Pregnancy and Epilepsy

1.Epilepsy does not carry an
increased risk of miscarriage or
obstetric complications per se.
2. A single fit during pregnancy is
unlikely to impose any risk to the fetus
nor is pregnancy associated
with an increased risk of seizures.
3. Most anti-epileptic drugs are asssociated
with incresed adverse outcome
4.Main culprit is Sodium Valproate.

Pregnancy Facts

Child-bearing years span
almost four decades, giving
the GP ample opportunity to
educate and prepare women
for pregnancy.
■ 70-90% of women with
bipolar disease and 60% of
those with major depression
will relapse if psychotropic
medication is ceased in
pregnancy.
■ It is recommended that the
HbA1c be maintained at ≤6 in
women with diabetes before
and during pregnancy.
■ Maternal perinatal depression
is a risk factor for premature
birth, reduced foetal growth ,PET, poor neonatal bonding
and longer-term neurodevelopmental
problems.
■ Although there is no
established safe level of
alcohol, 10-15% of women
continue to drink throughout

Diabetes facts

■ Lifestyle interventions can
prevent or delay diabetes in
half the people who have IGT.
■ Begin risk assessment at age
40, or age 18 in Aboriginal
and Torres Strait Islanders.
■ AUSDRISK may overestimate
risk in those under 25 years of
age and underestimate risk in
Aboriginal and Torres Strait
Islanders.
■ The risk of developing type 2
diabetes increases by 10-20
times in people with IFG or
IGT.
■ 41% of type 2 diabetes
patients and 76% of type 2
diabetes patients who are not
using insulin never check their
BGLs.
■ Only strategies that increase
an individual’s skills while
providing a supportive
environment can produce
sustainable lifestyle changes.

Fasting Plasma Glucose Interpretation.

Interpretation of fasting
plasma glucose


1.FPG < 5.5mmol/L
• diabetes unlikely
• retest after three years



2.FPG ≥ 7mmol/L
• diabetes likely
• repeat FPG unless diagnosis
unequivocal


3.FPG 5.5-6.9mmol/L
• diabetes possible
• perform oral GTT
• retest annually

DOCTOR LOCUM JOBS AUSTRALIA

LOCUM OPPORTUNITIES AVAILABLE AUSTRALIA WIDE
(added 23-Sep-2009)
For GPs and specialists. Excellent Rates. Registration required.
Contact: Skilled Medical Consultants Ph: 1300 900 100. Email: enquiries@skilledmedical.com

MEDICAL INSURANCE

WHAT IS THE IMPORTANCE OF MEDICAL INSURANCE?
WHAT IS INDEMNITY INSURANCE?
WHAT IS THE BASIC COVER AND WHEN IS THE EFFECTIVE DATE.?
WHETHER IT IS IN FORCE RETROSPECTIVELY?
WHAT IS THE COVER YOU CAN GET?

SKIN CARE ADVISE FOR PATIENTS WITH LYMPHOEDEMA.

1. Keep the skin supple using a non-perfumed moisturising cream such as sorbolene.
2. Avoid drying out your skin and consider using a soap-free alternative.
3. Clean any scratches, grazes or cuts immediately using an antiseptic solution,
use an antibacterial cream and cover the area with a clean, dry plaster.
4.Use an electric razor for shaving instead of a wet razor.
5.Avoid tattoos and body piercing.
6. Consider ways to protect the skin, such as wearing gloves while washing dishes,
gardening or handling pets.

How to treat elbow dislocation.

1.In complex elbow dislocation,
the most common fractures are
to the radial head followed by
fracture of the coronoid process
of the ulna.
2.The force needed to cause
dislocation in an adult is more
likely to cause a supracondylar
fracture of the distal humerus
in a child – however, the elbow
is the most frequently
dislocated joint in children.
3.Spontaneous reduction of a
dislocated elbow is common in
children – look for an avulsed
medial epicondyle.
4. Post-reduction radiographs
should be taken in at least two
planes to confirm that the joint
is well reduced.

