AMC EXAMS AUSTRALIA ,AUSTRALIAN MEDICAL EXAMS,MCQS,CLINICALS.

PSYCHIATRY 1.A lady with a previous divorce now comes to you with a seductive behaviour a. Narcistic b. Histrionic c. Borderline 2.In Australia bush fire are common either accidentally or some people lighting fire deliberately. Which is true regarding pyromaniacs? a. Done for notoriety or publicity b. To hide their acts c. As they like to play with fire d. Set fire and get panic attacks e. For satisfaction 3.Depersonalization may occur in a. Schizophrenia b. Ecstatic religious experience c. Depression d. Post traumatic disorder e. All of the above 4.A middle aged lady present to you with nausea dyspepsia abdominal distention. She had a past history of going to many doctors and being treated for many disorders. she has been treated by a rheumatologist for aches and pains, cardiologist for her palpitations and gave her propanolol without improvement , a neurologist for her epilepsy. On examination you find a tense anxious woman in spite of her daily dose of benzodiazepine. There are scar...

Fungal/yeast 1 Candida (oral or oesophageal) 2 Tinea infections (corporis, cruris, pedis, interdigitale etc) 3 Pityriasis versicolor 4 Seborrhoeic dermatitis (especially when severe or recalcitrant) 5 Pityrosporum folliculitis Viral 1 Herpes zoster 2 Herpes simplex 3 Viral wart infections 4 Molluscum contagiosum Bacterial 5 Staphylococcus aureusimpetigo, chronic folliculitis Mycobacterial 6 M tuberculosis Infestations 7 Scabies (especially Norwegian scabies) Other 1 Psoriasis 2 Kaposi’s sarcoma 3 Acne All of these skin conditions can occur without HIV, but consider HIV particularly if they are recalcitrant, recurrent or atypical.

Acute HIV-related conditions that may present in the emergency department 1. Community acquired bacterial pneumonia. People with HIV, regardless of their level of immunosuppression, are more at risk of bacterial pneumonia. They have similar signs and symptoms to the non-HIV-infected population, eg fever, cough, dyspnoea, increased respiratory rate and sputum production. 2. TB presents with malaise, weight loss, night sweats, fever, cough, sputum production (may be blood-stained), and lymphadenopathy. 3. Pneumocystis pneumonia (PCP) presents with exertional dyspnoea, fever, dry cough, normal auscultation. X-ray typically shows perihilar shadowing (ground glass haze), but may be normal. 4. Cryptococcal meningitis. This presents with headache, with or without classical signs of meningism. Occasionally rapid progression occurs, and the patient may present in coma. 5. Cerebral toxoplasmosis. This may present with headache, fever, lethargy and confusion, progressing to fits and coma.

Treatment of status epilepticus in hospital. 1.Immediate measures Secure airway Give oxygen Assess cardiac and respiratory function Secure iv access Give lorazepam 4 mg iv or diazepam 10 mg iv Repeat after 10 mins if no response 2.In hospital Take blood for electrolytes, LFT, calcium, glucose, clotting, AED levels and storage for later analysis Measure blood gases Establish aetiology Give thiamine or 50% glucose solution if indicated Within 30 minutes In patients with established epilepsy: give usual AED orally, NG or iv 3.In patients with new-onset epilepsy or if seizures continue: fosphenytoin (18 mg/kg phenytoin equivalent), up to 150 mg/min with ECG monitoring or phenytoin 18mg/kg, 50 mg/min with ECG or phenobarbital 15 mg/kg iv, 100 mg/min Longer than ITU may be necessary minutes Anaesthetise with EEG monitoring Midazolam, phenobarbital, propofol, or thiopentone most commonly used Non-convulsive status Augment or reinstate usual AEDs Consider ...

