please help us with the recall of march and April clinical

Discussion in 'Australian Medical Council (AMC) EXAM' started by Dr.S.alessawy, May 10, 2007.

  1. Dear doctor,
    please please help us with the recall of March and April clinical exam recall we have been crying for them and nobody answer why ??
    please help
    please :cry:
  2. Guest

    Guest Guest

    I got these from somebody, so wish to share with you guys.


    AMC Recall -28th April 2007 Melbourne

    1. Haemorrhoid (GP setting)
    Rectal bleeding in 25 y male, about 3 weeks. No other problem. Father rectal Ca at 49y.
    Task: Hx, PE, Ix, Mx
    Q from examiner: how to check haemorrhoid
    Q from patient: what’s high fibre diet



    2. Dysphagia (GP setting)
    50 y male with 15ys of reflux and heart burn. Increasingly difficult to swallow food. Decreased appetite, lost 3kg in weight.
    Task: Hx, PE, Ix



    3. Fibular fracture (ED setting)
    18 y boy, fell down and presented in ED with pain and swelling in his left ankle. You sent him for X-ray. X-ray has arrived and the patient is waiting for you.
    Task: Read the X-ray, explain the condition to the patient and answer patient’s questions, Mx.
    Q from patient:
    - how long do I need plaster
    - When I can recover



    4. Eye Examination / Myopia (GP setting)
    18 years old man come to you because RTA send him for eye check up, he have difficulty to see the traffic signs very well.
    Task: examine the eye and talk to the patient.
    On the visual acuity examination finding he has problem to read 6/18 then I did pin hole test to see refractive errors. Then I asked to do ophthalmoscopy to detect pathology in the lens, vitreous, and retina and rule out any serious problem. I arranged an appointment for them to see a specialist; he will give them lens or glasses (concave).



    5. Cardiovascular risk assessment (GP setting)
    A 50 y male came for check up. His brother just had coronary artery bypass
    Task: Hx ,PE, advice
    Hx of HT, no symptom, smoking for 20 ys, BMI 30, abdominal obese.



    6. Migraine (GP setting)
    A 38 year-old woman came to you with severe Headache and vomiting. She had a history of Migraine 2 months ago. The CT scan result doesn’t suggest any tumor.
    Task : Take relevant History ( not more than 2 minutes)
    Explain the condition to the patient
    Mx


    7. Hypothyroidism (GP setting)
    60 y lady presents with tiredness, weight gain, intolerance to cold weather. TSH increased T3, T4 reduced
    Task: Hx, PE, Ix, Dx and DDx,



    8. Nut induced anaphylaxis (GP setting)
    A 22 y male had a history of eczema and asthma. Last night in the party after eating a walnet he started having wheezing, SOB and urticaria. He had peanut allergy at 7, 9 and 17y. your diagnosis was nut allergy.
    Task: Counselling



    9. Viral bronchiolitis (ED setting )
    Mother brought on her 4 month baby to the A & E department. Baby has cold with runny nose 2 days ago. Last night child developed dry cough, SOB and fever. (AMC video was provided) can see accessory muscle movement.
    Task: Take a focused history from the father
    Ask physical examination findings from the examiner
    Counselling and Mx

    Q from patient:
    - Can I take my child to go home?
    - How long you want to keep my child in hospital?
    - What are you going to do for my baby?
    - Oxygen, then examiner ask why? (O2 Sat 91%)
    - Are you going to give my baby antibiotics?



    10. Glandular fever/Irritable hip (ED setting )
    A 3 y boy sudden hip pain from this morning. Refused to walk. Two weeks ago had sore throat.
    Task: Hx, PE, Ix, Mx
    Hip X-ray showed: just effusion, no fracture or other bone problem.
    FBE: can see atypical lyphocytes



    11. Encopresis, constipation (GP setting)
    5 years old boy is soiling his pants for the last 6 weeks.
    Task: Relevant history and PE from the examiner
    Discuss management with the mother


    12. Gestational diabetic (GP setting)
    A 34 years old lady with 28 weeks pregnancy came for antenatal checkup she had a fasting level of blood sugar at 7.5 and prandial level was 9.5.
    Task: Hx, PE from examiner and talk to the patient about your Management plan.


