Question 26

Que -
Which of following allied health can be involved to improved outcome in diabetes mellitus?
Ans -

1. Psychologist
2. Podiatry
3. Exercise physiologist
4. Diabetes educator
5. All of above

Question 25

Que -Which of the following is true for sulphonylureas?

Ans-

1. All sulphonylureas are safe in renal failure and doesn't need any adjustment.
2. Patient or doctor needs to notify license authority in Australia when you starting on sulphonylureas.
3. It is first choice in obese diabetic patient.
4. Two different sulphonylureas should be used together to increase effect.
5. It doesn't cause hypoglycemia.

Question 24

Que -
Which of following is side effect of Pantoprazole?
Ans -

1. Acute intestitial nephritis
2. Osteoporosis
3. Vitamin B12 deficiency
4. Increase risk of enteric infection
5. All of above

Question 23

Que -
A 60 y.o female presented with bone pain. Ix showed hypochromic anaemia. Peripheral smear showed Howell- Jolly bodies. Which investigation is useful to make diagnose?
Ans -

1. colonoscopy
2. bone scan
3. bone marrow aspiration
4. oesophagoscopy
5. Barium meal

Question 22

Que -
Hemochromatosis is best diagnosed by:

Ans -

1. serum ferritin
2. serum iron
3. serum transfer saturation
4. FBC
5. Ultrasound of liver

 

Question 21

Que -
Which one of following is true for PSA - prostate specific antigen?

Ans -
1 - Sensitivity is more than 95%
2 - Specificity is more than 95%
3 - It is highly recommended for screening
4 - It can be elevated in prostatis
5 - It is not useful as tumour marker

Question 20

Que -
A 25 y.o male returned from Bali and presents with bloody diarrhoea. He denied any history of sexual contact. What is the initial investigation?
Ans -

a) stool microscopy

b) HIV investigation

c) stool culture

d) biopsy of colon

e) barium enema

Question 19

Que -
A 60 y.o female patient with moderate severe HT and CHF. What is the best management?
Ans -

1 - Diuretic and ACEI

2 - Calcium antagonist and ACEI

3 - Calcium antagonists and B-blocker

4 - ACEI and B-blocker

5 - Nitrites

Question 18

Que -
A 40 y.o male presented with 1 week history of jaundice without pruritus, palpable tender hepatomegaly and knee pain. What is the likely diagnose?

Ans -
1 - Hepatitis B
2 - Hepatitis C
3 - Gall stone
4 - Cholecystitis
5 - Hepatocellular carcinoma

Question 17

Que - 25 year old male presented to emergency department with sudden onset of 10/10 headache with some photophobia and neck stiffness. He was afebrile. He had some neck stiffness and prefered dark room, otherwise examination was unremarkable. You suspected SAH and arrange CT scan which was unremarkable. What is your next management plan?
Ans -
1 - Discharge patient home with simple analgesia
2 - Arrange LP now
3 - Admit patient overnight and arrange LP tomorrow
4 - Arrange MRI
5 - Tell patient that he has migraine and should go home and rest until it settles

Question 16

Que - A child presented with headache, dizziness and vomiting. On basis of symptoms what is the cause?
Ans -
1 - Myopia
2 - Meduloblastoma
3 - Vestibulitis
4 - Gastroenteritis
5 - Tension headache

Question 15

Que - What is the commenst cause of intracerebral malignancy (secondary)?
Ans -
1 - Gastric Ca
2 - Prostate Ca
3 - Breast Ca
4 - Bronchial Ca
5 - Colon Ca

Question 14

Que - Which is the best test to exclude malignancy for breast lump?
Ans -
1- History and breast examiantion
2 - US
3 - Mammogram
4 - Combination of history and examination, imaging and tissue biopsy
5 - Tissue Biopsy

Question 13

Que - What is the most common symptoms of Schizophrenia?

