The Daily Dozen
Saturday, 21st April 2018.Note: site undergoing updates. Audiogram/tympanogram quiz now back. KFP / AKT quizzes back soon.
Absolute Cardiovascular Risk
Absolute cardiovascular risk should be calculated every 2 years for:
- Adults without established CVD aged 45 years and older.
- ATSI adults aged 35 years and older
Weakness + constipation + polyuria
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
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
Jenny, age 40, has a skin lump on her arm. On examination, it is 9mm, raised and soft with a bumpy surface. She thinks it has been there for a long time and hasn't changed recently in any way.
Dermal naevus. This benign dermal naevus doesn't require any specific treatment. It is important to be able to recognise benign lesions as not all lesions require treatment. Read more on DermNet
Ben, age 42, is a keen surfer. He has noticed a little red bump on the white of his eye over the past couple of days. It feels mildly uncomfortable but better after he uses artificial tears.
Pingueculum. Can be caused by excess UV exposure. It is usually less inflamed than episcleritis / scleritis, but if it doesn't improve reconsider the diagnosis and refer.
Dizziness + hearing loss + tinnitus (unilateral)
Julie, age 52, complains that her left eye is aching and red, and that it hurts to look at the light. She doesn't recall any trauma. Julie has a history of sarcoidosis but is otherwise well. On examination, there is no visible foreign body and fluorescein exam is normal. Intraoccular pressure is normal. Instillation of topical anaesthetic drops does not relieve the discomfort.
Anterior Uveitis. Red eye, peri-occular pain, photophobia, ciliary flush and the pupil may be irregular. This can be isolated or associated with systemic disease.
Cervical Cancer Screening
Screening with pap smears:
- Should be done every 2 years, beginning at age 18 or 1-2 years after becoming sexually active
- In pregnancy, should be done without using the cytobrush
- In postmenopausal women with atrophy, vaginal oestrogens can be used for 2-3 weeks prior to the pap
- In women with female sexual partners, they are still at risk of cervical cancer and should have normal screening
Asthma + rhinitis + vasculitis + hypereosinophilia
Toddler (12-18 months) Preventive Health Check
- ‘Lift the lip’ dental check
- Physical activity
- Risk of iron depletion and vitamin D deficiency
- Developmental progress including vision and hearing
- Family functioning
- Social and emotional wellbeing
- Toilet training
- Behaviour management techniques
Arthralgia + weight loss + fever (+/- skin lesions)
GP trove is an independent Free Open Access Medical education (FOAM) website for GP registrars and other FRACGP candidates in Australia.