June 23, 2019
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The Daily Dozen - Thursday, 23rd January 2020.
Penny, age 29, presents for a routine skin check. She has numerous flaky white patches across her trunk and arms, which she reports have been present for years. They seem to be worse at the end of summer.
Pityriasis versicolor. This is caused by a yeast infection (Malassezia) and is more common with sweating heavily so can be worse in summer. The lesions can be pale on tanned skin, or pink on pale skin. Topical treatments are effective but the skin can take a while to return to its normal pigmentation. Read more on DermNet
Intense abdominal pain + pale and shocked +/- back pain
Ruptured Abdominal Aortic Aneurysm
Jo, age 50, presents with severe left eye pain and redness on a background of Ulcerative Colitis. On examination, acuity is 6/6 and pupils react normally to light. There is no evidence of a foreign body and fluorescein examination is normal.
Scleritis. Compared to episcleritis, there is usually more pain and more associated symptoms such as photophobia / reduced vision, although acuity can be normal. Scleritis is also more commonly associated with autoimmune disease than episcleritis.
Cramps + confusion + tetany
Jenny, age 40, has a skin lump on her arm. On examination, it is 9mm, raised and soft with a bumpy surface. She thinks it has been there for a long time and hasn't changed recently in any way.
Dermal naevus. This benign dermal naevus doesn't require any specific treatment. It is important to be able to recognise benign lesions as not all lesions require treatment. Read more on DermNet
Malaise + painful shoulder girdle + morning stiffness (>50 years)
What does this Audiogram show?
Headache + visual obscurations + nausea / papilloedema
(often in an obese young female)
Benign intracranial hypertension
Molly, age 24, complains that both of her eyes are constantly itchy, red and watering. This seems to happen every spring, especially on hot windy days or after thunderstorms. Her vision is normal and she is otherwise well.
Allergic Conjunctivitis. Red, itching eyes with watery discharge.
Vertigo + vomiting + tinnitus + sensorineural deafness
In an emergency, what is ear-to-sternal-notch positioning?
Ear to sternal notch position optimises ventilation. This simple repositioning manoeuvre can make a large difference to the success of ventilating a patient in an emergency. There are many more useful tips for rural GPs on emDOCs.
Fatiguable weakness of eyelids / eye movement + limbs + bulbar muscles of speech and swallowing