Ans -
1 - Hallucination
2 - Delusion
3 - Lack of insight
4 - Suicidal ideation
5 - Depression

Question 12

Que - 15 y.o male bought in to ED via ambulance after having sudden collapse while playing sports. He is feeling fine and doesn't remember what happen. Examination is unremarkalbe.  What is the best management step you will do?
Ans -
1 - Discharge him home
2 - Do CBE and electrolytes
3 - Do ECG, CBE and electrolytes
4 - Do ECG, CBE, electrolytes and discussed the case with Cardiology prior to discharge
5 - Arrange CT scan of brain and abdomen

Question 11

Que - What is common side effect of ACEI?
Ans -
1 - Cough
2 - Headache
3 - Angioedema
4 - Renal failure and hyperkalemia
5 - All of above

Question 10

Que - 41 year old female presented to ED with central chest pain which is 'burning and tight' feeling and around neck. No previous medical history or significant family history. Examination - Unremarkable. ECG showed minimal non specific ST depression which resolved in repeat ECG in 30 min. CBE, MBA20 (EUC + LFT) and troponin T - negative. What is your next step?
Ans -
1 - Discharge patient without any intervention
2 - Discharge patient with pantoprazole and GP follow up for endoscopy
3 - Admit patient for serial cardiac enzymes
4 - Admit patient for endoscopy
5 - Arrange urgent primary coronary intervention

Question 9

Que - 55 y.o male presented with 5 years history of Type II DM to your clinic. He presented for general check up. His BP is 140/90 which was same 6 months ago. You did fasting urine analysis and then sent to lab which showed elevated ACR (Albumin Creatinine Ratio). What's your best next step?
Ans -
1 - Review again in 6 month
2 - Commence on ACEI
3 - Commence on beta blocker
4 - Commence on CCB
5 - Commence on Nitrites

Question 8

Que - 25 year old female presented to ED with sharp sudden onset of localised left lower abdominal pain, which resolved with panadol and NSAIDS. Now she is painfree. Patient has single partner for last 5 years. Examination - NAD. LMP 2/52 ago. Urine analysis - NAD. CBE, LFT, Lipase, EUC and pregnancy test - unremarkable. What is likely cause of abdominal pain?
Ans
1 - Ectopic pregnancy
2 -  PID
3 - Mittelschmerz syndrome
4 - Appendicitis
5 - Renal colic

Question 7

Que - For patient in question 5 which is next test you want to order?
Ans -
1 - Urine analysis
2 - Laproscopy
3 - Ultrasound
4 - Group and Hold
5 - CT scan of abdomen

Question 6

Que - Which is the best test to exclude ectopic pregnancy?
Ans -
1 - Urine pregnancy test
2 - Serum Beta HCG
3 - Ultrasound
4 - Laproscopy
5 - Abdominal examination

Question 5

Que - 26 year old female with no previous medical problem presented after collapse in shopping centre. She was complaining lower abdominal pain earlier on that day to her partner who is attending with her in emergency room. In emergency room, you noted that she is tachycardic and midly hypotensive (BP 100/60). LMP 5/52 ago. What is the first you want to exclude?
Ans -
1 - Diverticulitis
2 - Aortic dissection
3 - Ectopic pregnancy
4 - Myocardial infarction
5 - Renal colic

Question 4

Que - What is the most sensitive marker of iron deficiency?
Ans -
1 - Iron
2 - Ferritin
3 - Transferrin
4 - Transferrin saturation
5 - Hb

Question 3

Que - You arrange patient (in question 1) to have iron studies. Iron studies (normal values in bracket) showed Ferritin 8 microgram/L (20 -300microgram/L), Iron 17 micromol/L (8-30 micromol/L), Transferrin 3.96 g/L(2.0 - 4.0), Transferrin saturation 2% (10-55%). You asked further history and patient reported normal menstrual period and pregnancy test is negative. Family history is unremarkable. What is the next step for further management of this patient?
Ans -
1 - Commence patient on iron replacement and don't do anything
2 - Give antihelminth treatment and commence on iron replacement
3 - Refer patient to specialist for consideration of endoscopy
4 - Arrange blood transfusion and then commenced on iron replacement
5 - Arrange sigmoidoscopy

