Online Clinical Case Study (March 2017)

Clinical Cardiology Series

The content of the March Cardiology Series is provided by:
Dr. WONG Chi Yuen
MBBS (HK), MRCP (UK), FHKCP, FHKAM (Medicine), Specialist in Cardiology
Dr. CHUI Shing Fung
MBChB (CUHK), MRCP (UK), FHKCP, FHKAM (Medicine), Specialist in Cardiology

A lady with missed heartbeat

A 48-year-old lady complained of palpitation and feeling of missed heartbeat. She visited her family doctor and was found to have blood pressure of 130/80 and pulse rate of 45 per minute by the office BP machine.

A 12-lead ECG is performed (Figure 1).

1. What is shown in the ECG?
A. Atrial fibrillation
B. Sinus bradycardia
C. Ventricular bigeminy
D. Complete heart block
E. Idioventricular rhythm
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What investigation(s) should be considered?
A. 24 hour holter monitoring
B. Echocardiogram
C. Exercise treadmill stress test
D. Electrolyte testing
E. All except D
F. All of the above

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This patient has structurally normal heart and normal ventricular function. What treatment option(s) could be considered?
A. Beta blocker
B. Calcium channel blocker
C. Anticoagulation therapy
D. Catheter ablation
E. All except C
F. All of the above

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1. C,2. F,3. E

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Dermatology Series 皮膚科病例研究

Dermatology Series for March 2017 is provided by:
Dr. KWAN Chi Keung, Dr. TANG Yuk Ming, William,
Dr. CHAN Hau Ngai, Kingsley, Dr. LEUNG Wai Yiu and Dr. CHANG Mee, Mimi
Specialists in Dermatology & Venereology

Long Standing Warty Growth

A 38 year-old gentleman complained enlargement of a long-standing warty growth lesion on left pre-auricular region. He claimed that the lesion was present since adolescence. However, the size of lesion seemed increase in recent half year. There was totally asymptomatic. Clinical examination revealed a pale brownish warty plaque on left pre-auricular region.


1. What are the differential diagnoses?
The differential diagnoses include wart, seborrheic keratosis, lichen simplex chronicus, verrucous epidermal naevus and naevus sebaceous.

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2. What is your diagnosis?
The diagnosis is naevus sebaceous.

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3. What investigation would you offer?
The diagnosis of naevus sebaceous is mainly from history and its characteristic clinical presentation and no investigation is required in usual situation. It is commonly found in head and neck region. The lesion is likely presented at birth as a solitary tan patch and then becomes warty in adolescence.

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4. What is the prognosis of this lesion?
It is a harmatoma including all skin malformation of epidermis, follicles, sebaceous glands and apocrine glands. Most of sebaceous naevus remain unchanged. However, another tumour may grow within the lesion, for example trichoblastoma, trichilemmoma, infundibular cyst, sebaceoma, eccrine poroma and syringocystadenoma papilliferum.

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5. How do you manage this gentleman?
Since most of lesion remain unchanged, regular monitoring for any change of the lesion is the principle of management. Recent studies suggested that basal cell carcinoma (BCC) and other carcinoma transformation may appear in around 1%. Therefore, biopsy or surgical excision may be warranted in case of suspected any change of lesion.

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