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

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

■ Women often don’t recognise themselves as being depressed – they hide their symptoms or present as the baby having the problem. ■ When symptoms (anxiety, lowered mood, tearfulness, fears of not being able to cope or being a bad mother) are recurrent, severe or continue for more than two weeks, the diagnosis of depression or anxiety disorder must be considered. ■ In PND many anxieties arise from the lack a balanced perspective. Cognitive behavioural therapy is well suited to address these issues. ■ Maternal depression is associated with poor developmental outcomes for children with implications for the child’s education and the potential for mental illness as adults. ■ Mothers’ groups can be beneficial if they are specifically for women with PND but general mothers groups can alienate women if they feel different to the other “coping” mothers. ■ Early detection and treatment of PND may lead to remission of symptoms and improvement for mother, child and family members, but it does not ...

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

At the first pregnancy consultation the mother's blood group should be determined and blood taken for detection/ measurement of blood group antibodies. For complete and incomplete miscarriages all Rh(D) negative women who have not actively formed their own anti-D should be given 250IU of anti-D. There is insufficient evidence to suggest that a threatened miscarriage before 12 weeks gestation necessitates use of anti-D, but meta-analyses indicate that antenatal administration of anti-D (for all indications including miscarriage) can result in a 78% reduction in allo-immunisation.

Complete miscarriage • No intrauterine gestational sac • No ovarian/fallopian mass • Products of conception passed • No evidence of POC in uterus • Endometrial thickness Incomplete • No intrauterine gestational sac miscarriage • No ovarian/fallopian mass • POC passed • More POC seen in uterus Missed miscarriage • Intact intrauterine gestational sac • Fetal pole seen • No fetal heartbeat • CRL >6mm OR • Intact intrauterine gestational sac measuring >20mm • Fetal pole not seen

INITIAL MANAGEMENT When a woman describes bleeding in early pregnancy the treating doctor must first determine whether she has heavy bleeding and/or severe pain. Saturation of pads and/or passing clots larger than a 20 cent piece implies heavy bleeding. If either is present this scenario must betreated as a clinical emergency. The possibility of cervical shock should always be considered. A speculum examination should be performed, and any products of conception (POC) should be removed from the cervix . This is the only way to reverse shock associated with this condition. Basic life support principles apply. It is important to: • Ensure that the woman has a clear airway and adequate breathing before the speculum examination is performed. • Gain IV access with a cannula of at least 16G diameter and start IV crystalline fluids at a rate that maintains adequate blood pressure (>100/60) and pulse rate ( • As the IV is inserted, take blood for blood group typing and FBC, and arrange cros...

DIFFERENTIAL DIAGNOSIS OF VENOMOUS SNAKEBITE ■ non-venomous snakebite ■ bite or sting by other venomous creature (arthropod, including spider, octopus, jellyfish) ■ CVA ■ ascending neuropathy, eg Guillain-Barre syndrome ■ AMI ■ allergic reaction ■ hypoglycaemia/hyperglycaemia ■ drug overdose ■ closed head injury The combination of neurological disturbance and evidence of defibrination in a patient with an appropriate history is strongly suggestive of severe envenomation.

In managing the patient with suspected snakebite, it is necessary to establish whether significant envenomation has occurred and to attempt to identify the type of snake involved. A significant proportion of venomous snakebites don’t result in envenomation. The use of antivenom should be reserved for those cases with clinical or pathologic evidence of envenomation. 1.Snake venom Detection Kit 2.Clotting Studies 3.Creatinine Kinase-Indicating Myolysis 4.Urinalysis-Haemoglobin,Myoglobin 5.Renal Function-May be impaired secondary to Myoglobinuria or other mechanism.

Effects of Australian snake bite venom are usually species specific, but in general include: ■ neurotoxins ■ procoagulants ■ anti-coagulants ■ rhabdomyolysins ■ haemolysins (weak). Presentation Symptoms and signs of envenomation may include: ■ EARLY (within 30 minutes) - headache, nausea/vomiting, abdominal pain - coagulopathy ■ LATE (within several hours) - cranial nerve palsies (ptosis, ophthalmoplegia, dysarthria, dysphonia, dysphagia) - limb and truncal weakness - respiratory failure - haemorrhage ■ VERY LATE (delayed presentation, wrong/inadequate treatment) - prolonged paralysis - renal failure - uncontrollable haemorrhage Features suggestive of snakebite Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake antivenom, and Victoria, where bites should be treated with combined ti...