reproduced from BMJ, Pan N, Gao T, Qin D, Qin L, 384:e076773 2024, with permission from BMJ publishing.

Author

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

4. When blood blisters strike

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 12-year-old male presents with a two-year history of altered appearance of the dorsal tongue, with occasional ‘blood blisters’.</p><p>The area is not painful and does not interfere with speech, swallowing or eating.</p><p>He has no significant past medical history and appears fit and well.</p><p>Oral examination reveals multiple clear vesicular-like lesions, measuring 1-2 mm in diameter — with a few areas appearing blood filled, involving the mid-dorsal surface of the tongue.</p><p>The tongue is soft, although somewhat enlarged in this area.</p></p> <ul> <li>a. Oral lymphangioma</li> <li>b. Mucous membrane pemphigoid</li> <li>c. Oral haemangioma</li> <li>d. Multiple mucocoeles</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.

5. What's this rash on the tum after a run?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>Simon is a 25-year-old engineer who presents for review of recurrent rash affecting the wrists, forearms, axillae and abdomen (pictured).</p><p>This has occurred twice in the past year, both while running. The rash is itchy and associated with fatigue and shortness of breath, which meant he couldn’t complete the run.</p><p>Each of these episodes occurred when Simon was “running off” a large lunch of beer and pizza.</p><p>Simon runs 3-4 days a week, usually before breakfast, without any similar symptoms.</p><p>He has no known allergies to medications, food or alcohol.</p><p>Typically the rash resolves spontaneously within 2 hours of stopping exercise, with an oral antihistamine.</p></p> <ul> <li>a. Contact urticaria</li> <li>b. Solar urticaria</li> <li>c. Dermatographic urticaria</li> <li>d. Food-dependent exercise-induced anaphylaxis</li> </ul> </section> <p></p>Photo: Sijapati N, Sciturro M, Le M, et al. (March 11, 2022) Cureus 14(3): e23062

Author

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

6. Can you puzzle out these painful, pruritic lesions?

What is the most likely diagnosis?

<section data-block="SingleChoice"> <h3>What is the most likely diagnosis?</h3> <p><p>A 58-year-old lady presents with an episode of erythematous papulovesicular rash, which first appeared as weeping blisters on her back after an episode of sunburn when she was 18.</p><p>Over time, new lesions have developed on multiple body regions. She reports the condition worsens in summer.</p><p>She also reports experiencing dysuria and dyschezia. There is a significant family history, with her sister, nephew and father affected by similar skin lesions. </p><p>On examination, there are erythematous plaques with scaly crusts, symmetrically distributed on the chest and arms. The groin and inframammary folds are also involved.</p><p>These painful and pruritic lesions are clearly demarcated and thickened. </p><p>Erosions have resulted from the coalescence of lesions. The mucous membranes are spared.</p></p> <ul> <li>a. Darier disease (keratosis follicularis)</li> <li>b. Shingles (herpes zoster)</li> <li>c. Hailey-Hailey disease (benign familial pemphigus)</li> <li>d. Pemphigus vegetans</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.

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