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

■ 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 ...

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

At the first pregnancy consultation the mother's blood group should be determined and blood taken for detection/ measurement of blood group antibodies. For complete and incomplete miscarriages all Rh(D) negative women who have not actively formed their own anti-D should be given 250IU of anti-D. There is insufficient evidence to suggest that a threatened miscarriage before 12 weeks gestation necessitates use of anti-D, but meta-analyses indicate that antenatal administration of anti-D (for all indications including miscarriage) can result in a 78% reduction in allo-immunisation.

Complete miscarriage • No intrauterine gestational sac • No ovarian/fallopian mass • Products of conception passed • No evidence of POC in uterus • Endometrial thickness Incomplete • No intrauterine gestational sac miscarriage • No ovarian/fallopian mass • POC passed • More POC seen in uterus Missed miscarriage • Intact intrauterine gestational sac • Fetal pole seen • No fetal heartbeat • CRL >6mm OR • Intact intrauterine gestational sac measuring >20mm • Fetal pole not seen

INITIAL MANAGEMENT When a woman describes bleeding in early pregnancy the treating doctor must first determine whether she has heavy bleeding and/or severe pain. Saturation of pads and/or passing clots larger than a 20 cent piece implies heavy bleeding. If either is present this scenario must betreated as a clinical emergency. The possibility of cervical shock should always be considered. A speculum examination should be performed, and any products of conception (POC) should be removed from the cervix . This is the only way to reverse shock associated with this condition. Basic life support principles apply. It is important to: • Ensure that the woman has a clear airway and adequate breathing before the speculum examination is performed. • Gain IV access with a cannula of at least 16G diameter and start IV crystalline fluids at a rate that maintains adequate blood pressure (>100/60) and pulse rate ( • As the IV is inserted, take blood for blood group typing and FBC, and arrange cros...

DIFFERENTIAL DIAGNOSIS OF VENOMOUS SNAKEBITE ■ non-venomous snakebite ■ bite or sting by other venomous creature (arthropod, including spider, octopus, jellyfish) ■ CVA ■ ascending neuropathy, eg Guillain-Barre syndrome ■ AMI ■ allergic reaction ■ hypoglycaemia/hyperglycaemia ■ drug overdose ■ closed head injury The combination of neurological disturbance and evidence of defibrination in a patient with an appropriate history is strongly suggestive of severe envenomation.

In managing the patient with suspected snakebite, it is necessary to establish whether significant envenomation has occurred and to attempt to identify the type of snake involved. A significant proportion of venomous snakebites don’t result in envenomation. The use of antivenom should be reserved for those cases with clinical or pathologic evidence of envenomation. 1.Snake venom Detection Kit 2.Clotting Studies 3.Creatinine Kinase-Indicating Myolysis 4.Urinalysis-Haemoglobin,Myoglobin 5.Renal Function-May be impaired secondary to Myoglobinuria or other mechanism.

Effects of Australian snake bite venom are usually species specific, but in general include: ■ neurotoxins ■ procoagulants ■ anti-coagulants ■ rhabdomyolysins ■ haemolysins (weak). Presentation Symptoms and signs of envenomation may include: ■ EARLY (within 30 minutes) - headache, nausea/vomiting, abdominal pain - coagulopathy ■ LATE (within several hours) - cranial nerve palsies (ptosis, ophthalmoplegia, dysarthria, dysphonia, dysphagia) - limb and truncal weakness - respiratory failure - haemorrhage ■ VERY LATE (delayed presentation, wrong/inadequate treatment) - prolonged paralysis - renal failure - uncontrollable haemorrhage Features suggestive of snakebite Identification of snakes is often unreliable: polyvalent antivenom should be used if the type of snake cannot be identified in all areas of Australia apart from Tasmania, where both tiger snake and copperhead bite may be successfully treated with tiger snake antivenom, and Victoria, where bites should be treated with combined ti...

The therapeutic indications for bronchoscopy include: removal of secretions and mucus plugs: often used in ITU pneumonic lobar collapse allergic bronchopulmonary aspergillosis removal of foreign bodies stent insertion in benign airways disease: for example in relapsing polychondritis

Diagnostic role of flexible bronchoscopy lung cancer: the type and operability of lung tumours can be assessed pneumonia: good for identifying infecting organism interstitial lung disease: permits histoloy and analysis of bronchoalveolar lavage causes of haemoptysis, cough and recurrent pneumonia

bronchodilators Bronchodilation is a phenomenon of sympathetic stimulation. Thus drugs which attempt to achieve it include: 1.sympathomimetics salbutamol } beta-2 adrenoceptor terbutaline } agonists fenoterol } rimiterol } salmeterol } adrenaline isoprenaline 2.antimuscarinics Anticholinergics are drugs which antagonise cholinergic receptors. 3.xanthinesTypes of sympathomimetic include: Xanthines are compounds which inhibit phosphodiesterase and thus are able to produce bronchodilatation. theophylline aminophylline caffeine, theophylline and tannin

