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

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.

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...