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

Treatment of status epilepticus in hospital. 1.Immediate measures Secure airway Give oxygen Assess cardiac and respiratory function Secure iv access Give lorazepam 4 mg iv or diazepam 10 mg iv Repeat after 10 mins if no response 2.In hospital Take blood for electrolytes, LFT, calcium, glucose, clotting, AED levels and storage for later analysis Measure blood gases Establish aetiology Give thiamine or 50% glucose solution if indicated Within 30 minutes In patients with established epilepsy: give usual AED orally, NG or iv 3.In patients with new-onset epilepsy or if seizures continue: fosphenytoin (18 mg/kg phenytoin equivalent), up to 150 mg/min with ECG monitoring or phenytoin 18mg/kg, 50 mg/min with ECG or phenobarbital 15 mg/kg iv, 100 mg/min Longer than ITU may be necessary minutes Anaesthetise with EEG monitoring Midazolam, phenobarbital, propofol, or thiopentone most commonly used Non-convulsive status Augment or reinstate usual AEDs Consider ...

1.Haemophilus influenza -Smokers, COPD 2.Mycoplasma --------Young, otherwise healthy patients 3.Legionella --------Epidemic infection in older smokers, particularly when located near infected water sources, such as air-conditioning systems 4.Pneumocystis jiroveci (formerly carinii) pneumonia HIV-positive persons with 5.Coxiella burnetti (Q-fever) Exposure to animals, particularly at the time they are giving birth 6.Klebsiella Alcoholics 7.Staphylococcus aureus Following viral syndromes or viral bronchitis, especially influenza 8.Coccidioidomycosis Exposure to the deserts of the American Southwest, particularly Arizona 9.Chlamydia psittaci Exposure to birds 10.Histoplasma capsulatum Exposure to bat or bird droppings, spelunking (recreational cave exploration) 11.Bordetella pertussis Cough with whoop and post-tussive vomiting 12.Francisella tularensis Hunters, or exposure to rabbits SARS, Avian injluenza Travel to Southeast Asia 13.Bacillus anthr...

Symptoms and signs suggestive of androgen deficiency in men • Incomplete sexual development, eunuchoidism, aspermia • Reduced sexual desire (libido) and activity • Decreased spontaneous erections • Breast discomfort, gynecomastia • Loss of body (axillary and pubic) hair, reduced shaving • Very small or shrinking testes (especially • Inability to father children, low or zero sperm counts • Height loss, low-trauma fracture, low bone mineral density • Reduced muscle bulk and strength • Hot flushes, sweats

Autosomal dominant inheritance is seen in: Achondroplasia, Acute intermittent porphyria, Adult polycystic kidney disease, Ehlers-Danlos syndrome, Familial adenomatous polyposis, Gilbert's syndrome, Hereditary sensory and motor neuropathy, Hereditary spherocytosis, Huntington's disease, Hyperlipidaemia type II, Malignant hyperthermia, Marfan's syndrome, Myotonia congenita, Myotonic dystrophy, Neurofibromatosis, Osteogenesis imperfecta type 1, Noonan's syndrome, Polyposis coli, Rotor syndrome, Retinoblastoma, Tuberose sclerosis, Von Hippel-Lindau disease, von Willebrand's disease

Features of oral isotretinoin treatment • For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological distress • Extremely effective, as it targets all causes of acne • Duration of treatment and daily dose are individualised • Low starting dose is used that may be gradually increased, as tolerated • Side effects are usually manageable • Warn of mood changes and the potential risk of depression • Warn about contraception and teratogenicity

Features of oral isotretinoin treatment • For patients with severe acne • For patients unresponsive to conventional therapy • For acne patients experiencing psychological distress • Extremely effective, as it targets all causes of acne • Duration of treatment and daily dose are individualised • Low starting dose is used that may be gradually increased, as tolerated • Side effects are usually manageable • Warn of mood changes and the potential risk of depression • Warn about contraception and teratogenicity

Tips for antibiotic therapy • Do not use topical and oral antibiotics at the same time • Use oral antibiotics for a 6-12-week course • If a longer course of oral antibiotics is required, use benzoyl peroxide for a week between courses • Warn of side effects of antibiotic therapy, particularly photosensitivity with doxycycline