SHOULDER DISLOCATION IMPORTANT POINTS

Before any attempted
investigations or reduction
procedures, always document
the neurological and vascular
status of the arm.

OSTEOPOROSIS DIAGNOSIS

WHAT IS GOLD STANDARD?


Dual energy X-ray absorptiometry
(DXA) is the gold standard for diagnosis
of osteoporosis.

BUT DXA IS NOT ESSENTIAL TO START TREATMENT

.

WHAT ARE THE ANTI-OSTEOPOROTIC THERAPIES AVAILABLE

A Little Death In Dixie1.CALCIUM AND VITAMIN D SUPPLEMENTATION
2.BISPHOPHONATES-?ACTIVE UPPER GI DISORDERS ARE CONTRAINDICATIONS
3.HORMONE THERAPY-?RISK OF THROMBOEMBOLISM
4.PARATHYROID HORMONE
5.SELECTIVE OESTROGEN RECEPTOR MODULATORS(SERM)-RISH SIMILAR TO HORMONE THERAPY(BUT REDUCES BREAST CANCER)
6.STRONTIUM RANELATE.

OSTEOPOROSIS IMPORTANT POINTS

Osteoporosis is an A Little Death In Dixieasymptomatic process until afracture occurs.



■ Adults who have one fracture
are 2-4 times more likely to
have another.
■ Bone densitometry may not be
essential before starting
medical therapy if X-ray
investigation shows one or
more vertebral fractures typical
of osteoporosis.
■ Most elderly people in highand
low-level residency care
have vitamin D deficiency.

Renal calculi -Important points

http://amcexams.blogspot.com/?spref=gb


■ Abdominal examination is
most rewarding after ensuring
adequate analgesia.
■ Plain KUB has a sensitivity of
only 45-59% and a specificity
as low as 77% – it cannot be
used to rule in or rule out the
diagnosis of ureteric calculi.
■ Infection with obstruction
mandates urgent
decompression.
■ There is evidence of
permanent nephron loss within
72 hours of complete
obstruction.
■ The likelihood of spontaneous
stone passage is determined
by stone size and position.
■ Fifteen to twenty per cent of
all patients with ureteric
calculi will require intervention
using ESWL, ureteroscopy or
percutaneous nephrolithotomy.

Renal calculi -indictions for early intervention

1.Obstruction with evidence of infection-urgent decompression.
2.larger calculi -more than 6mm
3.Bilateral obstruction.
4.An obstructed solitary or transplanted kidney.
5.Renal impairment.(review the definition of renal impairment)
6.Ongoing unacceptable discomfort.

Haematuria

Haematuria

(usually
microscopic but sometimes
frank)
occurs in 95% of
patients with renal colic on day
one and 65% by day three,
but
up to 87% of patients with
AAA rupture will also have
haematuria.

TINNITUS IMPORTANT POINTS

■ Tuning fork testing is especially
important when otoscopy and
systemic examinations are
unremarkable.
■ It is vital to recognise the
possible causes of seemingly
innocuous tinnitus (especially
sudden onset) and institute
early appropriate treatment.
■ There is great variation in how
people react to tinnitus –
some cope well with little
disturbance while others feel
anxious or depressed.
■ Treating underlying anxiety
and depression improves
outcomes.
■ Many patients report their
tinnitus-related stress started
when their doctor told them
“nothing could be done”.
■ Most people will habituate
naturally to tinnitus, as long
as they regard the sound as
meaningless.

