Rash :: PLAB 2 Symptomatic Differential Stations

• Suspected malignant melanoma

  • Other presenting symptoms 

    • Sometimes itching with a tingling sensation. 

    • Irregular colour

    • Sometimes bleeds. 

    • No pain. 

    • Growing in size 

    • Sun exposure/ tanning

    • FLAWS

  • Past history and PMAFTOSA Rule out FLAWS, suicidal thoughts

  • Social 

  • Exam and Invs

    • GPE, vitals,

    • Lesion exam

    • Head-to-toe exam

    • Biopsy

  • Referral Dermatologist

  • Treatment 

  • Warning signs

    • Symptoms getting worse

• Cellulitis after Insect bite 

  • Other presenting symptoms 

    • Increasing pain and size

    • Fever

  • Past history and PMAFTOSA

  • Social 

  • Exam and Invs

    • GPE, vitals,

    • Lesion exam

    • Head-to-toe exam

  • Referral Medicine admission

  • Treatment 

    • Painkiller

    • IV antibiotics

  • Warning signs

    • Feeling faint, dizziness

• Lyme disease

  • Other presenting symptoms 

    • Round/oval, bulls-eye appearance with incomplete central clearing and central punctum

    • Increasing pain and size

    • Bleeding, itching, pain, pus/discharge/oozing, blistering.

    • Fever, night sweats

    • Flu-like illness

  • Past history and PMAFTOSA

    • Bitten by a tick, recently visited woodland / grassy area in the UK or abroad

  • Social 

  • Exam and Invs

    • GPE, vitals,

    • Lesion exam

    • Head-to-toe exam

  • Referral Infectious diseases

  • Treatment 

    • Painkiller, paracetamol

    • Doxycyclin for 21 days (start ASAP before referral)

  • Warning signs

    • Slight worsening of symptoms initially after starting treatment (Jarisch-Herxheimer reaction (reaction to the dying bacteria) - expected) but come back to the hospital if becomes too much.

    • General measures about tick safety and check other family members for tick bites as well.

• Chickenpox in a 3-year-old

  • Other presenting symptoms- 

    • Vesicles (fluid-filled)

    • Starts on the face and then spreads to the rest of the body. 

    • Fever, cough, and runny nose. 

  • Past history and PMAFTOSA- 

    • Pregnancy and birth history

    • Vaccination and development history

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals,

    • Lesion exam

    • Head-to-toe exam

  • Referral 

    • None

  • Treatment 

    • Paracetamol, antihistamines

    • Self-limiting

    • General measures (no scratching, loose clothes, avoid contact with others, plenty of fluids)

  • Warning signs- 

    • Signs of bacterial infection (high fever, redness/swelling around the vesicles)

• Measles in 25yr old student (404) 

  • Other presenting symptoms- 

    • Starts behind the ear then spread to the rest of the body. 

    • Fever, cough, and runny nose.

    • MMR vaccine not taken/ not sure

  • Past history and PMAFTOSA- 

    • 
      

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • Lesion exam

    • Head-to-toe exam

  • Referral 

    • Notify Health Protection Team

  • Treatment 

    • Self-limiting

    • Symptomatic management

  • Warning signs

    • Avoid contact with immunosuppressed people and others

    • MMR vaccine once recovered

    • Symptoms not resolved in a week.

    • Shortness of breath, uncontrolled fever

    • Convulsions, or altered consciousness

• Impetigo

  • Other presenting symptoms- 

    • Honey-crusted blisters/lesions around mouth

    • No pain, no itch

  • Past history and PMAFTOSA- 

    • Sexual history

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • None

  • Treatment 

    • Fusidic acid topical 2-3 times a day

    • General measures

      • Avoid scratching

      • Hygiene

      • Very contagious 

      • Avoid sex, contact

  • Warning signs

    • Fever, increasing lesions 

• Syphilis

  • Other presenting symptoms- 

    • Rash on genital area (single, painless)

    • Dysuria

    • Groin swelling

    • Lymph node enlargement

    • Fever

  • Past history and PMAFTOSA- 

    • Sexual history

  • Social

    • 
      

  • Exam and Invs

    • GPE, vitals

    • General examination

    • Groin examination

    • LN examination

    • Chest examination

    • Lesion swab

    • Screening for other STIs (offer)