    13. ovarian cyst (GP setting)
    28 y lady have overian cysts L 5mm and 20mm, R two 10mm from U/S
    Task: Hx, PE, Mx

    14. Pre-eclapsia (GP setting)
    25y primigravida attends GP at 36/40 w complains of generalized oedema and blurred vision, BP 180/120, urinalysis significant proteinuria
    Task: Hx, PE, Ix, Mx.



    15. Side effects of anti-psychotic medication/ Risperidone side effect
    Young man has schizophreniform disorder for some years and on antipsychotic medication. Stopped medication and since 3 days developed disordered thoughts, no auditory hallucinations. A GP prescribed Risperidone. He took 2 tabs in the night and 2 tabs in the morning and following which he developed dizziness: On examination BP was 140/80 lying; 110/75 standing
    Task: talk to the patient
    Assess the patient
    Hx: Have hallucination, Delusion, no suicide

    Q from examiner:
    Why is he getting dizziness?
    What should you do as a GP?

    23 yo man, diagnosed with schizophrenia 2 yrs ago, was on antipsychotics, which was stopped by Psychiatrist 6 months ago as symptoms under control. Patient developed delusion/perception symptoms recently, similar to his previous SCZ symptoms. Then his GP started him on Riseperidone, which he understood that 2 tablets every day. He took 2 tab last night, and 2 tab this morning. He c/o dizziness, esp. when standing up. Now he is in ED.
    Task:
    - further Hx (no psychiatry history)
    - Relevant PE findings from examiner
    - explain to pt the diagnosis and psychiatry care and management.
    Hx: as above, nothing excited, normal oral intake, no on other meds except Riseperidone, denied homicidal, suicidal ideation, denied visual or auditory hallucination.
    PE: BP sitting 110/80, standing 90/75 something like that, significant postural drop, no signs of dehydration, other PE unremarkable.
    Explain: dizziness due to the side effect of riseperidone, we call orthotic hypotension. It is common. Could be due to you took the 2nd dose in 12 hrs from the 1st dose. Recommend take it ease when change position. Stay in ED and wait for psychiatrist review for SCZ and medications. (some candidate said pt need to be involuntary admitted as SCZ, but I thought this patient has insight, and willing to stay in ED for psy. review, I didn’t admit the pt)



    16. Post traumatic stress disorder
    A policewomen has been sent to your clinic by the department as she seems to miss the first day after every new roster.
    Task: Hx for 5min
    DDx, at least three
    On history, she witnessed an incident six month ago in which her friend was injured. On enquiry she said she has increased her alcohol intake and feels depressed
  3. NEWEST GUEST

    NEWEST GUEST Guest

    thanks and an offer for discussion of clinical topics


    tnx excell.you are an angel.
    hi guys out there who are preparing for their clinicals ,how about some serious online dicussions about the afore mentioned cases.only serious members are to try .try writing down how you personally would manage each case and each one of the rest is to add in apoint .what do you think?
    shall we start?
  4. Dear Doctor,
    First of all I want to thank you for your kindness .We have been crying for the recall and nobody respode

    It is a great idea to discuss
    I will start with this case

    14. Pre-eclapsia (GP setting)
    25y primigravida attends GP at 36/40 w complains of generalized oedema and blurred vision, BP 180/120, urinalysis significant proteinuria
    Task: Hx, PE, Ix, Mx.
    In this case there is no much time to take Hx since it is an emergency and you need to admiite her immediatly

    I will ask
    any epigastric pain
    any SOB
    any vaginal bleeding + fetal movment ( abraptio Placenta)
    have you had HT before pregnancy
    are you on any medication
    ANC is it regular
    I will check Bp
    Oedema
    HR
    FHR
    Fundus hight /any tenderness
    reflex
    I will put I V line and Urin cath
    I will give Mgso4 IV 1g
    Hydralizin Iv
    MY aim to keep BP 140/90
    Check bpr 2hourly for 6 hr and then 4 lhr
    and urin for protien 2/day
    mean while i will check reflex and urine output , for any MgSo4 toxisity
    prepare for CS