GRADING OF BURNS AND HF ACID BUURNS

sKIN burns can be graded into three categories.
Grade 1 has redness or white marking only,
grade 2 has oedema and blistering and grade 3 burns are associated with necrosis.
HF acid burns Appearance
Grade 1 white burn mark and/or erythema and pain
Grade 2 white burn mark and/or erythema and pain
PLUS oedema and blistering
Grade 3 white burn mark and/or erythema and pain
PLUS oedema and blistering
PLUS necrosis

SHOULDER DISLOCATION IMPORTANT POINTS

There is no clear consensus on
the best management, surgical
or conservative, for first-time
anterior shoulder dislocation.
■ Always perform a thorough
examination before any
attempt at reduction and
document the neurovascular
status of the arm, in particular
the function of the axillary and
musculocutaneous nerves.
■ Plain X-rays should include
an antero-posterior view, a ‘Y’
lateral view and either an
axillary or a Garth view.
■ Recurrence rates are lowest in
patients who wear a sling for SIX WEEKS

STROKE iMPORTANT POINTS

A.Intervention for acute stroke is
most potent when applied as
close to the time of stroke
onset as possible.
B. High-risk TIAs can be
predicted and should be
investigated and managed
with the same urgency as
acute stroke.
C. Differentiating between
infarction and haemorrhagic
stroke on clinical grounds is
poor, even among experienced
clinicians. Acute imaging
(usually by CT) is essential to
direct ongoing management.
D. Thrombolysis with tPA for
acute ischaemic stroke up to
4.5 hours from symptom onset
is now the standard level of
care in units which have
stroke management expertise.
E. Admission to a stroke unit for
all stroke subtypes increases
the chance of functional
outcome and decreases
disability.

TIA RISK ASSESSMENT : ABCD SCORE!

Risk Score
A Age >60 years 1 point
B Blood pressure >140/90 1 point
C Clinical unilateral weakness 2 points
Speech disturbance without weakness 1 point
Other 0 points
D Duration >60 min 2 points
10-60 min 1 point
<10 min 0 points D Diabetes 1 point 0-3 points = low risk
4-5 points = moderate risk
6-7 points = high risk
(Maximum score 7 points)

HEALTH INSURANCE

NEVER DELAY A SINGLE DAY BEFORE YOU GET A HEALTH INSURANCE AND INCOME PROTECTION INSURANCE IF NOT LIFE INSURANCE WHEN YOU ARRIVE IN AUSTRALIA.THERE ARE MANY OPTION TO SELECT FROM.JUST ASK A COLLEGE THAT IS THE BEST WAY.DON'T GO BY ADVERTISEMENTS.AL THE BEST.

Acne Differential Diagnosis

Acne is a clinical diagnosis;
however, it is important to
consider the following differential
diagnoses:

• Rosacea.
• Perioral dermatitis.
• Acneiform drug eruption.
• Folliculitis on the trunk.

ACNE IMPORTANT POINTS.

ACNE IMPORTANT POINT IN HISTORY AND EXAMINATION.

History

• How long have you had
pimples for?
• Are there any triggers?
• Is there a family history?
• What treatments have you
had? How long did you
follow each treatment?
• What was the most
effective treatment? Why
did you stop it?
• How do you feel about
your skin? Does it stop
you from doing anything?

Examination

• Assess the severity and
whether there is any
scarring.
• Determine any
psychological impact.

HEALTH INSURANCE

HEALTH INSURANCE IS ONE OF THE MOST IMPORTANT THING YOU NEED TO HAVE WHEN YOU ARRIVE IN AUSTRALIA.IT IS A MUST I WOULD SAY.THERE ARE MANY OPTIONS TO SELECT FROM

HOW TO USE EPIPEN IN ANAPHYLAXIS

Auto-injectors (epi-pens) for anaphylaxis - an overview

Anaphylaxis is the most severe form of an allergic reaction and is life threatening. A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline injection (EpiPenﾮ/EpiPenﾮJr). An important aspect of anaphylaxis management is prevention and avoidance of the cause.

Please read Factsheet: Allergic and anaphylactic reactions.

