June 23, 2019
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The Daily Dozen - Thursday, 21st November 2019.
Type 2 Diabetes RiskPeople at high risk of Type 2 Diabetes:
- AUSDRISK >12
- History of heart attack or stroke
- Women with a history of Gestational Diabetes or PCOS
- Patients prescribed antipsychotics
- IFG or IGT on a glucose tolerance test
Severe epigastric pain + nausea & vomiting + relative lack of abdominal signs
Maria, age 42, complains that her right eye is bulging and she has double vision. This has gradually been worsening over the past couple of weeks. She is otherwise well and hasn't noticed any fevers or any other symptoms.
Orbital tumour. An orbital tumour is the most important diagnosis to consider and imaging is very important. There are other causes of a unilateral proptosis, ie cellulitis, Graves disease or other autoimmune disease, but in the absence of any other symptoms to suggest this a tumour must be high on the list of differentials.
Vertigo + vomiting + tinnitus + sensorineural deafness
Jack, age 31, presents with a painful red right eye. He works as a carpenter and he feels like he might have got something in his eye. Acuity is normal. A dark speck on his cornea is able to be removed with a moist cotton tip. Fluorescein examination shows a small abrasion on the cornea that is not dendritic.
Corneal foreign body. A tiny foreign body may have caused a small corneal abrasion. He needs to be reviewed in 24 hours to check that this abrasion has healed.
Fever + malaise (extreme) + anorexia / nausea / vomiting (+/- anaemia)
Bill, age 74, has numerous skin lesions over his face, arms and hands from many years in the construction industry. He has noticed that one on his right thumb has become thick, raised and firm.
SCC. SCC frequently occurs within an actinic keratosis, becoming thickened as it infiltrates. It may form a keratinous nodule or an erythematous plaque. It can ulcerate. Treatment is generally excision, or radiotherapy. Metastatic disease is possible.
Dysarthria + intention tremor + nystagmus (Charcot's triad)
Middle Age (50-64 yr) Preventive Health CheckAsk about:
- SNAP and readiness to change
- Risk of diabetes (AUSDRISK tool)
- Risk factors for osteoporosis
- Skin cancer
- Weight, height (calculate BMI) and waist circumference
- Fasting blood glucose in patients at high risk of diabetes
- Urinalysis for protein
- Cervical screening test every 5 years
- CRC screening - FOBT at least every 2 years
- Mammography every 2 years
- Vaccination for dTpa.
- Consider influenza and pneumococcal vaccination if high risk.
- Absolute cardiovascular risk.
Weakness + joint & muscle pain + violaceous facial rash
What does this Audiogram show?
Bilateral mild conductive hearing loss, i.e. bilateral Otitis Media with Effusions.
Recurrent oral & genital ulcers + uveitis + arthritis