    Thank
    SABA
  5. NEWEST GUEST

    NEWEST GUEST Guest

    answer to dr s.elesawy

    dear dr s.
    if you notice the question its a gp setting ,i dont think you can administer mg so4 in a gp setting,
    so my response would be to ask her about all the signs of imbending eclampsia as u kindly noted i.e headach,blurred vision, backache ,epigastric pain etc + antenatal regular questions as follow up. wt gain per week , drugs bld gp ,history of stillbirths etc
    do exam as yoy stated includig b.p pulse reflexes and abdominal exam and then describe to the pt her condition and tell her that it,s an amergency and discuss with her the importance of being admitted straight away.i wont mention mg so4 at this stage .
    i,m not sure about hydarlazine if i can give it at a gp practise or not?
    this needs to be answered by one of the guys who sat 4 z exam.
    appreciate the help.
    welcome guys to the discussion.lets finish this case first before moving to the next one.
    tnx to all.
  6. indp

    indp Guest

    If in doubt say will call an ambulance and nearest O & G consultant for advise and manage accordingly.
  7. Guest

    Guest Guest

    :arrow: Hi everyone.I have got a resit in april clinical exam-melbourne.I need a study partner who lives in melbourne & have done a bridging course. I live near footscray. If anybody lives near to my place it would be great.My mobile-0401807576
  8. Dear Doctor,
    thank you for your notce
    you are right , I have not read the quetion carefuly I dealed with it as I was at the ED.
    regarding MGso4 yes you can not give it at GP
    But if you where at the hospital it is the drug of choice for PIH
    because it decrese BPr , increase the blood follow to the placenta, decrease the chance of endothelial injury .


    in this case you will call an eambalnce .

    Thank you
    All the best
    Saba
  9. NEWEST GUEST

    NEWEST GUEST Guest

    DEAR DR S . AND ALL OTHERS .THANK U 4 YOUR ADDITION ,I THINK YES,I WILL CALL AN AMBULANCE AFTER DISCUSSING THE NECESSITY OF URGENT ADMISSION WITH THE MOTHER.
    OK NOW THAT WE ARE FINISHEDWITH THIS TOPIC,LETS MOVE ON TO THE CASE OF BRONCHIOLITIS IN A 4 MONTH OLD INFANT.
    SETTIND IS ED:
    SO TAKE HISTORY FROM FATHER:
    1- I WILL INTRODUCE MYSELF AND ASK THE FATHER WHAT IS EXACTLY THE COMPLAIN OF HIS CHILD.

    2- I WILL ENQUIRE ABOUT THE BABY, GENERAL HEALTH SINCE HE WAS BORN.THAT IS ANY COMPLICATIONS REGARDING HIE PREG AND BIRTH.I WILL ALSO ASK ABOUT HIS FEEDING ESP AT THIS ILLNESS AS REDUCED FEEDING IS ON OF THE INDICATIONS OF ADMISSION.I'L ASK IF HES BREAST FED OR OTHERWISE.

    3-I WILL MOVE ON TO ENQUIRE HOW DID THE ILLNESS START?DID IT START WITH OTHER FAMILY MEMBERS.

    4- ILL ASK IF DAD OR MUM ARE SMOKERS?AND IF THERE IS ANY FAMILY HISTORY OF ASTHMA AND ALLERGIC CONDITION.

    I WILL MOVE ON TO THE EXAMINER AND ASK ABOUT INV WHICH ARE:VITAL SIGNS OF THE BABY AND OXYGEN SATURATION
    FULL BLOOD COUNT, CHEST X RAY .