Signs and symptoms of a severe allergic reaction (Anaphylaxis)
Anaphylaxis is the term used to describe a severe, systemic allergic reaction that involves the respiratory and/or cardiovascular systems. Presentation of any of these symptoms, in addition to one or more of the above symptoms of a mild-moderate allergic reaction, indicates anaphylaxis:

Difficulty/noisy breathing
Swelling of tongue
Swelling/tightness in throat
Difficulty talking and/or hoarse voice
Loss of consciousness and/or collapse
Pale and floppy (infants/young children)
Treatment
The first line treatment for anaphylaxis is adrenaline, which may be given as an EpiPenﾮ injection for children weighing 20 kgs or more, or EpiPenﾮJr for children weighing less than 20kgs. An EpiPenﾮ/EpiPenﾮJr is a single dose auto-injector of adrenaline, which is prescribed by a doctor.

If a child has a history of anaphylaxis, and/or an EpiPenﾮ/EpiPenﾮJr, the following recommendations should be considered:

Each child who has been prescribed an EpiPenﾮ/EpiPenﾮJr requires an Anaphylaxis Action Plan, completed by a doctor.
The Anaphylaxis Action Plan should be provided to the school or child care centre by the parents, together with the EpiPenﾮ/EpiPenﾮJr.
Employers should support staff training, so that all staff can recognise an allergic reaction and be able to administer an EpiPenﾮ/EpiPenﾮJr appropriately.
If a reaction is suspected, the Anaphylaxis Action Plan should be followed.
If an EpiPenﾮ/EpiPenﾮJr is given, an ambulance must be requested by phoning 000.
Excursions and Camps
The Departments of Education and Early Childhood Development have clear guidelines for taking children on excursions and camps. Schools and children's services must read these guidelines prior to going on any excursions or camps.

The EpiPenﾮ/EpiPenﾮJr should be taken on all excursions and a staff member trained to use the EpiPenﾮ/EpiPenﾮJr must always be present. The EpiPenﾮ/EpiPenﾮJr must always be readily accessible.

Care of the EpiPenﾮ/EpiPenﾮJr:
Clearly label storage container with child's name.
Check expiry date regularly.
Store at room temperature.
Store in a safe, easily accessible location.
A copy of the Anaphylaxis Action Plan should be stored with the EpiPenﾮ/EpiPenﾮJr. This contains contact details for parents/guardians and medical services.

ALLERGY AND ANAPHYLAXIS IN CHILDREN-DIAGNOSIS AND TREATMENT

Allergic and anaphylactic reactions




Allergic reactions occur when the immune system reacts to something in the environment that is normally harmless: e.g. food proteins, pollens or dust mites. Symptoms may be localised or generalised and range from mild to severe.

The most common causes of allergy in children are milk, eggs, peanuts, tree nuts, cow milk, soy, wheat, fish and shellfish. Other causes are bee or other insect bites, some medications and latex (rubber).

Anaphylaxis is the most severe form of an allergic reaction and is life threatening. Rates of anaphylaxis are not well documented, but are estimated at approximately 5 in every 1000 school children.

A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline injection (EpiPen®/EpiPen®Jr). An important aspect of anaphylaxis management is prevention and avoidance of the cause.

Signs and symptoms


Mild to moderate allergic reaction
A reaction will include one or more of these symptoms, and it is possible that a number of them will happen at the same time:

Hives or welts (a red, lumpy rash, like mosquito bites).
A tingling feeling in or around the mouth
Abdominal pain, vomiting and/or diarrhoea
Facial swelling
Severe allergic reaction (Anaphylaxis)
This term is used to describe a severe allergic reaction that involves breathing and/or heart and blood. Any of these symptoms, as well as one or more of the above symptoms of a mild-moderate allergic reaction, indicates anaphylaxis:

Difficulty/noisy breathing
Swelling of tongue
Swelling/tightness in throat
Difficulty talking and/or hoarse voice
Loss of consciousness and/or collapse
Pale and floppy (infants/young children)




Prevention




Preventing an allergic reaction or anaphylaxis is most important.

