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

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 ...