FAMILY MEDICINE 21/6/2020 (DR JOHARI )

1. 50 YEARS OLD , HYPERTENSION FOR LAST 5 YEARS AND HYPERLIPIDEMIA

A) DESCRIBE LESION- YELLOWISH COLOUR, BELOW RIGHT EYE, SIZE IS AROUND 1CM , SURFACE IS
NODULAR,CLEAR MARGIN,SEMICIRCLE IN SHAPE, NO DISCHARGE AND ULCERATION, SURROUNDING
SKIN IS NORMAL
B) IMPRESSION- XANTHELASMA
C) TREATMENT-SURGICAL REMOVAL,LAZER REMOVAL

2. 18 YEAR OLD GENTLEMAN,

A) DESCRIBE LESION - HYPERPIGMENTED VELVETY APPEARENCE

BACK OF PATIENT NECK EXTENDED UP TO SHOULDER, NO CLEAR
DEMARCATION,MEASURING 3 CM WIDTH,NO ULCERATION AND
DISCHARGE
B) IMPRESSION- ACANTHOSIS NIGRICANS
C) OTHER AREAS-ARMPIT, INGUINAL REGEION, BELOW BREAST
D) INVESTIGATION- CAPPILARY BLOOD GLUCOSE(DM), CONNECTIVE TISSUE DISORDER

3.

A) DESCRIBE LESION -BILATERAL TONSILLAR SWELLING,EXUDATES

(PUS) PRESENCE ON TONSILLAR AREA,TONSILLAR ENLRGEMNT IS
INFLAMED, UVULA I SWOLLEN AND DEVIATED TO THE LEFT SIDE
(BECAUSE RIGHT TONSIL LARGE THAN LEFT SIDE), SOFT PALATE IS
INFLAMED
B) INVESTIGATION- FBC-WBC(LEUCOCYTOSIS/LYMPHOCYTOSIS),
THROAT SWAB( STREP),UREA&ELECTROLYTES
C) DIFFERENTIAL DIAGNOSIS
-ACUTE BACTERIAL TONSILITIS
-INFECTIONS MONONUCLEOSIS
-PERITONSILAR ABSECESS
D) TREATMENT
-CONSERVATIVE(PANADOL), LOZENGES, SALT GARGLE
-ANTIBIOTIC: PENICILLIN, ERTHROMYCIN

**PENICILIN WORSEN INECTIOUS MONONUCLEOSIS (EBV)-POSTERIOR TRIANGLE LYMP NODE

CENTOR CRITERIA: 5 SCORE (> 4 START ANTIBIOTIC)

FEVER> 38 DEGREE
TONSILLAR EXUDATES
ANSENCE OF COUGH
TENDER ANTERIOR CERVICAL LYMPH NODE
AGE<50

BY: HASPREET KAUR GILL

 3. 23 YEAR OLD GIL HIS OF EARACHE FOR PAST 2 DAYS PROCEDDED BY
URTI, UPON EAR EXAMINATIO LEFT TYMPANIC MEMBRANE

A) DESCRIBE THE LESION-TYMPANIC MEMBRANE LOOK SWOLLEN AND

ERYTHEMATOUS, COLLECTION OF FLUIF AT THE BACK OF TYMPANIC
MEMBRANE, CONE OF LIGHT VISIBLE, NO RUPTURED TYMPANIC
MEMBRANE, REST OF EAR CANAL APPEARS NORMAL
B) DIAGNOSIS- ACUTE OTITIS MEDIA
C) TREATMENT- PENICILLIN, AUGMENTIN, AMOXICILLIN
D) COMPLICATION-PERFORATION, HEARING LOSS, CHRONIC SUPPURATIVE

*LRTI-MACROLIDES CHOICE OF ANTIBIOTIC

4.36 YEARS OLD MAN, ON AND OFF RASHES

A) DESCRIBE LESION- SILVER PLAQUE, ERYTHEMATOUS, LOCATED AT OCCIPITAL

AREA AND ELBOW,MARGIN WELL DEMARCATED, ON EXTENSOR SURFACE, NO
DISCHARGE,SURROUDNING SKIN IS NORMAL
B) DIAGNOSIS-PSOARIASIS, ECZEMA
DIFFERENCEOF LOCATION: ECZEMA ON FLEXOR SURFACE, PSOARISIS LOCATED ON EXENSOR SURFACE
C) TREATMENT:CREAM (HYDROCORTISONE,BETA METHASONE, BECLOMETHASONE,
EMOLIENTS,PHOTOTHERAPHY,AVOID TRIGGERING FACTOR,

*PSOARIASIS NORMALLY NOT ITCHY

5.3 YEAR OLD GIRL HAVE THIS ITCHY LESION AND RASHES AT
BACK OF KNEE, HISTORY OF BRONCHIAL ASTMA, STRONG
HISTORY OF ATOPY IN FAMILY

A) DESCRIVE LESION- DRY SCALY ERYTHROMATOUS LESION ON FLEXOR SURFACE OF KNEE, WELL
DEMARCATED, SHAPE IS IRRGULAR, NO DISCHARGE OR ULCERATION, PRESENCE OF SCRATCH MARK
B) DIAGNOSIS-ECZEMA
C) TREATMENT-EMOLIENTS,STEROID CREAM,ANTIHISTAMINE (> 2 YEARS OLD)

BY: HASPREET KAUR GILL

6.EXHIBIT SHOWING LEFT HAND WHO COMPLAIN OF ITCHINESS

A) DESCRIBE LESION- PAPULAR VESICLES AND ULCERATION LOCATED AT

WEBSPACE OF HAND, EXCORIATION SEEN
B) DIFFERENTIAL DIAGNOSIS
-SCABIES
-ATOPIC DERMATITIS
-ALLERGIC DERMATITIS
-HAND FOOD AND MOUTH DISEASE

C) TREATMENT-PERMETHRIN SOLUTION ONCE IN A DAY,WASH LINENS AND BED SHEET IN THE

HOUSE, PERSONAL HYGEINE, NO SHARING PERSONAL STUFF, USE WASH WATER TO WASH THE
CLOTHES

BY: HASPREET KAUR GILL