Question 2

Que - Next morning, you received result of investigation for (patient in question 1)Result showed Hb of 100, MCV of 70 and MCH of 22. LFT, EUC and TFT were unremarkable. What is the next step will you do?
Ans -
1 Arrange patient to have iron studies
2 Start patient on iron replacement
3 Arrange Hb variant study
4 Arrange patient to have antihelminth treatment
5 Do nothing and tell patient that everything is fine.

Question 1

Que - 20 years old female presented to see in your general practice clinic with feeling tired all the time. He has no other complains and otherwise he is well. Examination is unremarkable. What initial investigation will you order? Choose the best answer from following.
Ans -
1 - CBE, LFT
2 - CBE, LFT, EUC
3 - CBE, LFT, EUC, TFT
4 - CBE, LFT, EUC, TFT, CMV serology and EBV serology
5 - None

(CBE - Complete blood examination, LFT - Liver function test, EUC - Electrolytes, Urea and Creatinine, TFT - Thyroid function test, CMV - Cytomegalovirus serology, EBV - Ebstain Barr virus serology)

MCQ questions

I will post MCQs with options and will post answer in few days after posting question in comment area, so people can practice their knowledge and prepare for examination. These questions are free MCQs for practice. These questions are not about recall questions from AMC examination. I have done my exams and I know what kind of questions they ask. I have been also involved in medical students education while in hospital, so we discussed so many things about clinical medicine. I Also do get interesting presentation while practising medicine in Australia. I remember when I was preparing for my exam, I had lots of questions and I was difficult to find right answer for few of them. It is easy if you are practising medicine in Australia and have access to electronic library. I encourage people to send me questions and I will find answer and will post here, so other people can practice too.

As you all know, our profession is ever changing profession and knowledge changes everyday. I don't believe that I know everything and don't get offended if anyone challenge my answer. I encourage healthy discussion and challenge, so if you think that my answer is incorrect feel free to post comment with appropriate evidence and explaination.

Again, please read disclaimer before using any information on the blog.

Resume writing

Resume is really important part of application process and getting job. Remember that you have to sell yourself, but you have to be honest. Presentation as well as wording is important part of resume. Writing good resume also reflects that you have good writing skill, which is one of core skill you need to be a good doctor in western country.  This is you chance of showing that you have good knowledge about computer and Microsoft word. I recommend that you include your professional photograph, use advance knowledge Microsoft word (use help button, ask your friend if you don't know or use professional) to formatting. Google for resumes/format of resumes, how to write good resume, as you will find lots of examples and good suggestion. I suggest resume should be edited according to job specification, so each job requires new resume, but most of the time it is just adding few things and deleting few things or editing. Make sure that you include mandatory and optional job requirement in your resume in some way.

There are few core things you need to include as a necessary and there are few optional things you can write to put more impression. This is your chance to get an interview. Most of the people do get job if they will get interview. Hospital administration doesn't want to waste your and their time for interview if they are not keen to give you job.

Core things:

