Clinical medicine (London, England)
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Psoriasis is a clinically heterogeneous lifelong skin disease that presents in multiple forms such as plaque, flexural, guttate, pustular or erythrodermic. An estimated 60 million people have psoriasis worldwide, with 1.52% of the general population affected in the UK. ⋯ Psoriasis treatments include topical agents (vitamin D analogues and corticosteroids), phototherapy (narrowband ultraviolet B radiation (NB-UVB) and psoralen and ultraviolet A radiation (PUVA)), standard systemic (methotrexate, ciclosporin and acitretin), biologic (tumour necrosis factor (TNF), interleukin (IL)-17 and IL-23 inhibitors) or small molecule inhibitor (dimethyl fumarate and apremilast) therapies. Advances in the understanding of its pathophysiology have led to development of highly effective and targeted treatments.
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Case Reports
Image of the month: An unusual cause of cough, stridor and dyspnoea: A giant aortic arch aneurysm.
A 78-year-old man with hypertension presented with dry cough and gradually progressive dyspnoea for 3 months. The patient had an audible stridor. Cardiovascular examination was unremarkable. ⋯ This case highlights an unusual presentation of a potentially lethal disease. Evaluation of patients presenting with cough and dyspnoea should not be restricted to respiratory diseases. The critical observations made from history.
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Infection rashes can present in a number of different ways, some giving a reactive pattern in the skin to infection elsewhere in the body, while others reflect infection within the affected skin itself. Recognising the possible systemic symptoms, characteristic distribution and morphology of rashes can lead to a high degree of accuracy in making a clinical diagnosis in the clinic room/at the bedside that can be confirmed with a few simple laboratory tests.
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A qualitative fit test using bitter-tasting aerosols is the commonest way to determine filtering face-piece (FFP) mask leakage. This taste test is subjective and biased by placebo. We propose a cheap, quantitative modification of the taste test by measuring the amount of fluorescein stained filter paper behind the mask using image analysis. ⋯ Fluorescein is detectable and sensitive at identifying FFP mask leaks. These low-cost adaptations can enhance exiting fit testing to determine 'pass' and 'fail' groups, protecting those who 'passed' the taste test but have high fluorescein leak, and reassuring those who 'failed' the taste test despite having little fluorescein leak.
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The annual review of competence progression (ARCP) is a high-stakes assessment which all UK postgraduate trainees undertake to ensure competence progression. Previous evaluations of the effectiveness of the ARCP as an assessment have reported deficiencies in both validity and reliability, however, there has been little focus on the educational impact of the ARCP. We conducted a mixed methods case study involving questionnaire, interviews and a focus group examining the impact of the ARCP on a respiratory higher specialist training programme. ⋯ Concerns were raised that the process promoted a reductionist approach to education. This research has resulted in several changes to local training, however, it has potential implications for the ARCP as a wider process. Trainers should be cognisant of the shortcomings of assessments and their impact on trainees, training and the future of the profession.