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

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.