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The Daily Dozen - Friday, 18th October 2019.

Tracy, age 32, has noticed increasing numbers of growths on her fingers since starting treatment for Crohn's disease. They are not painful or itchy.
Common wart. Warts are common, especially in children or in people who are immunosuppressed. Common treatment options include topical salicylic acid or cryotherapy. Read more on DermNet
Vertigo + vomiting + tinnitus + sensorineural deafness
Murtagh's Triads
Meredith, age 60, has noticed that the colour of her left eye is changing. She thinks the brown area has been enlarging over the past few months.
Iris melanoma. It could be a benign naevus or a melanoma, but if it is growing then melanoma should be suspected.

Jonathon Trobe University of Michagen Kellogg Eye Center

Fatiguable weakness of eyelids / eye movement + limbs + bulbar muscles of speech and swallowing
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
Facies + growth retardation + microcephaly
Murtagh's Triads
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.

Jonathon Trobe University of Michagen Kellogg Eye Center

Painful / itchy bite + agitation + hydrophobia (pain with drinking)
Murtagh's Triads
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.

Jonathon Trobe University of Michagen Kellogg Eye Center

Mid to low back pain / discomfort + inability to touch toes + kyphosis
Murtagh's Triads
In an emergency, if there is no Broselow tape, what is the formula for estimating a child's weight from their age?
Weight = (age + 4) x 2
abdominal cramps + flatulence + profuse diarrhoea
Murtagh's Triads