The Daily Dozen - Saturday, 15th December 2018.

Risk Factors for Dementia

  • Increasing age
  • A family history of Alzheimer disease
  • History of repeated head trauma
  • Down syndrome
  • Elevated cardiovascular risk (heart disease, stroke, hypertension, obesity, diabetes, elevated homocysteine, elevated cholesterol)
  • Mental health - history of Depression
Bruising + oral bleeding + epistaxis
Murtagh's Triads
Bob, aged 79, has a scaly lesion on his arm. On examination, it has a hard, scaly surface but the skin doesn't seem to be indurated or thickened. He has several other scaly lesions, but is particularly bothered by this lesion as it catches on his shirt cuff.
Actinic keratosis. This is an irritated actinic keratosis, also known as solar keratosis. Unlike an SCC, it hasn't developed the thickness that would suggest dermal infiltration. Treatment commonly includes cryotherapy.
Fair females under 5 + thin wispy hair + easy loss with pulling
Murtagh's Triads

Nutrition Advice

Enjoy a wide variety of foods each day:
  • five portions of vegetables and two portions of fruit
  • three portions of cereals (including breads, rice, pasta and noodles)
  • one to two portions of lean meat, fish, poultry and/or alternatives
  • at least 2 g per day alpha-linolenic acid by including foods such as canola-based or soybean-based oils and margarine spreads, seeds (especially linseeds), nuts (particularly walnuts), legumes (including soybeans), eggs and green leafy vegetables
  • drink plenty of water.
Take care to:
  • limit saturated fat and moderate total fat intake but consume about 500 mg per day of combined docosahexaenoic acid and eicosapentaenoic acid through a combination of the following: two or three serves (150 g serve) of oily fish per week, fish oil capsules or liquid, food and drinks enriched with marine omega-3 polyunsaturated fatty acids
  • limit salt intake to less than 6 g of salt a day (approximately 2300 mg of sodium a day), which is approximately teaspoons of salt
  • limit alcohol intake
  • consume only moderate amounts of sugars and foods containing added sugars.
  • prevent weight gain: be physically active and eat according to energy needs
  • care for food: prepare and store it safely
  • encourage and support breastfeeding.
Finger discomfort + arthralgia + reflux (+/- skin tightness)
Murtagh's Triads

Neonatal Preventative Health Check

Assessment
  • Metabolic screen
  • Feeding
  • Hearing - universal assessment
  • Physical exam as outlined in the Child Health Record
  • Any parental concerns
  • Maternal health
  • Settling
Injury Prevention Advice
  • passive smoking
  • SIDS prevention
  • UV exposure
Painful / itchy bite + agitation + hydrophobia (pain with drinking)
Murtagh's Triads
During a rare visit to his GP, Joe, age 77, complains that his eyesight is 'terrible'. He particularly finds it hard to manage glare. He thinks this has been gradually worsening over the past few years but he hasn't had his eyes checked in a long time. On examination you note that both pupils are opaque but of a normal shape and they react normally to light. Visual acuity is 6/18 left eye and 6/24 right eye.
Cataract. Nonurgent referral to an ophthalmologist to consider lens replacement.

Jonathon Trobe University of Michagen Kellogg Eye Center

Plethoric moon facies + thin extremities + muscle weakness
Murtagh's Triads
Josh, age 17, has a mole on his back that his new girlfriend is worried could be a 'skin cancer'. He is not sure if it has changed or grown as he has never noticed it before. It is not painful or itchy. On examination, it is flat, 8mm long, single coloured with well defined margins.
Junctional naevus. This is a benign junctional naevus. No treatment is required. It is important to be able to differentiate normal from abnormal skin spots, as not all lesions require removal! Read more on DermNet
Arthralgia + weight loss + fever (+/- skin lesions)
Murtagh's Triads
GP trove is an independent Free Open Access Medical education (FOAM) website for GP registrars and other FRACGP candidates in Australia.