    I WILL TELL DAD WHAT IS BRONCHILOITIS ,THAT WE NEED TO ADMIT THE BABY SO THAT WE CAN KEEP HIM UNDER OBSERVATION ESP THAT HE'S UNDER 6 MON OF AGE.
    WE WILL KEEP AN EYE ON HIS OXY LEVEL IN THE BLOOD AND WE MIGHT GIVE HIM EXTRA O2 IF HE NEEDS IT BY MASK OR VIA A TENT.WE WILL ALSO OBSERVE THR RATE OF HIS BREATHING AS WELL AS HIS FEEDING AND TEMP IS TO BE RECORDED IN A CHART.PARACETAMOLE IS TO BE STARTED IF TEMP. DOESNT SETTLE .
    SINCE IT S A VIRAL ILLNESS NO ANTIOBIOTICS AT THIS STAGE EXCEPT IF OVERINFECTION OCCURS.
    WE WILL KEEP HIM IN HOSP TILL GENERAL COND IMPROVES THAT CAN TAKE A DAY OR LONGER.

    THIS IS MY WAY OF TACKLING THE SITUATION. PLZ LET ME KNOW IF ANYTHING IS MISSING OR WRONG. PLZ LETS HURRY UP WITH ANSWERS SO THAT WE CAN MOVE ON TO THE NEXT QUESTION.

    TNX.
  10. Thank you doctor
  11. Here with anohter case


    2. Dysphagia (GP setting)
    50 y male with 15ys of reflux and heart burn. Increasingly difficult to swallow food. Decreased appetite, lost 3kg in weight.
    Task: Hx, PE, Ix

    first I will introduce myself
    and ask
    1.when the difficulty started
    2.is it constant
    3. any pain
    4.for sold or fluid , obviously it is for sold ,, but i will ask about fluid is drinking fluid as fast as usual
    5. is it difficult to intiate swalling
    6.Does food regurgitated in to the nose
    7. do you feel any lump in your throat
    8. vomiting
    9.Haemat, malena
    the Diagnosis is obviously Ca oesophagus

    But i will put being restriction of the OEsophagus as DDx
    Investgation will be
    FBC
    ESR
    BA swallow
    Endoscopy + biopsy


    If Iam wrong please let me know
    thanks
    Saba
  12. Guest

    Guest Guest

    Dysphagia

    Dear doctors
    Thank you for this discussion
    Here is my answer for this case

    I think we have here 2 problems:
    1-the progression of dysphagia
    2-symptoms and signs of malignancy

    So another way to approach this patient would be:
    Greeting and introduction then,
    As far I know you have been complaining of heart burn and reflux for 15 years, so can u tell me more about that?
    Have you been on any medication for this symptom?
    Have you done any test?
    Have you had an ulcer before?
    Do you smoke or drink alcohol?
    Have you been taking any analgesics regularly?
    What about your diet? Body weight?

    And about the difficulty in swallowing: can you tell me when did it start?
    Is it progressive or the same?
    Is it more for solid or fluid?
    Any water brush or regurgitations?

    Also you have lost wt and your appetite recently, so have you been feeling tired as well?
    Any pains in your abdomen, apart from the heart burn?
    Any masses or swelling in your abdomen?
    Any cough, chest pain, coughing or vomiting blood?
    Any voice changes?
    Any bloody vomits, blood from the back passage, or black stool?


    Past history: any HTN, DM, Heart Disease
    Hospitalization, surgery, allergy, medication
    Family history of cancer

    EXAMINATION:

    General appearance:
    Pallor
    Cyanosis
    Jaundice
    Body Weight


    Vital signs
    Abdominal examination; any pain, hepatomegaly,ascites.
    Heart and lung.
    Lower limb edema.

    Investigations

    FBE, LFT, RFT, U&E, URINE ANALYSIS.ESR
    CXR, CT, ABDOMINAL U/S
    BARIUM MEAL
    ENDOSCOPY,biopsy

    DD:
    Malignancy
    Achalisia

    Waiting for feed back
    thank you
  13. NEWEST GUEST

    NEWEST GUEST Guest

    hello all doctors out there esp dr s. and dr. mina.
    thank you for your responses.
    however i think there are few additions and notes to be made.
    i think your differentisl disgnosis is good dr. s , i dont agree that achalasia should enter here in this scenario,

    my approach would be:

    i will introduce myself to the pt and ask him about his main complaint.,which will be his dysphagia and wt loss.

    so first i will elaborate more on that symptom as part of history of presenting complaint:
    1- when did it start?

