www.emergencyone.com.au
A 4 year old child presents with a fine macular papular rash confined to the torso with concurrent lethargy and fevers around 39-40 degrees Celsius. The rash feels sand papery to touch. It is blanching. It does not extend to his face, although his face (with the exception of his mouth) appears flushed. The rash is pruritic.
He has a non productive cough. Two days previously he complained of a sore throat. No one else in his family or contact group has been sick.
1-What is your leading diagnosis/diagnoses?
2-In/on which body part might your expect to see a sign to help confirm your diagnosis?
3-What sign would you expect to see?
This is a true account of a patient I recently saw and is reproduced with permission of the parents.
The practice of medicine requires the doctor to collect information (history and examination); discriminate between relevant and non-relevant information; formulate a hypothesis (a differential diagnosis) test the hypothesis (ordering tests, eliciting signs) and then either arrive at a diagnosis or adjust the hypothesis.
Childhood xanthems are my favourite demonstration of this process. They often vary only subtly and the diagnosis is often in the details. The study of medicine requires the acquisition of facts by reading. In this case, the study of childhood xanthems will make certain of the above key words stand out. The process of reasoning then allows the doctor to formulate a hypothesis, seek proof of this hypothesis and favor one diagnosis over another.
The GAMSAT is no different. The study of science is essential to understand the vignette. The practice of reason is what imbues in the candidate the ability to selectively discriminate, logically derive or creatively solve the problem posed by each question.
Feel free to post your answers below. I will reveal the answer in the coming days.
Cheers
David
www.emergencyone.com.au
In my opinion this could be Measles.
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