Know and avoid the causes.
Do not allow food sharing or swapping.
Only give foods approved by the parents.
Use non-food treats where possible, but if food treats are used in class, give only those provided by the parents. (Encourage parents to provide a container of safe treats from home).
Practise routine hygiene and good food safety practices. Children and staff should always wash their hands after play and before eating.
Banning of products:
Banning of products that contain the allergen is NOT recommended.

Banning will not succeed in creating an "allergy free zone". It is difficult to achieve a 100% ban, for a variety of reasons. For example, product labels can be confusing, parents of non-allergic children may not comply with the ban, and lastly, staff and students can become complacent.

Food sharing:
Food sharing between children at risk of anaphylaxis should be completely avoided. These children must only have food provided from home or given with the parent's permission.

Food preparation:
Any staff, including relief staff, who are responsible for cooking or delivering food to children should know about the child's allergies. They should be aware of alternative words used to describe the particular allergy food. For example, cow milk may be called casein, and egg may be called ovalbumin. They should also be aware of contamination of other foods when preparing, handling or displaying food.

Art/craft:
Food containers or packages that contain the allergy food should not be used. Parents of children with anaphylaxis can help by checking art/craft products for hidden ingredients, as they are often more aware of terms used.

Separate tables should be used for art/craft and food. Where this is not possible, tables must be cleaned thoroughly between uses.

Excursions
The EpiPen®/EpiPen®Jr must be taken on all excursions and a staff member trained to use the EpiPen®/EpiPen®Jr must always be present. The EpiPen®/EpiPen®Jr must always be readily accessible.

Treatment
The first line treatment for anaphylaxis is adrenaline, which may be given as an EpiPen® injection. Please read the factsheet on Epi-pens for anaphylaxis - an overview.

If a child has had a history of anaphylaxis, an EpiPen®/EpiPen®Jr should be prescribed for the treatment or future episodes. Indications for prescribing an EpiPen®/EpiPen®Jr , can be found at Australasian Society of Clinical Immunology and Allergy (ASCIA). The following recommendations should be considered:

Each child who has been prescribed an EpiPen®/EpiPen®Jr needs an Anaphylaxis Action Plan, completed by a doctor.
If an EpiPen®/EpiPen®Jr is used, always call an ambulance by phoning 000.

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CERVICAL CANCER-IMPORTANT POINTS

■ A systematic approach to screening well women has contributed to a decline in incidence and
mortality from cervical cancer in Australia.
■ There is still room to improve participation in screening in Australia: older women and women
of low socioeconomic status are less likely to be adequately screened.
■ Indigenous women have not benefited from improvements in mortality through cervical cancer
screening.
■ Exposure to wart virus infection (HPV) is a normal part of sexual activity.
■ During the acute phase of infection, Pap smear show the changes of a low-grade squamous
cell abnormality.
■ Most women clear the HPV infection and the low-grade abnormality resolves.
■ Persistent infection with high-risk HPV subtypes carries
the possibility of developing high-grade squamous cell
abnormalities.
■ The new NHMRC guidelines on the Management of
Asymptomatic Women with Screen Detected
Abnormalities use evidence from the Pap smear
registries, new understandings of the epidemiology of
HPV and the revised terminology for cervical
cytology — the Australian Modified Bethesda
System 2004.
■ In women with a good screening history, only persisting
low-grade abnormalities require colposcopy.
■ Histologically confirmed low-grade lesions can be safely
monitored with repeat cytology at yearly intervals.
■ High-grade abnormalities continue to require colposcopic
assessment and treatment.
■ All glandular cell abnormalities require colposcopic
assessment and treatment.
■ For effective population screening, for any identified case,
the benefits of investigation and treatment need to outweigh
the risks of intervention and possible unnecessary treatment.
■ The safety of the new guidelines will be monitored using the
Pap test registries to detect any unexpected rise in the
incidence of cancer of the cervix.
■ GPs have a key role to play in recruiting women to screening