  • Referral 

    • GUM clinic

  • Treatment 

    • Antibiotics

    • Avoid sex till treatment complete

    • Safe sex

    • Partner notification program

  • Warning signs

    • Headache, dizziness, chest pain, SOB

• Genital warts

  • Other presenting symptoms- 

    • Multiple painless swellings

  • Past history and PMAFTOSA- 

    • Sexual history

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • General examination

    • Groin examination

    • LN examination

  • Referral 

    • GUM clinic

  • Treatment 

    • Topical cream

    • cryotherapy/excision

  • Warning signs- 

    • Discharge, Pain, fever

• Genital herpes

  • Other presenting symptoms- 

    • Multiple painful ulcers

    • Dysuria, discharge

    • Fever, flu-like illness

  • Past history and PMAFTOSA- 

    • Sexual history

    • Pregnancy history (Important)

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • General examination

    • Groin examination

    • LN examination

  • Referral 

    • GUM clinic

  • Treatment 

    • Painkillers

    • Topical anaesthesia

    • Plenty of fluids

    • Acyclovir in immunocompromised and in pregnancy 

  • Warning signs- 

    • Avoid sex till treatment complete

    • Safe sex

    • Partner notification program

• Herpetic Whitlow

  • Other presenting symptoms- 

    • No history of injury.

    • Current or recent oral or genital herpetic lesions (e.g. cold sores)

    • pain and paraesthesia of the affected finger.

    • oedema, redness, and localized tenderness of the infected finger 

    • A previous history of herpetic whitlow 

    • Presence of vesicles or blisters.

  • Past history and PMAFTOSA- 

    • Immunocompromised?

    • Sexual history

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • Finger examination

    • Groin examination if any ulcers

  • Referral 

    • None

  • Treatment 

    • Acyclovir if presented within 48 hours of onset

  • Warning signs- 

    • Infection gets worse or develops fever

• Intertrigo

  • Other presenting symptoms- 

    • Uniformly red without central clearing or scale

    • Under both breasts

    • mechanical causes (moisture, friction, heat), 

    • commonly associated with superimposed infection (candida or bacterial).

  • Past history and PMAFTOSA- 

    • 
      

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Breast examination

    • Head-to-toe examination

  • Referral 

    • none

  • Treatment 

    • Clotrimazole cream

    • Hydrocortisone cream

    • General measures

      • Avoid scratching

      • Hygiene

      • Loose clothes

  • Warning signs- 

    • Follow up after 7 days if not improved

    • Fever, feeling unwell

• Psoriasis

  • Other presenting symptoms- 

    • Distribution - symmetrical, extensor surfaces (elbows and knees), trunk, flexures, sacral and natal cleft, scalp and behind the ears, and umbilicus.

    • Silvery Scales

    • joints or nail involvement

    • Auspitz's sign - if the scale is gently removed, a glossy red membrane with pinpoint bleeding points is revealed.

    • Triggers - stress, smoking, alcohol, infections, drugs (including steroid withdrawal), UV light exposure, injury to skin, hormonal changes

  • Past history and PMAFTOSA- 

    • 
      

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • Dermatology routine

  • Treatment 

    • Symptomatic treatment

      • Emollients

      • Steroid and Vitamin D preparations

      • Smoking cessation

      • Stress management

  • Warning signs- 

    • Joint involvement (psoriatic arthritis)

    • Steroid side effects

• Eczema in a 15 yr old

  • Other presenting symptoms- 

    • Flexor aspects 

    • History of asthma usually

  • Past history and PMAFTOSA- 

    • Asthma

    • Previous similar episodes

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • 
      

  • Treatment 

    • Emollients

    • General measures

  • Warning signs- 

    • Swelling of the face, wheeze

    • psychological issues

    • any redness, oozing and crusting of the skin, high fever (bacterial infection)

• Molloscum Contagiosum 

  • Other presenting symptoms- 

    • Dome-shaped, central depression (umbilication), trunk and folds (knee, armpit, groin)

  • Past history and PMAFTOSA- 

    • contact history.