• A4 size paper (if you are going to send electronically, make sure that it prints on A4 without any correction). Ideally 2 pages and maximum of 3 pages of core things.
• Personal detail: Your full name (as in your passport), your current address and contact detail including email address (this is the last thing you want that hospital was happy to call you/email you, but your phone number was wrong or you don't access your email for 1 month) date of birth (optional, but I recommend), sex, marital status (write your spouse occupation, if your spouse is doctor), nationality (optional, but definitely write if you have Australian working visa - like PR, Australian citizenship), driving licence if you have one.
• Qualifications - write medically relevant qualifications in chronological manner (latest first) and then all other qualifications - non medical. Include your AMC status and IELTS/OET status.
• Experience in chronological order - if you are out from workforce for certain reason, make sure you write that like maternal leave, non medical study, travelling, but don't leave that up to guess. In your experience, you should include your key duties (here you can add, edit or delete duties according to job advertisement). Include your voluntary experience like observership, special program attendance, Sumatran work etc.
• Continuous professional development: explain how you keep yourself up to date with current medical knowledge and what did you do so far since your medical school. Write you publications or journal articles you wrote.
• Registration status: You must write if you are register in your country, other country and whether you have any registration (including past) like temporary registration in Australia.
• Non-clinical skills: write everything which is relevant like computer knowledge, sports, memberships
• Referee: you must include current referee who were your medical supervisor or at least write that happy to provide as necessary. Make sure you have at least 3 referee ready for this. Find out three strong people (ideally local, national then last chance in your country) like department head or unit head. If you have local referee (if you did any medical course or observership) then definitely include them. 

Optional things:

Most of your prospective employers are Australia based and usually doesn't travel to get information about overseas university or hospital. It would be nice to include nice summary for your university, attached hospital and hospitals where you have work experience. You can write 3-4 pages for this, but make sure that you write nice headings, so if your prospective employer wants to read about the organisations, they can do so. Again, if they are not interested then it goes in file and you are not wasting their time.

It is not essential, but it would be nice to have copies of your qualifications, registration certificates and relevant certificates attached to resume. Again put nice big headings, so you are not wasting your prospective employers time. I would suggest scan copy (.pdf format is usually better than .jpg) of your documents and provide with electronic resumes.

After you have done, read at least 2 times and make sure you are happy with your performance. Check spellings and grammatical mistakes. Ask your friends or partner to go through your resume for proof reading. I am happy to provide proof reading and formatting service at reasonable cost if anyone would like to have that done. Please email me with your resume and detail.

Please read disclaimer before using any of the information on this blog.

Useful resources for clinical practice

During my internship and general training, I found that there are lots of information available on website, but it can be really daunting task to go through all the website and find what is useful for AMC exam and clinical practice in Australia.

I am going to list the websites I found useful. I will also give small explanation for the website and information about what is useful in that website. Few of the websites and resources are useful, but they cost a lot like UpTodate. I haven't listed this costly resouces.

www.racgp.org.au/guidelines

This is official RACGP website. This is my favorite website for AMC examination preparation. Most of you know that John Murtagh wrote a bible for Australian GP, which is also excellent resouce for AMC examination. RACGP is publisher for the book.

Over the time, RACGP has developed few guidelines to guide general practitioners in Australia. Few of guidelines are adopted from external resources. These all guidelines are available free in electronic version.

RACGP also provides education via www.gplearning.com.au. This is free for RACGP member. RACGP membership costs around $150 pa for junior doctors, but I found that money worthwhile.

Out of these guidelines following guidelines are useful for IMGs to read for exam preparation and clinical practice.

Guidelines for preventive activities in general practice (the red book) 7th Edition 2009

Diabetes management in general practice (17th edition)

Clinical Guidelines for Stroke and TIA Management: A quick guide for general practice

SNAP: a population health guide to behavioural risk factors in general practice

National Heart Foundation of Australia physical activity recommendations for people with cardiovascular disease

The Australian Immunisation Handbook

Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006

Management of incontinence in general practice

Hepatitis C guideline

Acute gastroenteritis in Children

www.heartfoundation.org.au

Heart Foundation Australia website

Find guideline for hypertension, lipids management and reducing risk in health disease

www.rch.org.au/clinicalguide

Royal Children's Hospital, Melbourne Clinical Practice Guidelines

RCH CPG is also available on iphone and blackberry via iSilo, and good this about this is free at this stage.

