The Daily Dozen - Tuesday, 21st May 2019.

Jack, age 19, has a widespread rash and is itchy all over. He thinks he got it from his housemates, several of whom recently returned from backpacking in the UK. He begs you to do something to make the itching stop!
Scabies. Associated with poverty and overcrowding, scabies should be suspected in anyone with such an itchy rash. Burrows should be looked for. Treatment may include topical permethrin (ie Lyclear) from the neck down, applied at night and washed off the next morning. It is essential to also wash linen, towels and clothing, treat household contacts, and vacuum the house thoroughly. Read more on DermNet
Loin pain + haematuria + palpable loin mass
Murtagh's Triads
Ben, age 42, is a keen surfer. He has noticed a little red bump on the white of his eye over the past couple of days. It feels mildly uncomfortable but better after he uses artificial tears.
Pingueculum. Can be caused by excess UV exposure. It is usually less inflamed than episcleritis / scleritis, but if it doesn't improve reconsider the diagnosis and refer.

Jonathon Trobe University of Michagen Kellogg Eye Center

‘elfin’ face + intellectual disability + aortic stenosis
Murtagh's Triads
What does this Tympanogram show?
Type C tympanogram. There is a peak but it is shifted to the left of normal. This suggests there is negative pressure in the middle ear, such as sinusitis or eustachian tube dysfunction without a middle ear effusion.
Young female + nulliparous + dyspareunia
Murtagh's Triads

Type 2 Diabetes Risk

People at high risk of Type 2 Diabetes:
  • AUSDRISK >12
  • History of heart attack or stroke
  • Women with a history of Gestational Diabetes or PCOS
  • Patients prescribed antipsychotics
  • IFG or IGT on a glucose tolerance test
Sudden headache + altered consciousness + neck stiffness +/- vomiting
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
Fever + malaise (extreme) + anorexia / nausea / vomiting (+/- anaemia)
Murtagh's Triads
Peter, age 50, has a mole that has been changing over the past few months. It seems to be larger and different coloured now. It is not painful but slightly itchy. Peter has fair skin but no history of skin problems.
Superficial spreading melanoma. This is the most common form of melanoma. Concerning features include Asymmetry, Border irregularity, Colour variations, Diameter >6 mm and Evolution over time (ABCDE). On dermoscopy, features include pattern asymmetry, multiple colours, blue-grey structures and an atypical pigment network. Read more on DermNet
Facies + growth retardation + microcephaly
Murtagh's Triads
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