Happy New Year and the problem with scarlet fever

http://www.emergencyone.com.au/

Hello to all of our followers

We trust that you had a fantastic Christmas and a Happy New Year. We wish you all the very best for your personal and professional endeavours in 2012.

In answer to our "What's the Diagnosis?" post, the answer is, scarlet fever! The give-away is the sand paper like rash and as predicted, putting this single search term into Google gives the answer.

To recap:
-4 year old child
-febrile
-sand-papery rash confined to torso
-flushed face with pale mouth
-complained of sore throat 2 days prior

What is your leading diagnosis/diagnoses?
Based on this information, the leading diagnosis is scarlet fever. Differential diagnoses include erythema infectiosum (slapped cheek), rubella and measles. The distribution of the rash and lack of rash on the face tend to refute rubella and measles.

In/on which body part might your expect to see a sign to help confirm your diagnosis?In the mouth.

What sign would you expect to see?In this case the child had mild pharyngitis and a desquamating white coating on the tongue. Over the following days this coating shed to reveal the 'strawberry tongue' (a red tongue with prominent papillae) typical of scarlet fever.

The child recovered uneventfully with a brief course of penicillin. While the study of xanthems is standard medical school education, scarlet fever has become relatively rare. It's not uncommon for clinicians to spend an entire career having never seen a case. It remains highly prevalent in developing nations and indigenous Australian communities.

Rather what makes it an ideal case study for our purposes is its analogy to the GAMSAT.

Read the question=take a history
Identify the keywords=identify the key features of the disease
Discriminate=discard irrelevant information
Identify the most likely answer=formulate a hypothesis
Exclude other answers=exclude differentials
Pick the answer=test the diagnosis

While the GAMSAT may seem like a set of irrelevant questions, it aims to test the skills (as opposed to the knowledge) necessary in doctors. Interestingly it has been demonstrated that good performance in the GAMSAT does not correlate with good performance in medical school, 1, 2. So as to whether or not the GAMSAT is a GOOD test of the qualities needed in doctors I won't speculate. Because ultimately, GAMSAT is the reality of admission into graduate medicine in Australia and as an aspiring medical student, the mastery of this exam is your goal.

Good luck for your preparations people!!

http://www.emergencyone.com.au/