[b]gold coast july questions-28th july 2007.[/b]

Discussion in 'AMC Clinical Exam' started by roma, Jul 30, 2007.

  1. roma

    roma Guest

    1- Lady with BMI 45. talk to her about management. Examiner asked me abt the medicines, their mode of actions and details of surgeries.

    2- Typical meningitis case. talk to the father abt diagnosis and management

    3- Iddm in 11 year old boy. Came with polyuria,polydypsia and wt loss. Task - to ask the physical findings and investigations from the examiner and talk to the father abt short term and long term management. Had BSL of 22 and ketones(DKA).

    4- Diarrhoea for few weeks in 3 year old boy.Happy child with no positive physical findings. DDX- infective, coeliac and toddlers diarrhoea.

    5- An old man with prostate cancer-had chemo and RT. now came with wiespread pain and bone scan done which was there on the table. Talk to the pt abt the diagnosis and abt methods of pain relief and complications of those methods.
    Examiner asked me to point out the sites of mets on the bone scan.

    6- 30year ol lady with urinary retention.Take h/o and ask the examination finding from the examiner and discuss ur management.

    On physical exam had a mass in the pouch of douglas.

    7-A pregnant lady came t u at 34 weeks with US result which showed she has grade 4 placenta previa. Everything normal on history. she lives very far frm tertiary hospital, Task- Ask the physical findngs and investgations from the examiner and manage the pt.

    8- A pregnant lady 40weeks came with non engagement of head. talk to the pt abt the likely cause and manage.

    9- DM lower limb examination.

    10- A 45 year old man with chest pain.manage him.same old case as the one in which pt went into VF during the case .

    11- A lady with SOB. Task-further h/o,dx and management.she gave h/o of air travel on asking. PE.

    12-A young man with severe headache. Task- Further h/o, DDX and mangement. SAH

    13- A 30-40 year old lady with c/o chest pain in the evenings. Ecg and other investigations normal. Task- talk to the pt and manage. ON further h/o he told that she is worried about her daughter. Anxiety.

    14- A lady treated for depression in hospital and then discharged home on risperidone 8mg and mirtazepine 25mg. Task- Further h/o, relevent physical examination and mangemet.

    15- A young insurance agent with Diarrhoea for few months. Task-h/o,explain the likely diagnosis and management.On further h/o he told me that he had colonoscopy and stool examination which were negative.also on loperamide which didn't help with the diarrhoea. So most likely coeliac disease.

    16--A lady ith multinodular goitre. T4 and TSH normal. Talk to hr abt the treatment options and side effects of each treatment.


    Will do the additions once i get my result. All the best to everyone.Keep up the good work. This forum is really very helpful.
  2. Guest

    Guest Guest

    you are an angel

    Thank you very much for that wish u the best of luck and hope you have passed them all. :p :p :)
  3. Guest

    Guest Guest

    Dear dr. if you can provide more information that will be even better. Thanks in advance
  4. Guest

    Guest Guest

    Q6: genital herpes infection?
    any other thought?
  5. jinali

    jinali Guest

    but genital herpes wouldn't give a massin pouch of douglas.i reckon its a cancer in the genital tract....or fibroid..true the patient is young.......,but its a possibility.what do you think?
  6. roma

    roma Guest

    it was not genitl herpes.i asked about the rash and itching and there was none. There was a mass in the pelvis, so i referred her to a gyneacologist for U/s and management.
  7. zafar

    zafar Guest

    AMC clinical result

    Hi everyone there,

    With the grace of Allah,i passed amc clinical exam.

    Dr zafar
    PHO emergency
    RBWH Brisbane
  8. zafar

    zafar Guest

    Q 6

    This was a lady in her thirties with 16 hours hx of sudden onset urinary retention and no other symptoms,had 2 glasses of water in last 16 hours,No vaginal symptoms.No urinary symtpoms before retention and never had problem with urine before.
    O/E she had a mass in her suprapubic region dull on percussion,palpable mass on PR and vaginal exam.
    No past hx ,no medication and no abdomenal surgery and not preganant at present.

    So the management was to treat patient urgently,because she was in moderate to severe pain due to retention.
    Pass catheter ( or measure urine with handheld U/S ),do routine blood and urine invetigations and pregnanacy test.
    Once patient is comfortable do U/S abdomen to rule out or confirm any mass in abdomen and to find reason of retention.further management according to your findings.

    Zafar
  9. zafar

    zafar Guest

    Result of AMC clinical exam held in Gold coast on 28/7/7

    Hi all,

    40 candidates passed the exam,14 reset and 18 failed.
    Good result compare to other centres in last few exams i think.
  10. samora

    samora Guest

    congrats friend and good luck in your future plans I hope you will find job soon
  11. jinali

    jinali Guest

    congrats!!!!1

    could you kindly tell us how you answered these Q's?
    that'll be really great....
    thanx
  12. zafar

    zafar Guest

    Obesity

    My Answer,

    Took hx of obesity,its etiology,complications patient had,including full hx of past medical,surgical,drugs,OG,social,drugs and alcohol.