    2-how did it strat? to solids first and then progresed to liquids or is it to solids only ?

    3-is it painfull to swallow( odynophagia)?

    4-is it associated with any other symptoms such as:

    cough, food regur esp at night and on lying down,recurrent chest infections ,feelinf of fatigability ,vomitting of blood or food eaten days before .black stools or malena.

    5-i will look for signs of metastasis such as chest pain change in voice abd swelling and lower limb swelling.


    then i will move to past history of ulcer ,if yes was it diagnosed by endoscopy? what treatment did he have for it? did he follow up the progress of his ulcer?any smoking alcohol nsaids ingestion or others?what does he take now to relieve his symptoms?

    and definitely iwill ask about family history of malignancy?

    on exam:
    first iwill look at the pt's nutritional status ,is he dehydraeted ( this is in case he requires asmission for prentral feeding)
    that was my only addition to your remarks dr mina and dr s.
    as for the rest of the exam and investigation it will continue as dr.mina pointed it out.

    plz advice back if you think what i said is missing or wrong.
    thanks 4 your cooperation.


    by the way what are you guys reading for psychiatry?plz answer back asap.
  14. Guest

    Guest Guest

    Dysphagia

    Differential diagnosis of dysphagia : oxford hand book page 196

    in the examination: we forgot the cervical lymph nodes


    for psychiatry u can study the blue print of the usmle and it is more than enough,and for the psychiatric history and MMS it is from telly o'connor

    good luck
  15. thank you all the doctor it is really good discussion
    I agree with all of you
    I just want to make a comment about puting acalacia cardia as a DDx
    I do not agree with that because it will be a dysphagia for liquid not sold since it is a spasm snd sold can overcome this spasm .while with malginancy it will be for sold because of a space occupying lesion while fluid can pass easly
    other wise everything was mentioned is great

    thanks
    Saba
  16. HELLO DOCTORS:

    THANK UOU DR. MINA FOR YOUR SUPPORT AND RAPID RESPONSE AND THANK YOU FOR POINTING OUT THE PSYCHIATRY BOOKS.
    AS FOR YOUR DIFFERENTIAL DIAGNOSIS ,I FULLY AGREE THAT ACHALASIA DOES ENTER IN THE DX OF DYSPHAGIA,HOWEVER TAKE THE HISTPRY AND THE PATIENT AS A WHOLE AND NOT JUST THAT ONE SYMPTOM.SO DEAR FRIEND IF YOU CONSIDER HIS P.H. OF REFLUX WHICH OCCURED 15 YRS AGO AND THIS NEW SYMPTOM OF DYSPHAGIA WOULD BE A COMPLICATION OF THAT PAST HISTORY.THIS I CONCLUDED BY READING THE SCENARIO PRESENTED ,SO THIS IS WHAT THEY WANT TO HEAR (CA OESAPHAGUS) WHAT YOU SAY NEXT DOESN,T MATTER AS LONG AS YOU MENTION THIS ONE FIRST.
    HOWEVER I WOULD DEFINITELY PUT BENIGN STRICTURES AS MY SECOND DX, AND SHOULD THEY ASK FOR MORE DX I WOULD PUT ACHALASIA ( BUT CERTAINLY NOT AT THE TOP OF MY DX LIST TAKING THE PT'S HISTORY INTO CONSIDERATION)
    PLZ LET US ALL BE PATIENT AND ACCEPTING WITH CORRECTING OURSELVES BEFORE OTHERS.
    AND DEFINITELY YES WE DID 4GET CERVICAL L.N.THANK YOU 4 POINTING OUT ALL THE SIGNS TO LOOK FOR WHILE EXAMINIG THE PT AS WELL AS YOUR WONDERFUL LIST OF INV.DR MINA.
    KINDLY ACCEPT OUR CORRECTING EACH OTHER,THIS IS HOW WE LEARN.I HOPE YOU DIDN'T GET OFFENDED INANY WAY.PLZ I'M WAITING TO HEAR YOUR RESPONSE DR.MINA AND DR.S
    GOOD LUCK TO ALL OF US MY DEAR FRINDS.
  17. Guest