Lymphoedema after axillary dissection and/or radiotherapy. It can arise at any time, even many years after treatment. ● Cardiovascular toxicity after radiotherapy, and increased cardiovascular risk after premature menopause. Treat with appropriate medical and risk-reduction strategies. ● Congestive heart failure associated with anthracyclines and trastuzumab. Monitor (mandatory with trastuzumab) and manage medically if present. ● DVT, stroke (tamoxifen). Treat as usual if present. ● Hot flushes after premature menopause, tamoxifen or aromatase inhibitors (less so). SSRIs, SNRIs and gabapentin may be useful. Alternatives such as black cohosh have also been suggested. ● Vaginal dryness and dyspareunia. Non-hormonal moisturisers and lubricants; use local oestrogen with caution as there may be systemic absorption. ● Loss of libido resulting from altered body image, radiotherapy, chemotherapy, depression or dyspareunia. Counselling may be helpful, as well as appropriate medical treatment. ●...

Relative risk Advanced age >10 Genes, family history, personal history BRCA1/2 mutation 5-10 Breast cancer in first-degree relative 2 Previous atypical hyperplasia 4-5 Previous breast cancer >4 Breastfeeding for 12 months 0.96 One birth 0.93 Two births 0.84 Menstrual/reproductive history Menarche before 11 years 3 Menopause after 54 years 2 First child after 30 1.2-1.4 First child after age 40 3 Current use of HRT 1.3-1.6 Current use of oral contraceptive 1.2 Other Living in a developed country (?oestrogen exposure) 5 High breast density on mammogram (?oestrogen exposure) >5 Abnormal exposure to ionising radiation 3 ‘Lifestyle’ High socioeconomic status 2 High postmenopausal BMI 2 High premenopausal BMI One alcoholic drink daily 1.07 Lancet 2005; 265: 1727-1741. Cancer 2004; 101:353-62.

GOOD DAY 1.Zoster immunoglobulin (ZIG) should be offered to pregnant, varicella-seronegative women with significant exposure to varicella-zoster virus (VZV) (chickenpox) infection. 2.Oral aciclovir prophylaxis should be considered for susceptible pregnant women exposed to VZV who did not receive ZIG or have risk factors for severe disease. 3.Intravenous aciclovir should be given to pregnant women who develop complicated varicella at any stage of pregnancy. 4.Counselling on the risk of congenital varicella syndrome is recommended for pregnant women who develop chickenpox. 5.ZIG should be given to a baby whose mother develops chickenpox up to 7 days before delivery or up to 28 days after delivery. 6.Intravenous aciclovir should be given to babies presenting unwell with chickenpox, whether or not they received ZIG. 7.Breastfeeding of babies infected with or exposed to VZV is encouraged. 8.A mother with chickenpox or zoster does not need to be isolated from her own baby. 9.If siblings at h...

GOOD DAY ! ASTHMA Managing exacerbations SUMMARY OF PRACTICE POINTS LEVEL OF EVIDENCE Management of exacerbations in adults A short (7-10 days) course of oral corticosteroids is the current standard treatment for adults with moderate-to-severe asthma exacerbations. I When administering a SABA via MDI during an exacerbation, use a spacer. [√] In adults with acute exacerbations not considered severe enough for admission to hospital, high-dose ICS may be effective. II Merely doubling the maintenance ICS dose is not effective in managing exacerbations. II Management of exacerbations in children A short (up to 5 days) course of oral corticosteroids (prednisolone 1 mg/kg up to 60 mg daily) is the current standard treatment for severe exacerbations. Closely monitor response to treatment. I Children who are taking regular preventive medication should continue taking the same dose during an exacerbation. II...

GOOD DAY Cervical pathology ! Hot topic in AMC

GOOD DAY ! ACUTE ASTHMA SUMMARY OF PRACTICE POINTS LEVEL OF EVIDENCE Managing acute asthma in adults If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination. [√] Assess response to treatment using spirometry, oxygen saturation, heart rate, respiratory rate and pulsus paradoxus status. [√] Wheeze is an unreliable indicator of the severity of an asthma attack and may be absent in severe asthma. [√] Ensure every patient receives adequate follow-up after an acute asthma episode, including review of medications, triggers and asthma action plan. [√] Managing acute asthma in children If the patient is acutely distressed, give oxygen and SABA immediately after taking a brief history and physical examination. [√] Emergency management of acute asthma in a child is based on initial administration of salbutamol 4-6 puffs ( I Load the spacer with one puff at a time and give eac...

GOOD DAY !

GOOD DAY ! I need some feed back from you guys come on.....take it easy.

GOOD DAY ! Hi next to come is MCQ discussion............please mind that you needs to know what exactly is "ASKING".......this will help to select what is the answer.....!!!

GOOD DAY !

GOOD DAY !

GOOD DAY !

GOOD DAY Hi check this out too.