1.Haemophilus influenza -Smokers, COPD 2.Mycoplasma --------Young, otherwise healthy patients 3.Legionella --------Epidemic infection in older smokers, particularly when located near infected water sources, such as air-conditioning systems 4.Pneumocystis jiroveci (formerly carinii) pneumonia HIV-positive persons with 5.Coxiella burnetti (Q-fever) Exposure to animals, particularly at the time they are giving birth 6.Klebsiella Alcoholics 7.Staphylococcus aureus Following viral syndromes or viral bronchitis, especially influenza 8.Coccidioidomycosis Exposure to the deserts of the American Southwest, particularly Arizona 9.Chlamydia psittaci Exposure to birds 10.Histoplasma capsulatum Exposure to bat or bird droppings, spelunking (recreational cave exploration) 11.Bordetella pertussis Cough with whoop and post-tussive vomiting 12.Francisella tularensis Hunters, or exposure to rabbits SARS, Avian injluenza Travel to Southeast Asia 13.Bacillus anthr...

Symptoms and signs suggestive of androgen deficiency in men • Incomplete sexual development, eunuchoidism, aspermia • Reduced sexual desire (libido) and activity • Decreased spontaneous erections • Breast discomfort, gynecomastia • Loss of body (axillary and pubic) hair, reduced shaving • Very small or shrinking testes (especially • Inability to father children, low or zero sperm counts • Height loss, low-trauma fracture, low bone mineral density • Reduced muscle bulk and strength • Hot flushes, sweats

Autosomal dominant inheritance is seen in: Achondroplasia, Acute intermittent porphyria, Adult polycystic kidney disease, Ehlers-Danlos syndrome, Familial adenomatous polyposis, Gilbert's syndrome, Hereditary sensory and motor neuropathy, Hereditary spherocytosis, Huntington's disease, Hyperlipidaemia type II, Malignant hyperthermia, Marfan's syndrome, Myotonia congenita, Myotonic dystrophy, Neurofibromatosis, Osteogenesis imperfecta type 1, Noonan's syndrome, Polyposis coli, Rotor syndrome, Retinoblastoma, Tuberose sclerosis, Von Hippel-Lindau disease, von Willebrand's disease

Features of oral isotretinoin treatment • For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological distress • Extremely effective, as it targets all causes of acne • Duration of treatment and daily dose are individualised • Low starting dose is used that may be gradually increased, as tolerated • Side effects are usually manageable • Warn of mood changes and the potential risk of depression • Warn about contraception and teratogenicity

Features of oral isotretinoin treatment • For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological distress • Extremely effective, as it targets all causes of acne • Duration of treatment and daily dose are individualised • Low starting dose is used that may be gradually increased, as tolerated • Side effects are usually manageable • Warn of mood changes and the potential risk of depression • Warn about contraception and teratogenicity

Tips for antibiotic therapy • Do not use topical and oral antibiotics at the same time • Use oral antibiotics for a 6-12-week course • If a longer course of oral antibiotics is required, use benzoyl peroxide for a week between courses • Warn of side effects of antibiotic therapy, particularly photosensitivity with doxycycline

IMPORTANT POINTS 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.

Box 1: Nine ingestants that can be lethal in toddlers in low doses • Calcium channel blockers • Camphor • Imidazolines (eg, clonidine) • Cyclic antidepressants • Lomotil • Opiates • Salicylates • Sulphonylureas • Toxic alcohols Note: Not in order of lethality

A patient with successfully treated DVT remains at increased risk of DVT or PE for life and will need prophylaxis at times. Prophylaxis (with, for example, enoxaparin 40mg daily) should begin 12 hours before elective surgery. In orthopaedic surgery, it should be continued at this dose for three weeks after discharge from hospital2. Early remobilisation and compression stockings should be used routinely for all surgery. Intra-operative calf compression machines are often used in prolonged elective surgery. High-risk medical patients (eg, those likely to be inpatients for more than five days) should receive routine prophylaxis whether or not they have had a prior DVT. Seek advice if the patient has renal impairment because LMW heparins accumulate quickly in patients with moderate to severe renal failure. All women with previous DVT or artificial heart valves should receive daily heparin prophylaxis during pregnancy. Haematological review is recommended in those with diagnosed thrombophil...

