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The Daily Dozen - Saturday, 22nd February 2020.

George, age 60, has noticed sudden flashes of light occasionally when he moves his eyes over the past couple of days. He also has a floating ring in his vision that won't go away when he rubs his eyes. On examination, acuity is normal and there is no obvious visual field defect.
Vitreous detachment. As a normal part of ageing, the vitreous becomes more unstable and separates from the retina. This can lead to flashes and floaters. There is a risk of retinal detachment, which can start with subtle loss of peripheral vision.

Jonathon Trobe University of Michagen Kellogg Eye Center

Drowsiness + fever + purpuric rash
Murtagh's Triads
Aaron is brought in by mum as she has noticed his eyes are different colours in family photographs using a flash. On examination, the red reflex is absent in the left eye and he doesn't respond to visual stimulation when the right eye is covered.
Retinoblastoma. Leukocoria has many causes but the most serious is retinoblastoma.

Jonathon Trobe University of Michagen Kellogg Eye Center

Weakness + polyuria + polydipsia
Murtagh's Triads

Stroke Risk

All patients with suspected TIA should have stroke risk assessment including the ABCD2 tool:
  • A = Age >60
  • B = BP >140/90
  • C = Clinical features of unilateral arm weakness (2 points) or speech impairment without weakness (1 poinit)
  • D = Duration >60min (2 points) or 10-59min (1 point)
  • D = Diabetes mellitus
Other important factors include AF, crescendo TIA (2 or more TIAs in the past week) or anterior circulation signs suggesting carotid disease.
Abdominal pain + malar flush + fever +/- URTI
In a child
Murtagh's Triads
If an AED is available immediately, when should the first shock be given? a) immediately b) after 30 sec CPR c) after 2 min CPR
Immediately. Defibrillation should be performed as soon as possible. 2 min cycles of resus only start AFTER this.
Abdominal pain + diarrhoea + fever
Murtagh's Triads
Preventing acute kidney injury: which are the key drugs to be avoided on a sick day?
SAD MANS mnemonic: S sulfonylureas A ACE-inhibitors D diuretics M metformin A angiotensin receptor blockers N non-steroidal anti-inflammatory S SGLT2 inhibitors
Malaise + night sweats + painless lymphadenopathy
Murtagh's Triads

Teenage Preventive Health Check

  • Use the HEADSS framework:
    • H: Home
    • E: Education / Employment
    • A: Activities
    • D: Drugs
    • S: Sexuality
    • S: Suicide
  • Growth velocities including BMI
  • Nutrition
  • Physical activity (at least 60 min / day)
  • Screen sexually active young people for chlamydia
  • Depression screen
Preventive counselling and advice
  • Injury prevention – harm minimisation.
  • Sun protection
  • Social and emotional wellbeing
  • Oral health
  • If chronic comorbidities: transition from tertiary paediatric care to effective primary care with access to adult specialist care
Fever (often with rigors) + upper abdominal pain + jaundice
Murtagh's Triads