The Daily Dozen - Friday, 16th November 2018.

2 year old Preventive Health Check

Assessment  
  • Developmental progress including vision and hearing
  • ‘Lift the lip’ dental check
  • Nutrition
  • Physical activity
  • Emerging behavioural or emotional problems
  • Family functioning
  • Physical exam as outlined in the Child Health Record
Preventive counselling and advice
  • Injury prevention
  • Sun protection
  • Social and emotional wellbeing
Fever + severe aching + rash
Murtagh's Triads
Joe, age 72, has noticed a skin lesion on his forehead. He thought it started a few weeks ago as a mozzie bite, but it hasn't healed and seems to be getting slowly bigger. It is not sore or itchy.
BCC. This nodular BCC has the classic pearly rolled edges and central ulceration. On dermoscopy, you might be able to see arborising vessels among other features. Other types of BCCs include superficial and morphoeic. Read more on DermNet
Knee pain (after activity ) + tender knee 'lump' + pain on kneeling
In an older child, usually with a growth spurt
Murtagh's Triads
What does this Tympanogram show?
Type B. The tympanogram is flat. This can suggest a middle ear effusion, or tympanosclerosis / cholesteatoma / tumour.
Male with dysuria + fever + perineal pain
Murtagh's Triads
What does this Audiogram show?
Bilateral mixed hearing loss.
Fatigue + muscle weakness + cramps
Murtagh's Triads
Brandon, age 22, was treated in ED a week ago for a patch of 'ringworm' on his chest. He returns to his GP today as the treatment hasn't worked, and now the rash is spreading over his chest and back, with numerous smaller scaly patches. It is not itchy or sore.
Pityriasis rosea. Pityriasis rosea typically begins with a herald patch of scaly red skin, that develops into a secondary rash 1-20 days later. It is a viral infection that needs careful reassurance and explanation as it can take 6-12 weeks to resolve. Avoiding soap, moisturising and sensible sunlight exposure may also help. Read more on DermNet
Cramps + confusion + tetany
Murtagh's Triads
Bob, aged 79, has a scaly lesion on his arm. On examination, it has a hard, scaly surface but the skin doesn't seem to be indurated or thickened. He has several other scaly lesions, but is particularly bothered by this lesion as it catches on his shirt cuff.
Actinic keratosis. This is an irritated actinic keratosis, also known as solar keratosis. Unlike an SCC, it hasn't developed the thickness that would suggest dermal infiltration. Treatment commonly includes cryotherapy.
Angina + dysponea + blackouts
Murtagh's Triads
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