The Daily Dozen
Thursday, 22nd March 2018.Note: site undergoing updates. Audiogram/tympanogram quiz now back. KFP / AKT quizzes back soon.
Harry, age 84, complains that both of his eyes are always red and watering and that his lower eyelids have gradually become sagging.
Ectropion. Watery eyes (due to a lack of drainage), mild irritation, sagging lower eyelids and red conjunctiva. Often due to muscle weakness, but also due to paralysis, scarring or eyelid growths pushing the eyelid away.
2 questions to ask, looking for depression:
- Over the past 2 weeks, have you felt down, depressed or hopeless?
- Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Prevention in Pregnancy
How can the following hazardous exposures be avoided for women who are pregnant or planning pregnancy?
- Toxoplasmosis: avoid cat litter, garden soil, raw/undercooked meat and unpasteurised milk products, and wash all fruit and vegetables
- CMV / parvo B19: handwashing, wearing gloves when changing nappies (child and healthcare workers)
- Listeriosis: avoid paté, soft cheeses (feta, brie, blue vein), pre-packaged salads, deli meats and chilled/smoked seafood. Wash all fruit and vegetables before eating.
- Mercury: limit fish containing high levels of mercury
Transient amaurosis fugax or dysphasia or hemiplegia
Transient Ischaemic Attack
Joe, age 31, presents with a painful red right eye. He works as a carpenter and he feels like he might have got something in his eye. Fluorescein examination shows a vertical abrasion on the cornea.
Conjunctival foreign body. It is important to evert the eyelid to look for foreign bodies. Once the foreign body is removed, he should return for review in 24 hours to ensure the abrasion has resolved.
Male child + gait disorder + bulky calves
Duchenne Muscular Dystrophy
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.
Weakness + constipation + polyuria
Tom, age 62, presents with a tender swollen upper eyelid that has gradually developed into a lump. Visual acuity is normal.
Chalazion. Also known as a Meibomian cyst, it arises from a meibomian gland along the tarsal plate of the eyelid, whereas a stye arises from an infected hair follicle on the edge of the eyelid. Over weeks the tenderness and redness may resolve, leaving a lump of lipids and granulomatous material that can sometimes require surgical removal.
Jordan M. Graff via Wikimedia
Short + facies (broad forehead, ptosis, low set ears etc.) + webbed neck +/- pulmonary stenosis
Mid to low back pain / discomfort + inability to touch toes + kyphosis
Dental Preventive Health
- ‘Lift the lip’ screening - teach parents to look for signs of tooth decay once a month
- Dental hygiene - brush twice a day, but no toothpaste under 17 months and only use low fluoride toothpaste up to 5 years
- Dental visits annually after 12 months
GP trove is an independent Free Open Access Medical education (FOAM) website for GP registrars and other FRACGP candidates in Australia.