G’day guys, and welcome back to another installment of Diagnose This!
Last week we were introduced to the gentleman with the suspicious looking mole on his back. Hopefully you all concluded that it was a melanoma, a cancer of the melanocytes that commonly occurs on the skin. A good series of questions to ask would be the ABCDEFG questions: is there asymmetry? Are the borders irregular? What colour is it? What is the diameter? Has it been evolving over time? Is it firm to the touch? And finally, is it growing in size? These questions will help you determine if the mole is cancerous or not. Treatment for this depends on the staging of the cancer and the Breslow’s Depth (<1mm, 1-4mm, and >4mm being the three stages). I it has not metastasised then surgical excision with adjunct sentinel node biopsy should be done and chemotherapy for Stage III. However, if it has metastasised, the prognosis is not at all ideal and palliation is the overall goal rather than finding a cure.
So yeah, please remember to be SunSmart and keep that skin of yours nice and disease free… Which sounds like a Buffalo Bill kind of thing to say but yeah whatever.
Now, onto this week’s case:
A 2 year old girl is BIBA to the ED after appearing listless and spiking a fever at 40.2. Her parents say that she has deteriorated rapidly and has become practically unresponsive. On examination you discover this rash on her left leg:
Upon further questioning you discover that the parents do not believe in vaccination and as such have not vaccinated their daughter.
What are you concerned about in this patient? What test could you perform on this rash that could help determine the diagnosis? What investigations should you order? And finally, have these parents seriously injured or killed their daughter?
Find out next week on Diagnose This!
Since 1988, polio cases have decreased by over 99%! This could not have been possible without the introduction of the polio vaccine, so please, please, PLEASE vaccinate yourselves and your children.
Image credit: http://www.who.int/features/factfiles/immunization/en/