Paediatric Handbook is really useful, but it is not free. It can be purchased from Fishpond or Bookdepository. 

www.shinesa.org.au

Shine SA (sexual health informations, networking and education) provides sexual health service to population and education opportunities to health professionals. Website contains useful information about contraceptions and patient education material.

www.nps.org.au

National Prescribing Service Limited. This website provides evidence base independent information about medicines. Search Case studies for health professionals and you will find useful cases to read with expert comments. This case studies are really useful for AMC examinations.

http://www.nationalasthma.org.au/

National Asthma Council website is useful resource for Asthma. Go to health professional section and you will find Australian Asthma Handbook and useful resources for spirometry, asthma action plan and information for medications useful in asthma and COAD.

http://www.healthinsite.gov.au

Health Insight is Australian Government initiative to provide useful information to health practitioner. This website cover wide variety of topics and provide useful link for various medical conditions. This website is not on top of my list, but I use this website when I am looking for specific general information about the condition and cannot find on other websites.

www.mja.com.au/puclic/guides/guides.html

Medical Journal of Australia website

www.dermnet.org.nz

New Zealand Dermatology website contains lots of good dermatological pictures and treatment plan.

www.freemedicaljournals.com

International website to find lots of free medical journals online.

www.conchrane.org.au

The Australian Concrane Centre - useful website to find information base on evidence base medicine.

www.pubmedcentral.nih.gov

US National Institute of Health. This website provides free digital archive of biomedical and life sciences journal literature.

www.beyondblue.org.au

This website provides information to patient who have depression, but also provides useful resources for mental health to health practitioners.

www.sane.org

Sane Australia provides information for mental illness including schizophrenia, bipolar disorder, depression, antipsychotic medications and community care.

www.cdc.gov/travel

Centers for Disease Control and preventions. This website is US website. Provides useful and up to date information for travel medicine and communicable disease.

www.clinicalsportsmedicine.com

Clinical Sports Medicine provides useful information for Sport Medicine

Please read disclaimer before using any information provided on this blog. I do not take any responsible for information provided on external websites.

How to find job in Australia?

I know this is a burning topic. At the end of day, that's a goal. All IMGs do all exams to get a job in health field.

As I mentioned in my previous article, job is still there, but getting harder to find and get. It all depends on demand and supply. At present supply is increasing compare to demand which is stable. Although, it is getting harder, it is not impossible to find and get job. One of the mantra to get job is to be at right place at right time and see right person. One of my friend just recently got job after AMC 1 despite no local experience, but he tried too hard to stand out from crowd. Now that's the main point. You need to stand out from crowd (which is getting larger and more competitive) to be noticed from your prospective employer. So, what can you do to stand out from the crowd. I will explained few points for you to get out from crowd.

I am not going to talk about conventional method - like apply through seek.com and Department of Health website or register your name with database. I am pretty sure eveyone who are reading this know about this (happy to write about this if anyone wants to know). I am going to share my friend's experience and talking about unconventional method.

Application:

Don't be afraid to apply for a job. Apply to everything. Call them prior to application ask what's requirement of position. Try to address all requirements in your resume and if you cannot fill requirement try to explain what you can do to fulfil. Apply with standout killer resume (this is whole new topic and will try to cover in future article). Remember sending your resume is like selling yourself. You are selling your service. Call them once you have apply and follow up your application. You never know when your resume will be selected for interview. Call them/email them even if you are not successful for that particular position and offer that you are still available and happy to be contacted for future position.

I also want you to know that you also need to be careful about social networking site, so visit social networking site and make sure that things show up on your pages are suitable comments as a doctor.

Job Vacancies:

If you know about a job from Internet or from public access site, there is good chance that everyone else who are looking for that job will know the same thing. If you want to get job, you need to find job vacancy that only few people know about. More than half of the medical job vacancies are don't get advertise in public place. This is difficulty to find, but if you are in contact with medical administration or department secretary, there you have good chance of finding these kind of vacancy. It is also to ask or find doctor friend who is working in the system.

