Spot Diagnosis Flashcards
You are the FY1 doing a GP job
A 6 year old boy presents with tiny pustules with honey-coloured crusted plaques under 2 cm in diameter around the mouth
The infecting organism for the above condition is more commonly Staphylococcus aureus (non-bullous type)
The infection can also be cause by streptococcus pyogenes
Which condition am I?
Impetigo
You are the FY2 in the endocrinology ward
A 69 year old man complains of pain in his right lower leg.
On examination the anterior surface of the right lef is red, swollen and warm to the touch. The lesion covers most of the lower limb. The man has an ulcer on his leg in the same region that he hasnt been keeping clean and dry
What is most likely to be causing the redness?
Cellulitis
commonly seen in the lower limbs and usually affects one limb
many cases, there is an obvious precipitating skin lesion, such as a traumatic wound or ulcer, or other area of damaged skin.
erythema, pain, swelling and warmth of affected skin
You are the Paediatrician
A 1 year old boy presents with a red lesion on the face. No other symptoms such as fever itchiness or coughs and cold. The most common tumours of infancy.
The majority of these lesions will involute spontaneously over time and will require no treatment. Currently, propranolol is the preferred treatment
Which condition am I?
Strawberry Naevi (Haemangioma)
You are the Paediatrician
Posterior fossa defects Haemangioma Arterial anomalies Cardiac anomalies Eye abnormalities Sternal clefting/Spraumbilical midline raphe
Which condition am I that may present with all or some of these problems?
PHACES Syndrome
You are the Paediatrician
You see a 1 year old girl with a red lesion over the v1 trigeminal distrubution of her face. On further examination the lesion is flat and not painful.
You suspect ____ and check patient.info which says
a neurological disorder marked by a distinctive port-wine stain on the forehead, scalp, or around the eye. This stain is a birthmark caused by an overabundance of capillaries near the surface of the skin
Which syndrome may present with a port wine stain?
Sturge–Weber syndrome
You are the Paediatrician
A rare genetic condition that causes mainly benign tumours to develop in different parts of the body.
Cutaneous features: ash leaf macules, angiofibromas, shagreen patches, periungual fibromas
Which condition am I?
Tuberous Sclerosis (TSC)
You are the Paediatrician
You see a 3 year old girl with generalised redness of a large area of her skin with blistering. It is painful and she has a temperature as well. There is no mucosal involvement.
You swab the area. The results show S. aureus epidermolytic toxin A and/or B. Toxins reach skin from distant focus of infection
eg umbilicus, nappy area, conjunctiva
You give antibiotics and provide supportive measures
Healing occurs without scarring
Which condition am I?
Staphylococcal scalded skin syndrome
SSSS
You are the Paediatrician
You see a 4 year old. Mum tells you he has a temperature, and is nauseaous. On examination you find he has abdo pain, ‘strawberry tongue’ and a rash which looks like ‘sunburn with goose pimples’
Diagnosis: clinical/throat swab/blood test (ASO, anti-DNAase B titres)
What is the diagnosis?
Scarlet fever
You are the Paediatrician
You see a 2 year old boy with a rash. Dad tells you that the rash started on his face but has been spreading to his chest and arms. The infant has a temperature 39, puffy eyes, runny nose, cough, On examination you notice he has white spots on the inside of his cheeks reminiscent of Kopliks spots.
You suspect a highly contagious viral infection transmitted through the air.
What is the most likely diagnosis?
Measles
You are the Paediatrician
9 yr old girl presents with small diffuse red itchy papules. Mum tells you that some of the spots have scabbed over.
On examination you notice that some of the red papules have become fluid filled vesicles.
You decide to do a viral swab.
Diagnosis: clinical +/- Swab from vesicle (viral PCR)
Symptomatic treatment
What is the most likely differential?
Treat high risk groups (pregnant women, immunocompromised patients) with aciclovir. Routine vaccination not used in UK
Causative agent Varicella-zoster virus (HHV-3)
Incubation period 10-20 days
Reoccurence as Shingles
Chicken pox
Very common skin condition
Red (erythematous) patches of dry skin +/- papules
May be weepy or crusty
Chronic: lichenification, pigmentary change
Infancy: Face & extensor surfaces
1-2 years onwards: limb flexures
Adults: flexures, trunk, scalp, hands
Atopic Eczema
Wheals (hives): pale, raised areas surrounded by erythema; very itchy
Mast cell release of histamine, bradykinin, leukotrienes, prostaglandins
Acute (< 6 weeks) or chronic (>6 weeks).
Acute: viral infection, food & drug allergy (IgE mediated)
Chronic: often idiopathic
Inducible/physical urticaria: cold, heat, vibratory, aquagenic
Treatment: avoid trigger(s), second generation anti-histamines
Urticaria
Red nodules on shins \+/- fever, malaise, arthralgia Hypersensitivity reaction Inflammation of subcutaneous fat Common causes: Strep throat, sarcoidosis, inflammatory bowel disease, TB, pregnancy drugs eg OCP, salicylates, sulphonamides Treat underlying infection Light compression, anti-inflammatories
Erythema Nodosum
Red papules, evolve to target lesions
Hands, feet +/- limbs, may be itchy/painful
Usually triggered by infection: Herpes simplex virus (50%), Mycoplasma, EBV, CMV,VZV and others
Drugs/Vaccinations (<10%)
EM minor- no mucosal involvement
EM major ≥ mucosal site involved
Treat associated infection eg HSV, Mycoplasma
Resolves ≤ 2 weeks, can recur
Target Lesions
condition that causes the skin to become itchy, red, dry and cracked. AKA atopic dermatitis
Which condition am I?
atopic eczema
is characterized by red, flaky, greasy areas of skin, which are commonly found on the scalp (dandruff), nasolabial folds, eyebrows, behind the ears, and on the upper chest
Which condition am I?
seborrhoeic eczema