    Guest Guest

    I agree completely with you .cancer oesophagus is the first diagnosis and like u said that what they want to hear,and everthing next is ok . so let us move to another case to discuss.
  18. OK DR.TIME TO MOVE ON.
    I WILL DISCUSS THE HYPOTHYROIDISM CASE .
    THE SETTING WAS NOT DESCRIBED.
    PT IS 60 YRS WITH SYMPTOMS OF HYPOTHYROIDISM SO I'M REQUIRED TO DO HX EXAM IX DX AND DD.
    FIRST I'L INTRODUCE MYSELF AND ASK HER ABOUT WHAT IS BOTHERING HER.
    THEN I'L ASK THE FOLLOWING:
    1- WHEN WAS SHE LAST WELL?

    2-HOW DID SYMPTOMS START?DID IT FOLLOW A VIRAL INFECTION?

    3-HOW DID SMPTOMS PROGRESS ,FAST OR SLOWLY?DID IT START AS HYPOTHYROID FROM THE START OR DID IT FOLLOW A PERIOD OF INCREASED ACTIVITY?

    4-I,L ASK ABOUT HER WT GAIN,CONSTIPATION TIREDNESS INTOLERANCE TO COLD ,SLOW MOVEMENT , SKIN CHANGES, SLEEPINESS ,HAIR CHANGES ETC?

    5- THEN I WILL ASK IF SHE NOTICED ANY SUDDEN AND RECENT CHANGE IN HER THYROID GLAND SIZE? DOES IT HURT?DOES IT AFFECT HER SWALLOWING OR VOICE OR BREATHING?

    6- ANY F.H. OF THYROID DIS?DID SHE RECEIVE ANY RADIATION BEFORE ? IS SHE ON ANY MEDICATION?ANY PAST HISTORY OF THYROID DIS FOR WHICH SHE RECEIVED TREATMENT OR HAD ANY NECK SURGERY DONE?

    THEN EX :

    HANDS:
    PALLOR,TREMORS,SWEATING ,PULSE.

    EYES;
    CHECK FOR EYEBROWS FALL OUT .EYE PUFFINESS.

    NECK?
    SIZE AND SITE AND NODULARITY MOBILITY RETROSTERNAL EXT, MOVEMENT WITH DEGLUTION AND PROTRUSION OF TONGUE .SKIN OVER IT AND AUSCULATATE FOR BREWING .LN. & NECK VEIN ENGORGEMENT

    EXAMINE CVS AND DO NEUROLOGY REFLEXES.

    DD IS CAUSES OF HYPOTHYROIDISM AT THIS AGE:
    1-MALIGNACY
    2 HASHIOMOTO THYROIDITIS
    3- DRUG INDUCED

    IX : FBC AND TFT.LIVER FUN TEST.
    U/S . IODINE UPTAKE SCAN AND IF THE THROID IS NODULAR FNAC.
    CXR FOR RETROSTERNAL EXT.AND IF NEED CT SCAN CHEST OR ABD IF MALIGNANCY IS SUSPECTED.

    OK FOLKS HERE I WENT BLANK SO NOW LETS OPEN THE FLOOR FOR DISCUSSION ANDPPPPPPPPPPPPPPPPPPLLLLLLLLLLLLLLLLZZZZZZZZZZZZZZZ
    BE QUICK TO ANSWER.
    WAITING.
  19. Guest

    Guest Guest

    I would suggest that any hypothyroidism /endocrine disorder be referred to a specialist.

    Do / ask / order any investigations you may want but always refer to a endocrinologist.

    As a general rule: If in doubt refer.

    Either you will be a GP or you will be a hospital doctor : you need to refer in all circumstances.

