CLINICAL QUIZ

A patient presents complaining of a painless abnormality that has been slowly growing over the last six months

Q1. What action, if any, would you take?

Q2. What visible clinical feature suggests a malignancy?

Q2: What other clinical finding on examination would support malignancy?

Q3: Name two types of skin malignancy that could be present.

Q4: Which of the two has the better prognosis?

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ANSWERS TO CLINIC AL QUIZ JANUARY 2023

The winner is: Nicola Evans

Q1. A male patient, in his fifties, who you know from his social history to be a recovering alcoholic, attends after a few years gap for care under direct access arrangements. He brings a walkie-talkie into the treatment room which he reports is connected to a friend. The friend is in the waiting room and is highly critical of your advice and treatment plan to your reception team while your patient is paying He pays in cash that he has to ask the friend for, explaining that the friend takes care of his finances What action, if any, would you take?

A1. It would not be unusual for a friend of an alcoholic to monitor or have some control over their finances, as long there is consent. However, if you are concerned that this may not be the case then a discussion with the team and the practice safeguarding lead is appropriate A potential referral to the local adult safeguarding partnership if other members of the team share your concerns would be in order If no referral is made you should carefully document your reasons for not doing so

Q2. A child attends for routine preventive care. It has been several months since she had an examination, with several WNB annotations in her record and, you note, several new carious lesions. She has a large bruise on her cheek, which she claims to have sustained by walking into a door What does WNB stand for?

A2. Was Not Brought

Q3. What action, if any, would you take?

A3. Bruising on the soft tissue of the cheek is uncommon in an accident as injury tends to involve the bony prominences Gently ask the child about the injury and watch for evasiveness or inconsistencies Record your concerns carefully, preferably in a file separate to the clinical notes Record any injuries and record the child's own words about their injury. Discuss your concerns with the guardian, particularly regarding the deteriorating oral health and if the answers are unsatisfactory discuss with the practice safeguarding lead for a potential referral to the local children safeguarding partnership

Q4. As a practising clinician, what level of safeguarding training should you have attained and how often should you revisit that training?

A4. Level 2 - every 3 years