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