Tuesday, 29 September 2015

PLEASE SHARE YOUR EXPERIENCES WITH AMC CLINICAL EXAMINATION - 

SUCCESSFUL ATTEMPTS / 

REPEAT ATTEMPTS 

I was one of the AMC candidates and passed AMC clinical exam - retest. I gained a lot of informations in study groups. So I think it will be better and more happy to share my experiences to the ones who are preparing for this exam. I am sorry this is going to be too long to read.

This is only for the people who are not working in Australia and have no idea how will be the exam and desperately struggling for this exam.
Friends don't take too much time for the preparation. It always depends on the individuals capacity. But for a person like me who's forgetting whats been studied, a full 4 months are enough.
Finish the Hand book, atleast read for 3 to 4 times, know what are the critical points. Atleast you will get 1 or 2 cases from HB.. max even 4. So study it!
Karen or VMPF, A must read one. Beleive me it's very useful. But dont always memorize the same answers. Because guideline changes, so for each and every important topics know the guideline answers. Remember you have only 7 mints. Prepare what you have to inform the patient in that 7 mins. 
AMC IS NOT TOO HARD FOR THE CANDIDATEs WHO DONT KILL THE PATIENT. BE NICE TO YOUR PATIENT.
Start with studying examinations. Write what you have to do and practise!!! DO IT IN A REAL PERSON. ON YOUR PARTNER, FRIEND OR WITH SOMEONE. Pls dont skip that.. 3 or 4 Ex cases in exam!!! When studying practice how you are going to instuct the pt. During the test examiner will help you. Time is not an issue if you practice more than 10 times.. even more!!! Go in an order.. don't stuck with too much of special tests. Know the basics, learn the dermatomes, learn the muscle groups. Take enough time and prepare a good guide for ex. 

The main topics are really a little. For an example in paed resp, CVS, ortho, neuro, allergy rashes and infections....

Prepare your own notes with the help of karens/ VMPF. Write down your history taking format and examination for each main topics, it's going to be the same. I prepared by writing a common format for each main topics and just noted the answers In a point format for easy reference for each sub topics. Then when you study again it will be easy for you. You need atleast 2 months to prepare these. So you would have gone guidelines by this time too. Then what you have to study become very less.
The most important one is how you are dealing in an exam. Remember your are being marked for the attitude too. So learn how you are going to wish your pt. When taking history lean forward, listen your patient, have an eye contact, nod your head, change the tone of your voice accordingly. Show that you are listening your pt. When taking history go in an order when appropriate. It will be really annoying if you ask here and there. But of course you can get a reasonable marks with that too. But may affect your global score. When asking examination be nice to your examiner. Target the main system. Gen appear, vital signs, hydration, BMI, GROWTH CHART, neck stiff, ENT, lymph nodes, carotid bruit, fundoscopy.. you dont need to ask everything in every cases, but you should not miss when appropriate. 
In management cover the critical points. You dont need to go too deeply at the same time.. you cant overload the patient with informations and medical terms. When using medical terms explain it briefly.. itz difficult, it really needs practise. KNOW THE CRITICAL POINTS ALL THE TIME. Explain the condition, in 1 or 2 sentences. Quickly draw a diagram. You don't need to be an artist, examiners know that you will draw better in a real scenario. This is to get one tick from the examiner. Admit/ or follow up, investigation, adv and dis adv of that condition, reassure!!!!!!!!!! Follow up, contact tracing, notify DHHS, Safe sex, STI, CLEAR RED FLAGS, materials, follow up, review. So know what's important. 
Frankly AMC is not too hard, but frustating of course, especially for who fails the exam. Dont sit for an exam with out proper preparation, just like me. For some, luck plays, but not for the most of us. So pls, prepare and sit, and when you fail dont loose your hopes. I was not a brilliant one, but not a dump too. Just followed what I have written above. I didnt come out with all big answers during the exam. I believe this is true with the other passed candidates. defa varies for each and every individual. Examiners are not always bad. They mark what your doing. Your answers are being recorded. So they just can't fail you just like that. Their intention is not to fail you. They help through the test. But 1st impression is imp. be nice to your pt. 
I know this is too much of words. Hope this will help someone who is starting to prepare. DONT EVER SIT THE EXAM WITHOUT STUDYING UNLESS YOU WANT TO TRY YOUR LUCK. AND NO POINT IN BLAMING THE PASS RATES WITHOUT A PROPER PREP. You will definitely pass if you do it to the reasonable level. Always play safe!

Monday, 28 September 2015

DYSPHAGIA

DYSPHAGIA

DD:

CARCINOMA

BARRETS OESPHAGUS, PEPTIC STRICTURE

TIA STROKE

THYROID SWELLING

PHARYNGEAL POUCH

SCLERODEMA

HYSTERIA/GLOBUS HYSTERICUS

MEDICATION INDUCED/ RADIATION

HISTORY:
Duration
Suddenly/ Gradually
Progressive
Liquids/ Solids/ Both
How Many Mouthful/ Full Meal

  • Any LOA/ LOW
  • Bad Odour/ Reflex/ Tummy Apin/ Bowel Motion/ Lumps/Bumps
  • Hoarness Of Voice/ URTI/ SOB/ Chest Pain/ Neck Swelling
  • Numbness Of Face/ Body
  • Bluish Discolouration Of Hands
  • Stress/Mood
  • Previous Hx Of Ca/ Fam History

