December 15th, 2012
We asked you about the treatment to this skin rash… and the answer is….
a. Coal Tar
This is the classic salmon pink rash of psoriasis. You can see the surface has a scaly appearance.
As the rash in psoriasis is palpable and spread over an area of >0.5cm it is called a plaque not a macule – (If it was an impalpable area of colour change it would be called a patch).
Skin psoriasis is treated by emmollients, vitamin D analogues, coal tars, dithranol, topical steroids and oral retinoids. Methotrexate and Anti TNF therapy in addition to other immune modulating therapies are used in severe cases. Remember the four main types:
- plaque (seen here)
- pustular (pustules often occuring on the hands and feet)
- guttate ( teardrop lesions -sometimes occuring following a streptococcal infection)
- erythrodermic (diffuse skin involvement – potentially lifethreatening)
Capsaicin is a Rubefacient: a topical skin irritant. Its use is based on the principle that irritation of the skin produces a “distracting” effect from the pain from OA/ neuropathy (e.g. post herpetic neuralgia).
It is used topically for osteoarthritis and neuropathic pain.
Capsaican is the “active” ingredient in chillies which gives them their heat. Its use over a rash like psoriasis would be liable to produce excruciating pain and significant inflammation.
December 12th, 2012
“It was horrible”- emerging consensus on the Situational Judgement Test sat by medical students for the UK Foundation Programme
Photo by clemsonunivlibraryIn December, the long nights and cold mornings make things tough for medical students on their way to clinical placements. Friday the 7th of December was no exception as the first round of the Situational Judgement Test (SJT) rolled out across the UK for medical students. The SJT is used to help to rank the job applications of thousands of medical students qualifying to be doctors in 2013.
So what was the verdict on the new assessment? Our own contact with students suggests two key themes: question difficulty and time pressure. This left many students struggling to cope with the time pressure, grasping for answers, and filling out the final questions without reading them in detail.
“It was horrible”
Recurring comments include long stems, long answers, and similar question responses making things difficult. As some students turned to the range of revision resources available, no single source seems to have provided all of the answers. A writer who has produced situational judgement tests for MedicalEducator gave her thoughts.
“It’s not surprising that the SJT proved a tough task for medical students. A new assessment, with one question every two minutes seems tight for what are detailed scenarios. For some students it will be relief that the SJT round is over, for the second half of UK medical students, at least they know what to expect- a difficult, time pressured assessment.”
The second round of SJTs will take place in January 2013. MedicalEducator has authored a range of situational judgement tests for the MPS, which are freely available to all members of the MPS. Just sat the SJT? Give us your verdict below!
November 22nd, 2012
Look at this skin rash. It measures 6cm in length and is occurring over the extensor aspect of the upper forearm.
Which of the following treatments is likely to result in the resolution of the rash?
a. Coal Tar
d. Topical ibuprofen
e. Topical capsaicin
Leave your answers as a comment below! Answer in a few days…
October 15th, 2012
We asked you about this 27 year old female who presented with a 3-day headache. After looking at her lumbar puncture results, the diagnosis is….
a. Benign Intracranial Hypertension
The pressure is very high! The CT was normal essentially excluding raised intracranial pressure secondary to an obstructive hydrocephalus (e.g. meningioma obstructing the 4th ventricle draining CSF). The red cells are high in the first sample of CSF but as further CSF is tapped off, this clears. This supports a slightly “traumatic” tap. Xanthochromia testing in the sample is negative, providing no evidence of a prior bleed into the CSF which has then been broken down into xanthochromia.
To diagnose a S.A.H. you have to have either blood or altered blood in the CSF. As a rule of thumb you should have “no” red cells in the CSF if its not a traumatic tap and there is no other pathological processes.
The diagnosis is BIH. This is reasonably common in young people and is not benign: untreated it can threaten sight. Treatment is via means to reduce CSF pressure e.g. repeated lumbar punctures.
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September 29th, 2012
A 27 year old female presents with a headache. She has had it for 3 days. She has no other symptoms. She has a normal CT brain.
Her lumbar puncture shows the following.
|CSF Opening Pressure (10-20cm H20)
|Bottle 1Bottle 3
||RBC 150 mm3, WCC 0mm3RBC 0mm3,WCC 0mm3
What is the most likely diagnosis?
a. Benign Intracranial Hypertension
b. Tension headache with traumatic Lumbar Puncture
c. Sub arachnoid haemarrage missed on CT
e. Sub Arachnoid Haemorrage
f. TB Meningitis
Leave your answer below!