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Family medicine training ideas from Belgium.

Medpharm Publications
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Prof DS Rossouw, MBChB, MMed(Int), D Phil Prof J H Retief, MBChB, MMed(Int), MSc(Clin Epid) Department of Internal Medicine, Kalafong Hospital, Faculty of Health Sciences, University of Pretoria Correspondence to authors: [email protected] Contributions to this column: E-mail: [email protected], Fax (012) 664 6276 or P.O. Box 14804, Lyttelton Manor 0157. This column is aimed at developing your clinical acumen. A clinical quiz will alternate with a short discussion of a clinical sign. You are invited to send us requests for future topics and to provide photographs of clinical signs for the quiz section. Kindly send a fax or e-mail with your requests and mail high gloss photographs or a disk with high resolution (300dpi) jpeg files to us. (See contact details above) Photographs may include clinical signs, photographs of poisonous insects, plants, snakes, contaminated water or anything that may cause sickness or disease in South Africa. Kindly provide a short clinical synopsis of 100-200 words from which a quiz can be formulated. This intensely itchy lesion appeared on a 65 year old patient’s toe, six days after spending a week on the golden beaches of neighbouring Mozambique. What may be the cause? Unlikely causes: •Ingrowing toe nail (septic paronychium)? Big toe usually affected. •Acute gout ? Not likely at age 65 for a first attack, and also more likely to affect the big toe. •Trauma ? The patient would most likely be aware of some incident. •Larva migrans (creeping eruption)? More likely, but wrong again. Because dogs are not forbidden from beaches, canine hookworm larvae from dog excreta are often found in the sand. As the name creeping eruption implies, one would expect an inflamed red track of the larva, instead of a single round lesion as seen here. (See picture) With more South Africans visiting tropical destinations, other possibilities will have to be considered as well. Tunga penetrans Also called sand flea infestation, this tiny blood-sucking

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