October 10, 2018
The Daily Dozen - Tuesday, 23rd October 2018.
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.
Colicky central abdominal pain + vomiting + distension
Small bowel obstruction
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
Plethoric moon facies + thin extremities + muscle weakness
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.
Male child + gait disorder + bulky calves
Duchenne Muscular Dystrophy
Jim, age 64, presents with acute painless visual loss in the left eye. Jim has a history of type 2 diabetes, hypertension and hypercholesterolemia, but he does not take his medication. On examination, there is an absent red reflex in the left eye.
Vitreous haemorrhage. Bleeding from a retinal vessel has leaked into the vitreous cavity. Other causes include trauma, retinal detachment or malignant hypertension.
Tall stature + dislocated lens and myopia + aortic root dilatation
What are the 3 elements of a Kidney Health Check?
Kidney Health Check = BP check + Urine albumin:creatinine ratio (ACR) + eGFR.
Anxiety + weight loss + weakness
Bill, age 52, has had severe left eye pain and blurry vision for the last 2 hours. It started completely 'out of the blue'. He also feels sick, he has vomited twice and he has a terrible headache. He doesn't like looking at bright light but when he does he complains there are funny coloured rings around the lights.
Acute Angle-Closure Glaucoma. Acute visual loss, severe pain, headache, photophobia, blured vision, ciliary flush, hazy cornea and unreactive pupil. Intraoccular pressure will be high.
Fever (often with rigors) + upper abdominal pain + jaundice
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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