AON, DWS question

Dear Sir

How are you? I passed all 16stations in amc clinicals. I didnt get job in NT campaign and I am not selected in round 1 WA. I am very concerned about my career.Now I am thinking about taking up GP job but for this I need to pass PESCI and thers lot of other confusions like AON, DWS. Could you please advise me in this regard? I am getting few GP jobs in Sydney but I dont know whether I would get registration if its not in AON or DWS. I called AHPRA they told me I dont require AON or DWS to obtain registration but what about provider number? could you please explain me these?

Hi Dr Z, 

Don't feel bad - at present market in Australia is saturated. People not even getting observership, so if you has observership, you will get there. 

Try less competition area - like SA and QLD, where you have higher chances. Try in rural area of this states. 

If you want to get in GP land - you have to understand 10 year memorandum for overseas trained doctor. 

You cannot have your provider number for 10 years, but you can work in hospital without that. As a GP, you get limited provider number and it is location specific. You can only work in AON and DWS - in rural area, where you can get provider number. After 10 years, you are free to go anywhere in Australia. 

It is unlikely that you will get provider number for Sydney, but outer Sydney or other area would be fine. It is not your problem, your employer will apply and get that done, otherwise you won't get job. 

Remember, registration and provider numbers are not your problem, if your prospective employer is happy to give you job, then things will get sorted and he/she will have answer for that. 

APHRA is registration body who usually gives registration to all appropriate candidates. If you have job as doctor - obviously you are appropriate!!

NSW Jobs

Application for NSW Junior Medical Officer (JMO) has commenced today. Please visit http://www.health.nsw.gov.au/jobs/recruitment/jmo.asp
for further information about application.
Remember application closes on 15 August 2012. 

QLD jobs

Application for junior medical officer (resident medical officer) for Queensland Health has commenced today. Please visit http://www.health.qld.gov.au/rmo/apply_now.asp for application and further information.
Remember application closes on 16 of July 2012.

MCQ 62

Haematochromatosis is

1. Autosomal dominant
2. Autosomal recessive
3. X - linked condition
4. It has not genetic cause
5. It is a type of iron deficiency anaemia

MCQ 61

You arranged FNAC for patient in question 58. Showed degenerative colloid nodule with carcinomatous changes. You refer patient to Endocrine surgeon for review and further management. What is not true about Thyroid surgery from following?

1. If there are pressure symptoms due to multinodulat goitre with a dominant nodule, total thyroidectomy is recommended choice
2. In a patient with a thyroid nodule and Graves' disease, anaesthesia and surgery must be deferred until TSH has normalized
3. If there is a definite diagnose of malignancy, hemithyroidectomy is appropriate
4. The major risks of total thyroidecomy are hoarseness of the voice and permanent hypothyroidecomy
5. Surgery should be done if there is clinical suspicion about malignancy or concern about growth of nodule even if investigations are unremarkable. 

MCQ 60

Patient in question 58 came to see you again for blood result and US. TFT was unremarkable. US showed 4 cm nodule in thyroid in right side. Unable to comment whether it is malignant or not, but suggest it showed some cystic and solid area. What will be the next step?

1. US guided FNAC
2. CT scan
3. MRI
4. Nuclear medicine scan
5. Do nothing and review in 6 months time. 

MCQ 59

Patient in Question 58, you are suspicious about thyroid gland nodule. What will be the next step for investigation?

1. TFT and US of thyroid gland
2. TFT and XR of neck
3. TFT and CT scan of neck
4. TFT only
5. TFT and MRI of thyroid gland 

MCQ 58

60 y.o male presented with lump on right side of his neck, which he noted about 2 months ago and has increased in size. He is otherwise asymptomatic. His lump is about 4 cm in size and move with tongue. What is likely diagnose?

1. Lymphadenopathy
2. Thyroid nodule
3. SCM muscle haematoma
4. Skin cancer
5. Subcutaneous Lipoma

MCQ 57

Which of following shows best outcome on superficial burn patient?

