The Daily Dozen - Wednesday, 24th October 2018.

What does this Audiogram show?
Normal audiogram.
Weakness + weight loss + vomiting (severe / projectile)
In an infant <3 months, usually male.
Murtagh's Triads

Infant (2-6 months) Preventive Health Check

Assessment
  • Any parental concerns
  • Feeding including introduction of solids
  • Development including vision and hearing
  • Quality of child–parent relationship
  • Parental health, support and family functioning
  • Physical activity ie. supervised floor-based play
  • Physical exam as outlined in the Child Health Record
  Preventive counselling and advice
  • Injury prevention, including:
    • passive smoking
    • SIDS
    • UV exposure
    • water
    • home environment
  • Settling
  • Teething
  • Play
Rigidity + bradykinesia + resting tremor
Murtagh's Triads
George, age 77, has noticed an odd skin lesion growing on his cheek. It isn't itchy or sore, but it does stick out with a hard lump on the end.
Cutaneous horn. This horn could be caused by an actinic keratosis or well differentiated SCC, but it generally requires removal by shave, excision or curette and cautery. Read more on DermNet
Lanky men + small testes + infertility
Murtagh's Triads

Middle Age (50-64 yr) Preventive Health Check

Ask about:
  • SNAP and readiness to change
  • Risk of diabetes (AUSDRISK tool)
  • Depression
  • Risk factors for osteoporosis
  • Skin cancer
Measure:
  • Weight, height (calculate BMI) and waist circumference
  • BP
  • Lipids
  • Fasting blood glucose in patients at high risk of diabetes
  • Urinalysis for protein
Perform:
  • 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.
Calculate:
  • Absolute cardiovascular risk.
Pale child + severe 'colic' + vomiting
Murtagh's Triads
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
Polyarthritis + fever + rash
Murtagh's Triads
In a paediatric emergency, why is a surgical airway contraindicated? What is the alternative?
Children's airways are anatomically different shapes and vital structures could be damaged by a scalpel cricothyroidotomy. The alternative is a needle cricothyrodotomy and jet insufflation (you can oxygenate but not ventilate through this).
Drowsiness + cough + wheezing
In a child <12 months.
Murtagh's Triads
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