Show your genuine interest:

Now let me tell you about my friend. He was genuine and he showed up his skill and knowledge in genuine manner, so he got the job. He contacted ED secretary of a hospital and asked for job, obviously on first instance he was refused about the job. Then he contacted the secretary again for observership, again didn't get. Then he asked to attend teaching sessions, which after a while he was told that ED consultant/supervisor is happy for him to attend lectures. He showed genuine interest in learning about the system and clinical knowledge. Luckily after 2 months, ED department had vacancies. This vacancy was advertise in local newspaper (now how many people will read every page of newspapers from every state everyday?). Guess who knew about the vacancies first!! He already established his reputation in 2 months and after application guess who got the job!! So in short, he offered his service as try before you buy!!!

I can write about this topic for another couple of hours, but the main thing I want to tell you that try with conventional method about finding job, if you are not sucessful think about unconventional method. Stand out from crowd!!

Job condition in Australia for doctors

I think this is bit tricky and sticky topic. This topic will be difficult to address too. The situation is different for junior doctors and specialist. It is also different in metropolitan and rural location. I will discuss the situation for junior doctors here in this article.

In my view, jobs are getting less and more difficult to find for junior doctor who has no experience in Australia, but on the other side there are still plenty of jobs available for junior doctors who has local experience and are fully registered with AHPRA.

Recently, few things have happened which is affecting the job markets for doctors. In past few years, Australia made migration easy and open the gate for more people (now they have put more restriction though), which made more people aware about Australia as a opportunity. Couple of years ago, AMC decided to start offshore AMC examination for part one, which made examination available to lots of new people and increased flow to Australia. And the last thing, which is happening now is Australia has increased more medical places for local students, which is now increasing more graduate coming out from universities and feeling out places as a junior doctors.

Job condition is also different between different states and different parts of states. States like NSW, ACT and Vic, it is pretty difficult to find job in metropolitan areas, but still plenty of jobs available in rural and remote location, but some of are not suitable for junior doctors who has lack of experience and required supervisor. SA and QLD are still hot for junior doctors as it is still possible to find internship and plenty of RMO positions in ED, even in metropolitan hospitals. WA, TAS and NT are neutral for the situation in my view. I occasionally do locum work, main to find out more about different hospital and system, but also to find out demand and supply ratio in different hospital. Trust me there are still places to be fill by junior doctors, but it is getting more harder. You need to find right person at right time and right place to get the job. I will discuss this in my next article.


Please read disclaimer before using any of information available on this blog.

What is after AMC 1 ( or AMC MCQ)?

Recently, I received email from a doctor who asked above question.

Guys, there are multiple options after AMC1. I will try to answer above question in this article.

I believe if you have done AMC1, you are planning to come to Australia and work as a doctor. I will also assume that you have done your IELTS/OET.

Basically, if you want to be fully registered in Australia, you have to do AMC 2 and 1 year of supervised training (internship) if you are coming after MBBS and want to follow general pathway of AMC. I have not discussed specialist pathway and competent pathway.

Option 1 would be to stay in your home country and continue doing clinical practice while awaiting for AMC 2. There are pros and cons about this option.
Pros -

* You will be practicing medicine and your will be building your clinical experience which will come with all your life.

* You will be earning money to support your venture about AMC exam

Cons -

* You will be working in your home country and my understanding is that you want to work in Australia as a doctor, but remember your experience will count at some degree even in Australia

* It is hard to pass AMC clinical exam with this option as you have no/little clinical experience in Australia

* You will be waiting for exam dates for about 18-20 months or may be longer

* It is difficult to find job as a doctor in Australia if you are overseas

Option 2 would be to come to Australia and wait for the exam

Pros -

* It is little bit easier to find job in medicine compare to 1st option
* You will learn about Australian culture

* Your English language and communication skill will improve (If English is not your first language)

* The best benefit would be lot easier to clear clinical exam

Cons -

* You may need to work in other areas while looking for job in medicine
* Finding job can be difficult in medicine in Australia and it may take up to 12 months or longer
* You need visa to enter in Australia - well, most of people will need

* If you cannot find any other job then it can be very costly to support yourself in Australia - cost depends upon where you live in Australia

Please read disclaimer before using the information in this blog.