A patient with successfully treated DVT remains at increased risk of DVT or PE for life and will need prophylaxis at times. Prophylaxis (with, for example, enoxaparin 40mg daily) should begin 12 hours before elective surgery. In orthopaedic surgery, it should be continued at this dose for three weeks after discharge from hospital2. Early remobilisation and compression stockings should be used routinely for all surgery. Intra-operative calf compression machines are often used in prolonged elective surgery. High-risk medical patients (eg, those likely to be inpatients for more than five days) should receive routine prophylaxis whether or not they have had a prior DVT. Seek advice if the patient has renal impairment because LMW heparins accumulate quickly in patients with moderate to severe renal failure. All women with previous DVT or artificial heart valves should receive daily heparin prophylaxis during pregnancy. Haematological review is recommended in those with diagnosed thrombophil...

1. The surgical or sick medical patient is the classic high-risk person for DVT. 2.High clinical suspicion and a positive D-dimer mandate further investigation. 3.If suspicion is high, treatment for DVT or PE should be started as soon as the diagnosis is suspected, not delayed for confirmatory imaging studies. Many DVTs are unprovoked, especially in males. 4.Testing INR too often wastes resources and leaves you making frequent dose changes to ‘chase your tail’. 5.Electing to continue warfarin for 12 months delays recurrence of VTE but does not eliminate it.

Clinical presentation Possible diagnosis Investigations Maculopapular rash Rubella IgM and IgG* Parvovirus IgM and IgG* Enterovirus Throat or faecal culture Vesicular rash Varicella Rash IgM and IgG* if uncertain Enterovirus Throat or faecal culture Flu-like symptoms CMV IgM and IgG* (fever, myalgia, malaise, LFTs, FBC +/- lymphadenopathy) Toxoplasmosis IgM and IgG* Listeriosis Blood and faecal culture Other viral infections Serology or culture as required *In parallel with previous antenatal serum and 2-4 weeks later if required

GPs should encourage couples who are planning to conceive to have counselling and testing before conception. Tests for infection should include: • rubella IgG • syphilis serology – TPHA or RPR • hepatitis B serology – hepatitis B surface antigen • hepatitis C serology – hepatitis C antibody • HIV • varicella – IgG • CMV IgG (in high-risk patients) Women who have negative rubella serology should be offered MMR vaccine and retested for rubella seroconversion eight weeks later. About 5% will need revaccination. A very small number of women will remain rubella seronegative despite two successive MMR vaccinations. It is unlikely that further vaccination will lead to seroconversion. In these cases it is best to counsel the woman to avoid rubella contact in her subsequent pregnancy. Women found negative to varicella IgG should be offered varicella vaccine with two doses, eight weeks apart. Pregnancy should be delayed until eight weeks after vaccination for rubella or varicella. In those at hi...

■ an irregular or peaked pupil ■ a shallow anterior chamber compared to the other eye ■ absent or diminished red reflex ■ a boggy haemorrhagic swelling over the sclera ■ uveal tissue, which is dark, lying external to the globe Note: not all these signs need be present.

■ a vision chart ■ a light source with a cobalt blue filter ■ a means of magnification such as loupes (or a pair of +3.0 “chemist’s glasses”) ■ amethocaine drops to anaesthetise the ocular surface ■ fluorescein drops to stain any epithelial defects ■ cycloplegic drops to dilate the pupil ■ an ophthalmoscope to visualise the red reflex and/or posterior segment of the eye ■ cotton buds to wipe up any secretions and help evert the upper lid.