    This sort of proves / tells them that you are a safe doctor.
  20. Guest

    Guest Guest

    hypothyroidism

    :) your answer is nearly complete just some points to add:
    In the history I think we should ask about
    1-diet,iodine deficiency.
    2-cardiac symptomes like bradycardia,hypotension,
    3-Mood,sleep,activity,just to differentiate from depression

    In the examination
    Vital signs: may be bradycardia,hypotension
    skin :rough and dry

    investigation
    ECG
    BSL

    and in the management we will refere to endocrinologist to start her on throxine which will start by 25 micro/day because she is old and then increse it slowly every3-4 weeks till the optimum dose .
    follow up every 6 weeks until the symptoms corrected by doing TFT and ECG to monitor the heart .


    other wise everything else is perfect.
    thank you and good luck[/list]
  21. Dear doctor,
    I do agree with you all ,
    But I have some points to discuss .
    I thinks there are some points in the Hx
    1.Introduce my self
    2. What is your occupation ( hypo Thyroid effect their productivity)
    3. what is the presanting symptom , usauly wt gain , lethargy
    So I will ask how much wt have you put nad the duration
    4. what about your appetide
    5. bowel activitiy
    6. have you notice any recent changes in your voice
    7. can you tolarte cold wethear how many blanket do you use
    8.have you notice any lump or swalling in your neck?
    9.any difficulty swallowing food
    10.any changes in your skin ,hair
    11.any swelling in your ankles
    Phx
    - any medical conmdtion , especaily heart problems
    -any surgery thyrodactomy

    Are you taking any medication ?
    thiazide , lithum any raidio therapy
    Examination
    appearnce colour hair puffenes of the face
    vital singe
    thyroid examination
    reflexes
    non bitting Oedema
    CVS examination

    Inve
    TSH , T3/T4
    thyroid Abs
    US and Cxray
    Nuclear up take scan
    FNA
    ECG
    FBC <ESR,

    DDX
    Hashimoto thyroiditis
    drug inducing Hypo thyroidism
    Iodin dificinency

    treatment

    of cours thyroxin as one of the doctor said start with small dose
    SE is Angina to prevent it we use Propranalol

    I will follow up with TSH , I need to do Lipid profil also
    I think these are the main point to be discuss .
    you have mentioned a very good points and a very smart point but i htink these are the points to cover the exam


    All the best
  22. Guest

    Guest Guest

    Hi Dr Alessawy,
    what you are mentionning is very true however you have only 8 minutes in the exams which is very short to do a complete history/examination/DD/management. The examiner will focus on how you communicate with your patient rather than your extensive knowledge. You will have to focuse on one aspect, either history and management or clinical examination
    One thing that works well: always ask your patient if she/he understands and if she/he has any questions (that is also true in real practice).
    Alle the best to you all :D
  23. tnx for your feedbacks.time to move on.
    i'l talk about nut anaphylaxis station.task pt couselling.
    ok i'l start with introducing myself and asking the pt to tell me exactly what happened at the party ,what did he eat?how long after he ate the nuts did he start feeling unwell?what were his symptoms?
    what treatment did he receive? any intubation needed? icu admission ?and ask about f.h. of similar cond?
    i'l tell the pt that what he has is nut allergy which is life threatening and that this is alife long cond so he has to stay away frm nuts for the rest of his life.il also tell him that he needs to tell people around him his cond esp if he's invited to aparty so that they can inform him about which foods to avoid.
    he has to carry an epinephrine pen which is adevice that loks like apen and it has got inside the medication that is called epin.this med is life saving since it acts to counteract the effects of the nut which is regresses the swelling of his upper resp airway which could suffocate him to death if not dealt with promptly.it also relaxes the lower airways and stops them from narrowing down so that his breathing is less laboured.so another good idea would be to teach the people around him how to use the pen in case he is unable to do that.
    i will also suggest to him to wear a bracelet with his cond and who to contact or what to do in case he passes out and is unable to help himself.


    this is how i would handle this case.
    plz advice about the following:
    how the epi pen is exactly used?the way of using it?as i'm not familiar with it?

