The Daily Dozen - Monday, 17th June 2019.

Nutrition Advice

Enjoy a wide variety of foods each day:
  • five portions of vegetables and two portions of fruit
  • three portions of cereals (including breads, rice, pasta and noodles)
  • one to two portions of lean meat, fish, poultry and/or alternatives
  • at least 2 g per day alpha-linolenic acid by including foods such as canola-based or soybean-based oils and margarine spreads, seeds (especially linseeds), nuts (particularly walnuts), legumes (including soybeans), eggs and green leafy vegetables
  • drink plenty of water.
Take care to:
  • limit saturated fat and moderate total fat intake but consume about 500 mg per day of combined docosahexaenoic acid and eicosapentaenoic acid through a combination of the following: two or three serves (150 g serve) of oily fish per week, fish oil capsules or liquid, food and drinks enriched with marine omega-3 polyunsaturated fatty acids
  • limit salt intake to less than 6 g of salt a day (approximately 2300 mg of sodium a day), which is approximately teaspoons of salt
  • limit alcohol intake
  • consume only moderate amounts of sugars and foods containing added sugars.
  • prevent weight gain: be physically active and eat according to energy needs
  • care for food: prepare and store it safely
  • encourage and support breastfeeding.
Cramps + confusion + tetany
Murtagh's Triads

Stroke Risk

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
Other important factors include AF, crescendo TIA (2 or more TIAs in the past week) or anterior circulation signs suggesting carotid disease.
Genital pruritus + soreness + white wrinkled plaques
Murtagh's Triads
Paul, age 74, presents with double vision and a drooping right eyelid. On examination, when his eyelids are elevated with assistance, his eye appears 'down and out' and his right pupil is dilated.
Third nerve palsy. The 3rd cranial nerve is damaged, leading to ptosis, impaired occular movements, diplopia and mydriasis.
Wang et al via Wikimedia

Jonathon Trobe University of Michagen Kellogg Eye Center

Fatiguable weakness of eyelids / eye movement + limbs + bulbar muscles of speech and swallowing
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.
Young female + nulliparous + dyspareunia
Murtagh's Triads

Toddler (12-18 months) Preventive Health Check

Assessment
  • ‘Lift the lip’ dental check
  • Nutrition
  • Physical activity
  • Risk of iron depletion and vitamin D deficiency
  • Developmental progress including vision and hearing
  • Family functioning
Preventive counselling and advice
  • Social and emotional wellbeing
  • Toilet training
  • Behaviour management techniques
Fever + sore throat + cervical lymphadenopathy
Murtagh's Triads
Loss of vision with washed out colours, pale optic disc on fundoscopy.
Optic atrophy. DDx ischemia, optic neuritis, tumours, inflammation / infection, trauma.

Jonathon Trobe University of Michagen Kellogg Eye Center

‘elfin’ face + intellectual disability + aortic stenosis
Murtagh's Triads
GP trove is an independent Free Open Access Medical education (FOAM) website for GP registrars and other FRACGP candidates in Australia.