The Daily Dozen - Friday, 19th April 2019.

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.

Jonathon Trobe University of Michagen Kellogg Eye Center

Jaundice + anorexia + weight loss (+/- epigastric pain radiating to back)
Murtagh's Triads
Annie, age 17, presents with a red left eye that she has noticed since she woke up this morning. There is no pain or photophobia. Annie has a history of hayfever but is otherwise well. Acuity, eye movements, pupils and fundoscopy is normal.
Subconjunctival haemorrhage. This may be caused simply by sneezing, coughing or straining, although hypertension / blood dyscrasias are also possible causes.

Jonathon Trobe University of Michagen Kellogg Eye Center

Spontaneous haemarthrosis + muscle bleeds + delayed bleeding
Murtagh's Triads
Chloe, age 4, has a rash that started yesterday with a few itchy red spots on her abdomen. She now has scattered crops these lesions across her trunk, face (including mouth) and limbs. Some of the earlier lesions have progressed to vesicles. Chloe is not immunised.
Chickenpox. A highly contagious viral infection. A hallmark is having different stages of lesions present simultaneously. There can be just a handful of lesions or many hundreds and they are very itchy. The child should be excluded until all blisters have dried. Read more on DermNet, or view school exclusion guidelines here.
Fever + pneumonia + myalgia
(e.g. after wading through rice paddies)
Murtagh's Triads
What does this Audiogram show?
Noise-induced hearing loss. Note the notch at 4000Hz. This is common but not diagnostic – there are other causes of this notch apart from noise.
Fair females under 5 + thin wispy hair + easy loss with pulling
Murtagh's Triads
Jenny, age 30, is worried about her left eye because it has been red and mildly irritated for the past 7 days. She tried chlorsig from the chemist but there was no improvement. On examination, there is localised redness of a segment of the left eye. Acuity is normal. There is no evidence of a foreign body and fluorescein examination is normal. Jenny is otherwise well.
Episcleritis. This can be idiopathic, or sometimes associated with autoimmune diseases like Crohn's or ulcerative colitis. It can be recurrent but is usually self limiting. Compared to scleritis, there is usually less pain and there are fewer associated symptoms such as photophobia / reduced vision. Scleritis is also more commonly associated with autoimmune disease.

Jonathon Trobe University of Michagen Kellogg Eye Center

Vertigo + provoked by movement (especially rolling in bed) + Hallpike positive
Murtagh's Triads

Teenage Preventive Health Check

Assessment
  • Use the HEADSS framework:
    • H: Home
    • E: Education / Employment
    • A: Activities
    • D: Drugs
    • S: Sexuality
    • S: Suicide
  • Growth velocities including BMI
  • Nutrition
  • Physical activity (at least 60 min / day)
  • Screen sexually active young people for chlamydia
  • Depression screen
Preventive counselling and advice
  • Injury prevention – harm minimisation.
  • Sun protection
  • Social and emotional wellbeing
  • Oral health
  • If chronic comorbidities: transition from tertiary paediatric care to effective primary care with access to adult specialist care
Leg weakness + ataxic gait + clumsiness (appears about 12 years)
Murtagh's Triads
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