    Explained to pt

    1) Etiology of obesity,like
    life style,
    medical conditions and
    drugs

    2) complications of obesity including almost every system in boday from top to toe
    sking,cns,respiratory,cvs,git,MS,endocrine,visual,GU,sexual etc

    3) Investigations to exclude medical condition and complications

    4) Mangement

    life style mainly diet and activities

    medicine and its side effects

    surgical


    and most important follow up of the patient
  13. zafar

    zafar Guest

    Thanks

    Hi samora ,

    thanks .i am already doing job as PHO in emergency and already in training programe of royal college of emergency medicine fellowship.

    i will answer questions as i did in exam one by one.Dont have too much free time realy to answer all Qs right now.

    zafar
  14. samora

    samora Guest

    That is alright. It is really kind of you to reply and answer. Good luck and I wish you a very blossom career
  15. samora

    samora Guest

    the reply was to dr. zafar!!!!
  16. Guest

    Guest Guest

    dear dr ZAFAR,

    i see u have passed amc mcq and clinical

    and i feel much more sincerity in ur repliies unlike some others who want only to discourage and frustrate young doctors wishing to come to australia.

    this encouraged me to ask for ur advice about:

    - for the amc mcq.....which source do u suggest: toronto notes or general practice by john murtagh?

    - u said u are workin as a pho emergency medicine and in a place accredited by the royal college for fellowship.......so how u get this job?.......is it easy after amc mcq to get such positions?.....or u have postgraduate qualification from home?.....and r there vacant accredited positions in other specialities?

    -what about the supervised internship after amc clinical...... is it true that it is becoming more difficult for amc graduates and that positions for amc graduates r decreasing every year?

    i just dont want to spend time and money investing in amc and then they say oh sorry no enough internship positions?!!!!!

    and what r the job opportunities for a fresh graduate not holding pg qualifications and only passed amc mcq and amc clinical ?

    am sorry for these long questions but i really in need for ur advice to choose my destiny correctly

    my best wishes for you
  17. samora

    samora Guest

    Hi Dr. Roma. Have u passed the exam or not?? I hope that u have. good luck
  18. gladiator2

    gladiator2 Guest

    hi all!!
    i am appearing for amc clinicals next week in mel. it would be good if u guys can devote a little of ur precious time and lemme know the answers.
    ta
    glad
  19. jinali

    jinali Guest

    hi Roma and zafar.
    thanx guys for helping all of us by giving us feed back.
    I know that you guys are really bc adn doing yourbest to help us.

    i would greatly appreciate if you could answer me 2 Q/s....
    1.what should you do for the woman with placenta prvia?I would admit her for LSCS when term,but i dont know if its appropriate to do it right away or wait till she is term to admit.

    2.what did you do with the woman with Mukti nodular goitre?

    I would appreciate if you could answer these 2 Q/s for me.thanx a heap.
    and all the best
  20. roma

    roma Guest

    HI Samora

    I passed the exam but i am still waiting for the feedback and result card. Have u got it yet?

    RE the questions- The lady with placenta previa- in the question it eas given that she was 80km from this hospital and abt 250km from a tertiary hospital if i remember the qustion correctly. So i told her that she will need a CS at term and referred hr to hospital straightway. Then she asked me abt any precautions she need to take and i told her to avoid any heavy physical work and abstain from sexual intercourse. Dont know whether it was right or wrong.

    The lady with Multinodular goitre- Since she was euthyroid and was not having any symptoms of hyper and hypothyroidism, so i didn't start her on any medications but told her that since multinodular goitre has tendency to go into hyperthyroidism, she will need antithyroid drugs in future and referred her to an endocrinologist. Then she asked me - What abt the lump in my nack, i feel very embarassed abt it. Then i told her that we can consider surgery for cosmetic reasons and then she asked me the complictions of surgery.

    S, don't know whether it was right or wrong. Feedback from anyone would be welcome.
  21. jinali

    jinali Guest

    thanx roma..........
    congrats on passing the exam.
    if you have time,could you just write how you answered each of the stations that'll be great,even without feedback.thanx a heap.
  22. Guest

    Guest Guest

    thanks, roma and zafar
    14- A lady treated for depression in hospital and then discharged home on risperidone 8mg and mirtazepine 25mg. Task- Further h/o, relevent physical examination and mangemet

    I wonder this station is about the side effect of antidepressant or is the pt need to be admitted to hospital or refer to psychiatrist?
    really apprieciate your briefing
    :D
  23. roma

    roma Guest

    hi.. this lady came to u for repeat prescription and as u were talking to her, you noticed that she was having resting tremor of her hands.Task was further h/o, Physical examination and management.