The size of the waistline is the key to selecting patients to investigate. People who are genetically predisposed and who take in an excessive amount of calories are most likely to develop this condition. The lean man with a pot belly, a shape seen commonly in general practice, could be considered the most toxic shape of all. Objective assessment of known risk factors (cholesterol, fasting lipids, blood glucose level, blood pressure, smoking, obesity and sedentariness) is also necessary. Risk factors for metabolic syndrome often cluster together and have a multiplicative rather than an additive effect. In women, it is the level of fasting triglycerides, rather than cholesterol, that predicts subsequent cardiovascular disease and death. Waist target parameters have tightened over time and vary according to genetic polymorphism (see table below). If BMI is >30kg/m2, central obesity can be assumed and waist circumference does not need to be measured. Abnormal blood glucose should be in...

the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome. It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose

the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome. It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose

the International Diabetes Federation published a consensus worldwide definition of metabolic syndrome. It is defined as central obesity in concurrence with any two of the following factors: raised triglycerides, reduced HDL cholesterol, raised blood pressure or raised fasting plasma glucose

CASE ONE A mother brings her six-year-old son to your emergency department. He was practising his “Power Ranger” moves in the family’s split-level living room and leapt from the upper to the lower level, landing heavily on his feet. He complains of neck pain but no other symptoms. What features are present on inspection? He has a torticollis, and is in some degree of pain. What immobilisation is indicated? This child would not fit into a collar. Forcing the issue would create further pain and distress and may exacerbate an injury. He should be allowed to adopt a position of comfort, with padded support if necessary, and given simple analgesia as required. What imaging is indicated? X-rays are indicated as an initial investigation, but should be interpreted with care, with recognition that in this age-group plain X-rays are known to be poorly sensitive. What is the injury? X-rays showed an anterior subluxation of C2 on C3. In this particular case, injury was missed on two presentations,...

1. The awake, alert patient, with no other significant injuries. Bony and ligamentous injury to the cervical spine and its supporting structures is intrinsically painful and also causes pain because of secondary muscle spasm. Patients in this category can tell you where it hurts, and are able to respond adequately to examination. If these features are present, the neck can be cleared clinically: ■ No midline cervical tenderness ■ No focal neurological deficit ■ Normal alertness ■ No intoxication ■ No painful distracting injury ■ 50% or greater active range of movement in all planes. If any of the first five features are present, standard plain three-view X-rays are indicated. These three views should include a lateral view (to include all seven cervical vertebrae and enough of the first dorsal vertebra to demonstrate alignment), an anterior- posterior projection, and an openmouth odontoid view. 2 . The mentally obtunded patient . Thisgroup is the most difficult to assess accurately. T...

Non-ulcer dyspepsia Functional or non-ulcer dyspepsia is defined as at least three months of dyspepsia in which no definite biochemical or structural cause can be found to explain symptoms. There is no confirmatory test and the diagnosis can only be made after exclusion of the aforementioned structural causes. A diagnosis of non-NSAID, non-H pylori ulcer should only be entertained after: ■ exclusion of surreptitious NSAID use ■ careful exclusion of H pylori infection by several biopsies ■ use of more than one H pylori diagnostic test ■ exclusion of confounders that would alter the sensitivity of these tests, such as concurrent proton pump inhibitor (PPI) use, recent antibiotic therapy or gastrointestinal bleed. Management involves 4-8 weeks of PPI therapy. Although rare, exclusion of gastric carcinoma and other upper gastrointestinal malignancies is important in those with “alarm symptoms”, which the American Gastroenterological Association guidelines summarise as: ■ age older than 55 ...

peptic ulcer disease (5-15%) ■ gastro-oesophageal reflux disease (5-15%) ■ gastric or oesophageal cancer ( ■ gallstones/biliary pain ■ chronic pancreatitis/ pancreatic cancer ■ coeliac disease ■ lactose intolerance ■ medications – digoxin, theophylline, erythromycin, potassium supplements, corticosteroids and NSAIDs ■ infiltrative diseases of the stomach – eosinophillic gastritis, Crohn’s disease, sarcoidosis ■ metabolic causes – hypothyroidism, hypercalcaemia, hyperkaelemia, heavy metals ■ hepatoma and steatohepatitis ■ intestinal angina ■ abdominal wall pain ■ Zollinger-Ellison syndrome ■ diabetic radiculopathy Functional dyspepsia (up to 60%) ■ caffeine, alcohol and smoking can exacerbate symptoms