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

PSYCHIATRY 1.A lady with a previous divorce now comes to you with a seductive behaviour a. Narcistic b. Histrionic c. Borderline 2.In Australia bush fire are common either accidentally or some people lighting fire deliberately. Which is true regarding pyromaniacs? a. Done for notoriety or publicity b. To hide their acts c. As they like to play with fire d. Set fire and get panic attacks e. For satisfaction 3.Depersonalization may occur in a. Schizophrenia b. Ecstatic religious experience c. Depression d. Post traumatic disorder e. All of the above 4.A middle aged lady present to you with nausea dyspepsia abdominal distention. She had a past history of going to many doctors and being treated for many disorders. she has been treated by a rheumatologist for aches and pains, cardiologist for her palpitations and gave her propanolol without improvement , a neurologist for her epilepsy. On examination you find a tense anxious woman in spite of her daily dose of benzodia

1.Epilepsy does not carry an increased risk of miscarriage or obstetric complications per se. 2. A single fit during pregnancy is unlikely to impose any risk to the fetus nor is pregnancy associated with an increased risk of seizures. 3. Most anti-epileptic drugs are asssociated with incresed adverse outcome 4.Main culprit is Sodium Valproate.

Child-bearing years span almost four decades, giving the GP ample opportunity to educate and prepare women for pregnancy. ■ 70-90% of women with bipolar disease and 60% of those with major depression will relapse if psychotropic medication is ceased in pregnancy. ■ It is recommended that the HbA1c be maintained at ≤6 in women with diabetes before and during pregnancy. ■ Maternal perinatal depression is a risk factor for premature birth, reduced foetal growth ,PET, poor neonatal bonding and longer-term neurodevelopmental problems. ■ Although there is no established safe level of alcohol, 10-15% of women continue to drink throughout

■ Lifestyle interventions can prevent or delay diabetes in half the people who have IGT. ■ Begin risk assessment at age 40, or age 18 in Aboriginal and Torres Strait Islanders. ■ AUSDRISK may overestimate risk in those under 25 years of age and underestimate risk in Aboriginal and Torres Strait Islanders. ■ The risk of developing type 2 diabetes increases by 10-20 times in people with IFG or IGT. ■ 41% of type 2 diabetes patients and 76% of type 2 diabetes patients who are not using insulin never check their BGLs. ■ Only strategies that increase an individual’s skills while providing a supportive environment can produce sustainable lifestyle changes.

Interpretation of fasting plasma glucose 1.FPG < 5.5mmol/L • diabetes unlikely • retest after three years 2.FPG ≥ 7mmol/L • diabetes likely • repeat FPG unless diagnosis unequivocal 3.FPG 5.5-6.9mmol/L • diabetes possible • perform oral GTT • retest annually

LOCUM OPPORTUNITIES AVAILABLE AUSTRALIA WIDE (added 23-Sep-2009) For GPs and specialists. Excellent Rates. Registration required. Contact: Skilled Medical Consultants Ph: 1300 900 100. Email: enquiries@skilledmedical.com

WHAT IS THE IMPORTANCE OF MEDICAL INSURANCE? WHAT IS INDEMNITY INSURANCE? WHAT IS THE BASIC COVER AND WHEN IS THE EFFECTIVE DATE.? WHETHER IT IS IN FORCE RETROSPECTIVELY? WHAT IS THE COVER YOU CAN GET?

1. Keep the skin supple using a non-perfumed moisturising cream such as sorbolene. 2. Avoid drying out your skin and consider using a soap-free alternative. 3. Clean any scratches, grazes or cuts immediately using an antiseptic solution, use an antibacterial cream and cover the area with a clean, dry plaster. 4.Use an electric razor for shaving instead of a wet razor. 5.Avoid tattoos and body piercing. 6. Consider ways to protect the skin, such as wearing gloves while washing dishes, gardening or handling pets.

1.In complex elbow dislocation, the most common fractures are to the radial head followed by fracture of the coronoid process of the ulna. 2.The force needed to cause dislocation in an adult is more likely to cause a supracondylar fracture of the distal humerus in a child – however, the elbow is the most frequently dislocated joint in children. 3.Spontaneous reduction of a dislocated elbow is common in children – look for an avulsed medial epicondyle. 4. Post-reduction radiographs should be taken in at least two planes to confirm that the joint is well reduced.

