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

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 ...

peptic ulcer disease (5-15%) ■ gastro-oesophageal reflux disease (5-15%) ■ gastric or oesophageal cancer ( ■ gallstones/biliary pain ■ chronic pancreatitis/ pancreatic cancer ■ coeliac disease ■ lactose intolerance ■ medications – digoxin, theophylline, erythromycin, potassium supplements, corticosteroids and NSAIDs ■ infiltrative diseases of the stomach – eosinophillic gastritis, Crohn’s disease, sarcoidosis ■ metabolic causes – hypothyroidism, hypercalcaemia, hyperkaelemia, heavy metals ■ hepatoma and steatohepatitis ■ intestinal angina ■ abdominal wall pain ■ Zollinger-Ellison syndrome ■ diabetic radiculopathy Functional dyspepsia (up to 60%) ■ caffeine, alcohol and smoking can exacerbate symptoms

■ Women often don’t recognise themselves as being depressed – they hide their symptoms or present as the baby having the problem. ■ When symptoms (anxiety, lowered mood, tearfulness, fears of not being able to cope or being a bad mother) are recurrent, severe or continue for more than two weeks, the diagnosis of depression or anxiety disorder must be considered. ■ In PND many anxieties arise from the lack a balanced perspective. Cognitive behavioural therapy is well suited to address these issues. ■ Maternal depression is associated with poor developmental outcomes for children with implications for the child’s education and the potential for mental illness as adults. ■ Mothers’ groups can be beneficial if they are specifically for women with PND but general mothers groups can alienate women if they feel different to the other “coping” mothers. ■ Early detection and treatment of PND may lead to remission of symptoms and improvement for mother, child and family members, but it does not ...