SADMA, SOCIAL DETAILS

PE:

General Appearance – BMI, Pale, Dehydration
Vital Signs
Hands – Auto Immune Disease –    Cyanosis
                                                                 Sausage Shaped Digits
               Flapping                 
ENT & Lymph Nodes, Throid
Esophageal Obstruction Test

Indirect Laryngoscope

Chest & Heart Examination

Abdomen
Digital Rectal Examination

Neurology – Cranial N Examination

INVESTIGATION:

FBE ESR/CRP U/E RFT LFT
CXR PA
Barium Swallow
If Endoscopy Normal   ?Dysmotility Disorder

MANAGEMENT:

Cancer – UGIE & BIOPSY
                  Preliminary Contrast Imaging – BARRIUM SWALLOW - Site Of Stricture &                               Extrinsic Compression

CT to Stage
Speech Therapist


Sunday, 27 September 2015

Ear examination

EAR   EXAMINATION 


General appearance 
Vital signs

Inspection: facial / skull defects
                         Normal set ears
                         No external ear abnormality- normal pinna, no swelling, discharge or redness
            
No mastoid tenderness/ Tragus

Otoscope- Ear canal - no redness/ discharge/ wax(impacted cerumen)/ cholasteatoma
                      Tympanic membrane - normal translucency/ no fluid level/ movement

No nasal septum/polyp
Throat - tonsils

Whisper test

Rinnes/ weber test


( Tests- < 4 years - tympanometry.  > 4years - pure tone audiometry)




Saturday, 26 September 2015

Rheumatology History

RHEUMATOLOGY - HISTORY 

DD:
Rheumatoid arthritis 
SLE
Osteoarthritis 
Psoriatic arthritis 
Connective tissue disorder - dermatomyositis
Reactive arthritis
GOUT
Trauma

Pain - started suddenly/ gradually
           Progressing?
           Bilateral/ Joints involved
           Severity/ aggravating and relieving factors
           How this is affecting the day to day activities?
           First episode?

Associated symptoms- morning stiffness/ restriction of movements/ 
                                      swelling/ redness/ hot to touch

  • Trauma
  • Fever/ flu like illness
  • Rash/ oral ulcers/ photosensitive rashes(SLE)
  • LOA/ LOW/ feeling tired
  • Nausea/ vomiting/ diarrhoea/ water works
  • SLE- SOB, chest pain, headache, seizure ( headache- if polymyalgia Rheumatica to exclude TA)
  • Dermatomyositis- muscle aches & weakness
  • Raynaud's phenomena ( finger/ toes--- pale, blue, red)
Females - periods, pregnancy, HIV/ STI
MOOD 
Smoking, alcohol, medication, PMH
FH- RA, SLE, psy illness
BACK PAIN - Patient Education 

Back bone- spine is made up of many bones called vertebrae. In between each vertebrae there is a cushion like structure called disc.
The spinal cord is protected back bones. Disc can bulge out and press the nerves here.
(DRAW)

Cause- heavy lifting in a wrong way, bad posture
Risk factors- lack of exercise, increased weight, mental stress

Management:

1. Pain killers- PCM, ibuprofen, panadeine, muscle relaxants - diazepam

2. Move around as soon as possible, if resting for a longer period - slow recovery & persistent            pain

3. Medical certificate and Centrelink support for 1- 2 days
    Social worker, occupational therapist if needed

4. Physiotherapy, education on manual handling techniques

5. Red flags, review, referral and reading material.

RHEUMATOLOGY




PALPITATION

DD:
Arrhythmia 
Pheochromocytoma
Thyroid
Anxiety/ panic attack
(Hypoglycaemia, fever, vasovagal attack)
MVP/pericarditis, CHF, pulmonary dis
Alcohol, tobacco, Coccain, coffee, drug induced

History:

Tell me more/ TAP
Since when? First time?
How frequently? 
Relieving/ aggravating factors

  • Chest pain/ exertional dyspnea? 
  • Cough/ SOB
  • Headache/ LOC/ Numbness or weakness of body
  • BP/ episodic sweating
  • Weather preference? tremor
  • Stress/ fever/ exercise

SADMA -  alc, illicit drug, coffee, energy drinks, digoxin, theophylline 
PMH, FAmily Hx, Social Hx- Sress




NERVOUSNESS

DD:
Panic Attack
Hyperthyroidism
Pheaochromocytoma
Menopause
Drugs
Coffee

History:
Tell me more?
First time?
How frequently?
Any particular reason or ppt factors?/ worried/mood
Affecting your life? How?
  • Any weather preferences? Appetite? Weight? Bowel motion? Periods? Hors mess of voice? Neck lump? Vision change/ FEVER (Thyroiditis)/ Breathing/ Swallowing
  • Tremors/ shakiness of your hands
  • Episodic sweating/ headache/ Nausea & vomiting
  • Heart racing/ chest pain/ ever checked BP earlier
  • Sleep/ mood/ anxious 
  • 5 P Menstrual irregularities/ hot flush/ mood swings
PMH- CVD, thyroid, CA
Family Hx- CA
Alcohol, coffee, medications 
Social history: stress

Physical examination:

GA BMI
Vital signs PR- regular BP
Thyroid ( neck ex, eye signs, peripheral edema, proximal myopathy - when relevant)
Hand - moisture, tremor

CVS, RS, ABD
Neurological ex - cerebellum signs, Hyperthyroidism- brisk reflex

UDS BSL ECG