Before any attempted investigations or reduction procedures, always document the neurological and vascular status of the arm.

WHAT IS GOLD STANDARD? Dual energy X-ray absorptiometry (DXA) is the gold standard for diagnosis of osteoporosis. BUT DXA IS NOT ESSENTIAL TO START TREATMENT .

A Little Death In Dixie 1.CALCIUM AND VITAMIN D SUPPLEMENTATION 2.BISPHOPHONATES-?ACTIVE UPPER GI DISORDERS ARE CONTRAINDICATIONS 3.HORMONE THERAPY-?RISK OF THROMBOEMBOLISM 4.PARATHYROID HORMONE 5.SELECTIVE OESTROGEN RECEPTOR MODULATORS(SERM)-RISH SIMILAR TO HORMONE THERAPY(BUT REDUCES BREAST CANCER) 6.STRONTIUM RANELATE.

Osteoporosis is an A Little Death In Dixie asymptomatic process until afracture occurs. ■ Adults who have one fracture are 2-4 times more likely to have another. ■ Bone densitometry may not be essential before starting medical therapy if X-ray investigation shows one or more vertebral fractures typical of osteoporosis. ■ Most elderly people in highand low-level residency care have vitamin D deficiency.

http://amcexams.blogspot.com/?spref=gb ■ Abdominal examination is most rewarding after ensuring adequate analgesia. ■ Plain KUB has a sensitivity of only 45-59% and a specificity as low as 77% – it cannot be used to rule in or rule out the diagnosis of ureteric calculi. ■ Infection with obstruction mandates urgent decompression. ■ There is evidence of permanent nephron loss within 72 hours of complete obstruction. ■ The likelihood of spontaneous stone passage is determined by stone size and position. ■ Fifteen to twenty per cent of all patients with ureteric calculi will require intervention using ESWL, ureteroscopy or percutaneous nephrolithotomy.

1.Obstruction with evidence of infection-urgent decompression. 2.larger calculi -more than 6mm 3.Bilateral obstruction. 4.An obstructed solitary or transplanted kidney. 5.Renal impairment.(review the definition of renal impairment) 6.Ongoing unacceptable discomfort.

Haematuri a (usually microscopic but sometimes frank) occurs in 95% of patients with renal colic on day one and 65% by day three, but up to 87% of patients with AAA rupture will also have haematuria.

■ Tuning fork testing is especially important when otoscopy and systemic examinations are unremarkable. ■ It is vital to recognise the possible causes of seemingly innocuous tinnitus (especially sudden onset) and institute early appropriate treatment. ■ There is great variation in how people react to tinnitus – some cope well with little disturbance while others feel anxious or depressed. ■ Treating underlying anxiety and depression improves outcomes. ■ Many patients report their tinnitus-related stress started when their doctor told them “nothing could be done”. ■ Most people will habituate naturally to tinnitus, as long as they regard the sound as meaningless.

sKIN burns can be graded into three categories. Grade 1 has redness or white marking only, grade 2 has oedema and blistering and grade 3 burns are associated with necrosis. HF acid burns Appearance Grade 1 white burn mark and/or erythema and pain Grade 2 white burn mark and/or erythema and pain PLUS oedema and blistering Grade 3 white burn mark and/or erythema and pain PLUS oedema and blistering PLUS necrosis

There is no clear consensus on the best management, surgical or conservative, for first-time anterior shoulder dislocation. ■ Always perform a thorough examination before any attempt at reduction and document the neurovascular status of the arm, in particular the function of the axillary and musculocutaneous nerves. ■ Plain X-rays should include an antero-posterior view, a ‘Y’ lateral view and either an axillary or a Garth view. ■ Recurrence rates are lowest in patients who wear a sling for SIX WEEKS

A.Intervention for acute stroke is most potent when applied as close to the time of stroke onset as possible. B. High-risk TIAs can be predicted and should be investigated and managed with the same urgency as acute stroke. C. Differentiating between infarction and haemorrhagic stroke on clinical grounds is poor, even among experienced clinicians. Acute imaging (usually by CT) is essential to direct ongoing management. D. Thrombolysis with tPA for acute ischaemic stroke up to 4.5 hours from symptom onset is now the standard level of care in units which have stroke management expertise. E. Admission to a stroke unit for all stroke subtypes increases the chance of functional outcome and decreases disability.