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • None

  • Treatment 

    • Self-limiting

    • General measures:

      • Keep dry

      • Avoid contact

      • Avoid scratching

  • Warning signs

    • Increasing or painful 

• Erythema Nodosum

  • Other presenting symptoms- 

    • Painful, red, hot nodules and plaques on the shins/knees/ankles,

    • Symmetrical, not well demarcated, typically 15-45 years old

    • Common causes (idiopathic, streptococcal infections, sarcoidosis, medications: antibiotics / NSAIDs / COCP, pregnancy, IBD).

• Past history and PMAFTOSA- 

  • 
    

• Social-

  • Confidence and self esteem

  • Psychological issues

• Exam and Invs

  • GPE, vitals

  • Lesion examination

  • CVS, RS, CNS, abdomen examination

  • Routine bloods

  • Calcium/ACE level (sarcoid)

  • ASO titre, throat culture (strep)

  • CXR (sarcoid, TB, mycoplasma)

  • Fecal calprotectin (IBD)

• Referral 

  • Specialist if not idiopathic

• Treatment 

  • Self-limiting if idiopathic

• Warning signs- 

  • Follow up with results in 1-2 weeks

  • Fever, cough

  • Increasing nodules or pain

  • Bowel symptoms

• Folliculitis

  • Other presenting symptoms- 

    • Clusters of red/yellow pimples

    • Recent wax/shaving history

  • Past history and PMAFTOSA- 

    • Sexual history

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Groin examination

    • Inguinal lymph node examination

  • Referral 

    • None

  • Treatment 

    • Emollients

    • Hygiene

    • Self-care measures

      • Clean razor

      • Apply after-shave

      • Lubricate skin when shaving

  • Warning signs- 

    • Increasing pain, number or high fever

• Cat Bite

  • Other presenting symptoms- 

    • 
      

  • Past history and PMAFTOSA- 

    • Vaccination history:

      • Tetanus 

      • Rabies

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals 

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • None

  • Treatment 

    • Pain relief

    • Clean wound

    • Tetanus (if not given within last 10 years)

    • Rabies (ask senior)

    • Co-amoxiclav for 3 days

  • Warning signs- 

    • Signs of infection

• Ringworm

  • Other presenting symptoms- 

    • Itchy, red, round lesion

    • Contact history might be there

  • Past history and PMAFTOSA- 

    • 
      

  • Social-

    • Confidence and self esteem

    • Psychological issues

  • Exam and Invs

    • GPE, vitals

  • Referral 

    • none

  • Treatment 

    • Topical antifungal cream (clotrimazole)

    • General measures:

      • Keep dry

      • Avoid contact

      • Avoid scratching

  • Warning signs- 

    • Fever, worsening symptoms

• Heat-related Urticaria 

  • Other presenting symptoms- 

    • Pinkish rash

    • Itchy

    • Trigger (Hot shower/Sun exposure)

  • Past history and PMAFTOSA- 

    • Atopy/allergy history

    • Vaccination history

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • None

  • Treatment 

    • Self-limiting

    • Rash diary for triggers

  • Warning signs- 

    • Fever, swelling of the face, wheeze

• Scabies in 5yr old (343) | 

  • Other presenting symptoms- 

    • Rash between fingers

    • Recent camping history

  • Past history and PMAFTOSA- 

    • Atopy/allergy history

    • Vaccination history

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • None

  • Treatment 

    • 5% permethrin

      • Apply on whole body

      • Dont apply after a hot bath

      • Allow cream to dry before putting on clothes

    • Treat all household members and contacts even if asymptomatic

    • Decontaminate bedding and stuff

  • Warning signs- 

    • If itching lasts longer than 4 weeks

    • High fever

• Ingrown toenail / acute paronychia (infected ingrown toenail)

  • Other presenting symptoms- 

    • Big toe commonly involved

    • Trauma/tight shoes/improper grooming

    • Pus maybe present if paronychia

  • Past history and PMAFTOSA- 

    • Rule out Gout history (previous episodes/ alcohol history/ family history)

    • Rule out diabetes (can worsen if has diabetic neuropathy)

  • Social-

    • 
      

  • Exam and Invs

    • GPE, vitals

    • Lesion examination

    • Head-to-toe examination

  • Referral 

    • Podiatrist if badly ingrown toenail

  • Treatment 

    • Self-care measures

      • Hygiene

      • Proper technique of cutting toenails

    • Topical/Oral antibiotics if paronychia

  • Warning signs