The Daily Dozen
Monday, 19th March 2018.Note: site undergoing updates. Posts and quizzes back next week.
Lifestyle Modifications for Hypertension
- >30min moderate-intensity exercise on most days
- Smoking cessation
- Waist circumference <94cm for men, or <80 cm for women.
- Alcohol intake ≤2 standard drinks per day for males and ≤1 standard drink per day for females.
Kelly, age 23, presents with blurred vision, photophobia and foreign body sensation in her left eye since waking this morning. Kelly wears contact lenses. On examination, there is a hazy, irregular light reflection and fluorescein examination shows an area of ulceration. There is no evidence of foreign body.
Keratitis. Contact lens wearing is a red flag for an infectious keratitis.
Febrile illness + vomiting + stupor
Japanese B Encephalitis
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.
Joe, age 74, presents with confusion, headache, visual agnosia and dizziness. Pupils react normally to light. He is found to have a left homonymous hemianopia.
Posterior stroke. Stroke in the vertebrobasilar circulation. The fundoscopy is normal.
weakness + back pain + weight loss
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.
Betty, age 76, has noticed a gradual decline in her vision. She complains that sometimes straight lines appear wavy and there seems to be a dark patch in the middle of her vision. She has stopped driving at night because she was finding this particularly difficult. Visual acuity is 6/9 left eye, 6/12 right eye.
Age-related macular degeneration. Elderly patient, gradual onset, mildly reduced visual acuity, visual distortions, central visual field defect (ie on Amsler grid), retinal drusen on fundoscopy. There is a risk of progression to wet macular degeneration.
Justin, age 48, is a keen windsurfer. He has noticed a growth on his left eye that seems to be slowly increasing in size over the past few months.
Pterygium. This growth can be caused by repeatedly heavy sun and wind exposure. It tends to develop very slowly but can grow across the cornea, which may require referral.
All patients with suspected TIA should have stroke risk assessment including the ABCD2 tool:
- A = Age >60
- B = BP >140/90
- C = Clinical features of unilateral arm weakness (2 points) or speech impairment without weakness (1 poinit)
- D = Duration >60min (2 points) or 10-59min (1 point)
- D = Diabetes mellitus
Severe epigastric apin + 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.
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