Risk Score A Age >60 years 1 point B Blood pressure >140/90 1 point C Clinical unilateral weakness 2 points Speech disturbance without weakness 1 point Other 0 points D Duration >60 min 2 points 10-60 min 1 point <10 min 0 points D Diabetes 1 point 0-3 points = low risk 4-5 points = moderate risk 6-7 points = high risk (Maximum score 7 points)

NEVER DELAY A SINGLE DAY BEFORE YOU GET A HEALTH INSURANCE AND INCOME PROTECTION INSURANCE IF NOT LIFE INSURANCE WHEN YOU ARRIVE IN AUSTRALIA.THERE ARE MANY OPTION TO SELECT FROM.JUST ASK A COLLEGE THAT IS THE BEST WAY.DON'T GO BY ADVERTISEMENTS.AL THE BEST.

Acne is a clinical diagnosis; however, it is important to consider the following differential diagnoses: • Rosacea. • Perioral dermatitis. • Acneiform drug eruption. • Folliculitis on the trunk.

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.

HEALTH INSURANCE IS ONE OF THE MOST IMPORTANT THING YOU NEED TO HAVE WHEN YOU ARRIVE IN AUSTRALIA.IT IS A MUST I WOULD SAY.THERE ARE MANY OPTIONS TO SELECT FROM

Auto-injectors (epi-pens) for anaphylaxis - an overview Anaphylaxis is the most severe form of an allergic reaction and is life threatening. A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline injection (EpiPenﾮ/EpiPenﾮJr). An important aspect of anaphylaxis management is prevention and avoidance of the cause. Please read Factsheet: Allergic and anaphylactic reactions. Signs and symptoms of a severe allergic reaction (Anaphylaxis) Anaphylaxis is the term used to describe a severe, systemic allergic reaction that involves the respiratory and/or cardiovascular systems. Presentation of any of these symptoms, in addition to one or more of the above symptoms of a mild-moderate allergic reaction, indicates anaphylaxis: Difficulty/noisy breathing Swelling of tongue Swelling/tightness in throat Difficulty talking and/or hoarse voice Loss of consciousness and/or collapse P

Allergic and anaphylactic reactions Allergic reactions occur when the immune system reacts to something in the environment that is normally harmless: e.g. food proteins, pollens or dust mites. Symptoms may be localised or generalised and range from mild to severe. The most common causes of allergy in children are milk, eggs, peanuts, tree nuts, cow milk, soy, wheat, fish and shellfish. Other causes are bee or other insect bites, some medications and latex (rubber). Anaphylaxis is the most severe form of an allergic reaction and is life threatening. Rates of anaphylaxis are not well documented, but are estimated at approximately 5 in every 1000 school children. A reaction can develop within minutes of exposure to the allergen, but with planning and training, a reaction can be treated effectively by using an adrenaline injection (EpiPen®/EpiPen®Jr). An important aspect of anaphylaxis management is prevention and avoidance of the cause. Signs and symptoms Mild to moderate

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■ A systematic approach to screening well women has contributed to a decline in incidence and mortality from cervical cancer in Australia. ■ There is still room to improve participation in screening in Australia: older women and women of low socioeconomic status are less likely to be adequately screened. ■ Indigenous women have not benefited from improvements in mortality through cervical cancer screening. ■ Exposure to wart virus infection (HPV) is a normal part of sexual activity. ■ During the acute phase of infection, Pap smear show the changes of a low-grade squamous cell abnormality. ■ Most women clear the HPV infection and the low-grade abnormality resolves. ■ Persistent infection with high-risk HPV subtypes carries the possibility of developing high-grade squamous cell abnormalities. ■ The new NHMRC guidelines on the Management of Asymptomatic Women with Screen Detected Abnormalities use evidence from the Pap smear registries, new understandings of the epidemiolo