    i urge doc.who are familiar and confident about the psychiatry and obs cases to come foreward and discuss these cases as i'm not v.good at these issues.this is for the benefit of all.

    tnx.
  24. Dr. Sus

    Dr. Sus Guest

    Combined OCP is not given after menopause because:

    a. breast cancer
    *b. endometrial Ca
    c. Ca ovary
    d. hypertension
    e. venous thrombosis

    Endometrial hyperplasia is MOST LIKELY to be found in:

    a. ovulating woman
    *b. an obese diabetic woman
    c. a woman on cyclic combined oral contraceptive pill
    d. woman on Depo provera for endometriosis
    e. woman with IUD

    . Foetal distress is more common when foetal head is in the OP position. The most likely reason for the increased incidence of foetal distress is:
    a. The prolonged labour which often occurs.
    b. The use of forceps to deliver the child
    c. The increased pain relief required in labour
    d. meconium aspiration in labour
    *e. The increase resting intrauterine pressure which accompanies the incoordinate uterine action.

    With regards with liquor amni, all of the following are true EXCEPT:

    *a. anencephaly is associated with oligohydramnios.
    b. Oesophageal atresia is associated with polyhydramnios.
    c. bilirubin is a normal finding below 36 weeks of gestation.
    d. Decrease in volume after 36 weeks.
    e. can be sampled to determine fetal sex before 16 weeks.


    The most important initial action to be taken in the management of a septic abortions is:

    a. serum human chorionic gonadotrophin estimation
    b. ergometrine administration
    c. curettage
    *d. direct smear and culture to identify the infecting organism
    e. antibiotic administration
    .
    A multiparous lady presents at 37 weeks gestation wiwth breech presentation and ruptured membranes. No signs of labour. What would you do first?

    *a. per vaginal examination
    b. ultrasound examination
    c. start syntocinon
    d. Caesarian section
    e. Xray pelvimetry
    . The treatment of choice for Ca of cervix Stage II is

    a. partial hysterectomy
    b. excisional biopsy
    *c. radiotherapy
    d. chemotherapy
    e. hormonal therapy



    After irradiation of the cervix due to carcinoma, which of the following organs is more likely to be affected?

    *a. rectum
    b. bladder
    c. small intestine
    d. large intestine
    Which of the following is/are main support of the uterus?

    a. round ligament
    *b. cardinal ligament( transcervical)
    c. uterosacral ligament
    d. broad ligament
    e. pericervical ligament
    A 37 week gestation, multigravida, with breech presentation comes with ruptured membranes, but was not in labour. What will be your initial management?
    *a. per vaginal examination
    *b. induction of labour with an oxytocin drips
    c. CS
    d. emergency ultrasound
    e. pelvimetry

    Asthma in pregnancy need
    a. less medication than non pregnant
    b. more medication than non pregnant
    c. Hydrocortison is contraindicated.
    d. aminophylline is contraindicated
    e. salbutamol spray is teratogenic

    3. What is true of squamous metaplasia of the cervix :

    a. premalignant
    *b. a physiologic phenomenon
    c. associated with viral infection
    *d. it is a source of abnormal cells
    e. hysterectomy should be done
    f. a cone biopsy is necessary
    In Australia , the most common cause of urinary incontinence is:

    a. vesicovaginal fistula
    b. 50% of cases have more than 3 children
    c. bladder reflux
    *d. needs urodynamic studies


    Clomiphene can cause all except:

    a. multiple pregnancy
    b. fetal deformityh
    c. inappropriate luteal phase
    d. shortens luteal phase
    e.
    whats the right answer?
    b/d


    b is correct amcq book q 73
  25. samar78

    samar78 Guest

    Thanks for these cases and comments wish u all good luck
  26. Guest

    Guest Guest

    Hello everyone

    I tried hardly before to get these recalls as I was gasping for it but no one respond nor reply??!!! That's really sad. Howeverfor those how live in sydney you can go to Westmead Hospital and study there. It's really helpful as you 'll meet lots of doctors like you. the good news is that I have passed the test and wish you all the best of luck :D

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