October 10, 2018
The Daily Dozen - Thursday, 17th January 2019.
John, age 11, complains of a sore, sticky red left eye. Occasionally his vision has been a bit blurry, though this has cleared with blinking. On examination his acuity is 6/5 bilaterally.
Bacterial Conjunctivitis. Sore, diffusely red eye, usually unilateral but can be bilateral, purulent discharge. Remember to consider gonococcal particularly in neonates / young adults.
Tanalai via Wikimedia
Anorexia/nausea + faecal leaking + abdominal bloating
Ben, age 24, complains that his eyes have been mildly red, irritated and watering for at least 3 weeks. They didn't get any better after a course of chlorsig from the chemist. Ben has had multiple sexual partners lately and despite your advice he does not practice safe sex.
Chlamydial Conjunctivitis. This can be a cause of non-resolving conjunctivitis in sexually-active adults. Conjunctival scrapings may confirm the diagnosis. It can also occur in neonates, where it must not be missed.
Ataxia + ophthalmoplegia + areflexia
Miller-Fisher variant of Guillain Barre Syndrome
Mary, age 79, has had worsening left eye pain and redness for the past 2 days. She reports having had an injection into this eye 3 days ago by her eye specialist for her 'macula'. On examination, visual acuity is reduced to counting fingers and the surrounding tissue is swollen and sore
Endophthalmitis. Acute visual loss, severe eye pain and red eye. There may be a history of trauma or eye surgery. There is a collection of pus in the anterior chamber (hypopyon). This is an emergency and must not be missed.
Anxiety and prostration + intense central abdomen pain + profuse vomiting +/- bloody diarrhoea
Mesenteric arterial occlusion
David, age 68, presents for a routine review. He has a history of obesity, hypertension, hyperlipidemia and ischemic heart disease.
Hypertensive retinopathy. There is AV nicking, where the stiffened arteries displace the veins due to chronic hypertension.
Amenorrhoea + loss of axillary and pubic hair + breast atrophy in females
Jim, age 83, has an area of discoloured skin on his cheek. The staff at his residential aged care facility think it has been getting bigger with more colours in it over the past couple of months. He reports it is mildly itchy. On examination, it is large, irregular, asymmetrical and part of it feels thickened.
Lentigo maligna melanoma. Lentigo maligna is an early type of melanoma that grows slowly over many years. It can progress to lentigo maligna melanoma in around 3-10% of cases. Read more on DermNet
Finger discomfort + arthralgia + reflux (+/- skin tightness)
Sexual Infection Screening
- All sexually active people 15-29: chlamydia annually
- Low risk heterosexual asymptomatic requesting ‘STI check-up’: chlamydia, Hepatitis B, Syphilis and HIV
- Sexual contacts from the last 6 months of infected women and men: Treat presumptively, retest 3-12 months for re-infection (not retesting for cure).
- Asymptomatic men who have sex with men: urine and rectal swab for chlamydia, throat and rectal swab for gonorrhoea, HIV, syphilis, Hep A and B if not immune (offer vaccination)
- HIV positive or history of IVDU: Hepatitis C
Leg weakness + ataxic gait + clumsiness (appears about 12 years)
Article of the Month
Removal of ear, nose and throat foreign bodies: A review
This is a practical guide to removing different shaped foreign bodies from the ear, nose or throat.
Apart from batteries and vegetable matter that may expand with moisture, most ear foreign bodies do not need to be removed immediately.
AJGP October, 2018
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