    I asked first abt depression symptoms for which she was treated and then focussed on EPS- mainly dizziness to rule out postural hypotension, rigidity, restlessness and tremors. In the examination, i told the examiner that i would first like to measure the BP to rule out postural Hypotension,then mentioned abt no abnorma orobuccal movements. She was having tremors of both hands in resting and outstretched position and cog wheel rigidity of her arms. Then i asked the pt to walk few steps to look for any parkinsonian symptoms.

    Management- reduce the dose of rsiperidone to 4mg.
  24. Guest

    Guest Guest

    thanks roma
    8- A pregnant lady 40weeks came with non engagement of head. talk to the pt abt the likely cause and manage.

    Is the lady breech presentation? Is the task including taking hx, ask for investigation and then mamagement?
    is this pt high risk pregnant? previous us, concerning fetal wellbeing?possible C-section, depending what informations you get from the pt and examiner

    again preciate your briefing
  25. laoerlaoer

    laoerlaoer Guest

    Study partner wanted

    AMC clinical exam in Oct. 2007
    Wish to study in a small group.
    Please contact me on 0410109556 after 5pm everyday.
    In Perth, WA

    Regards,

    Laoer
  26. Guest

    Guest Guest

    Risperidone can cause dose-dependent EPS, reduce its dose is the way go, also give short term benztropine 1mg bd may help tremor.

    Mirtazapine is a dual action anti-depressant (just like popular Efexor), I don't think it causes resting tremor which is a part of parkinsonism.

    So don't mixed up anti-depressants and anti-psychotics.
  27. Guest

    Guest Guest

    [thanks roma
    8- A pregnant lady 40weeks came with non engagement of head. talk to the pt abt the likely cause and manage.
    Is the lady breech presentation? Is the task including taking hx, ask for investigation and then mamagement?
    is this pt high risk pregnant? previous us, concerning fetal wellbeing?possible C-section, depending what informations you get from the pt and examiner
    again preciate your briefing]

    For patients presenting with breech or unstable lie, think about its causes. ask yourself why the baby still lies high at 40 weeks. Someting must be wrong. This the clue. just use common sense to work out yourself.
  28. roma

    roma Guest

    A pregnant lady 40weeks came with non engagement of head. talk to the pt abt the likely cause and manage. Is the lady breech presentation? Is the task including taking hx, ask for investigation and then mamagement?

    is this pt high risk pregnant? previous us, concerning fetal wellbeing?possible C-section, depending what informations you get from the pt and examiner

    In this question the lady was primi with normal antenatal h/o..no risk factors and when i asked whether she knows anything abt the position of placenta from her previous u/s, she told me that it was high. The lie was cephalic and there were no associated risk factors. So,i discussed abt placenta previa, Large head, cephalo-pelvic disproportion with her and referred her to a gyneacologist. She then asked mewhether she is likely to need a CS as she is already 40wks and head is not engaged. I told her maybe depending on cause of non engagement. Then examiner asked me if no cause is found and everything is normal,what would be ur management. I was not very abt it.

    I asked one of the obsterician here and he told me that it is normal even in primi for head not to be engaged till the labour starts. So, always keep that possibility in mind but mention the other causes as well.
  29. Guest

    Guest Guest

    A pregnant lady 40weeks came with non engagement of head. talk to the pt abt the likely cause and manage
    thank you roma for your briefing.
    I guess you passed this station
    my opinion about the causes:
    1: the fetus: large baby( DM mother), hydrocephaly, or tumor of neck
    2:abnormality of pelvis: small size or irregular size
    3: uterus: fibroids, inefficient uterine activity or contraction, placenta previa(less likely, cause bleed early, in this case us show it is high)
    4: cephalo-pelvic disproportion
    5: prolong pregnancy?
    so referred to gynaecologist is right things to do
    if no cause is found, Mx will be confirm EDD,fetal surveilance(CTO,AFI),d/w induction of labour at 41week, possible CS if fetal distress

    any other thought?
  30. Guest

    Guest Guest

    9- DM lower limb examination
    hi, Roma
    How did you go with this station?
    what kind of qestions did the examiner ask you?
  31. omerfadl

    omerfadl Guest

    Brisbane group ?

    hi everyone

    If any one in Brisbane interested or already engaged in agroup (clinical),please e-mail me on: omerfadle@yahoo.co.uk

    thanks,

    Omar
    Brisbane
  32. Guest

    Guest Guest

    hi can I introduce my self?
  33. Guest

    Guest Guest

    My name is Ahmed egyptian qualified in Austria and want to migrate to Australia to live and practise medicine. I have tried to get some information in the embassy of Australia in Vienna without any benefit and also tried to know how the necessary steps are in the internet but there are a lot of sites and information that made me confused.
    please can anybody, who has been qualified in his homecountry and could succeed to get a visa to Australia, tell me in concise what I have to do.
    like for examble concerning the IELTS test , do I have to pass the test in ther british council in Vienna before applying for a visa or can I make it in Australia.

    Do I have to attain registration in the AMC before applying for a visa.
    thank you in advance.

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