1. Application of ice
2. Urgent medical intervention
3. Application of cold water for 20 minutes
4. Application of burnaid 
5. Surgical intervention like skin graft 

MCQ 56

If you are being ask to request only one blood test for anaphylaxis, what of following will you order?

1. FBC
2. Tryptase
3. IgE
4. CK
5. Electrolytes

MCQ 55

Which of following is not common sign of anaphylaxis reaction?

1. Hypotension
2. Abdominal pain
3. Wheeze in chest
4. Cold and clammy skin
5. Tachycardia

MCQ 54

30 year old male presented with thickening of skin on extensor surface of both elbow. O/E the thickening showed erythmatous patch with silvery scaly appearance. He also mentioned that his father also had similar rash. What would be the likely cause of his rash?

1. Eczema
2. Psoriasis
3. Tinea Versicolour
4. Squamous Cell Carcinoma
5. Contact dermatitis

MCQ 53

In MCQ 52, you diagnosed that this person is having anaphyxis. What is your next step?

1. Give 0.5 mg of 1:1000 adrenalin IV
2. Give 0.5 mg of  1:10000 adrenalin IV
3. Give 0.5 mg of 1:1000 adrenalin IM in thigh
4. Give 0.5 mg of 1:10000 adrenalin IM
5. Give 0.5 mg of 1:1000 adrenalin IM in deltoid

(Note - If you don't the answer of above question, I would recommend that you visit ASCIA website and consider doing free e-training. Follow the link ASCIA website )

The CEPD at Monash University will be running a 3 day intensive weekend AMC Clinical Bridging Course for IMG / OTD.
Date 27-29 July 2012
Cost $1500
Contact - Ms Caroline Menara  Ph - 03 9902 4498   Email - caroline.menara@monash.edu.au

MCQ 52

25 year old male presented with difficulty in breathing. He mentioned that he is allergic to peanuts and he probably had peanuts with his lunch. On examination, he was flushed with tachycardia and widespread wheeze on lung auscultation. What would be the correct diagnosed?

1. Allergic reaction to peanut
2. Anaphylaxis to peanut
3. Asthma exacerabation
4. Septic shock
5. Cannot tell, he will need further investigation including blood and CXR prior to making diagnose. 

MCQ 51

What is Bowen's disease?

1. SCC
2. BCC
3. Melanoma
4. Squamous Cell Carcinoma in situ
5. None of above

MCQ 50

How does Melanoma of skin spread?

1. Direct spread
2. Lymphatic system
3. Blood stream
4. All of above
5. Neither of above

MCQ 49

How does SCC of skin spread?

1. Direct spread
2. Lymphatic system
3. Blood stream
4. All of above
5. Neither of above

MCQ 48

How does BCC of skin spread?

1. Direct spread
2. Lymphatic system
3. Blood stream
4. All of above
5. Neither of above

MCQ 47

What is the first line abx for tonsillitis in children in Australia (according to evidence based medicine - answer in Therapeutic Guideline)?

1. Amoxicillin
2. Phenoxymethyl penicillin
3. Cephelexin
4. Azithromycin
5. Doxycycline

MCQ 46

45 year old teacher presented with right sided hand pain which is worse at night time and gets better when she wakes up and walk around. What will be the likely cause of her pain?

1. Malignancy
2. Osteoarthritis
3. Carpal Tunnel Syndrome
4. Raynaud's phenomenon
5. Rhematoid arthritis 

MCQ 45

What is the most common cause of moderate to severe exudative pleural effusion in Australia?

1. Tuberculosis
2. Bronchial Carcinoma
3. Metastatic Carcinoma to lung
4. Pneumonia
5. Cardiac failure

Hepatitis - Free resource

If you are working in Western Australia (WA) or planning to work in WA, you will find this resource invaluable. Even if you are not planning to work in WA and planning to come to Australia as health practitioner I would recommend that you go through this resource which provide free online education for Hepatitis B and C. Edith Cowan University has provided this invaluable resource for free which is useful for GP, medical students and health workers. You will need to register once to access, but registration is free (you just need a valid email address).

http://hepatitis.ecu.edu.au/

MCQ 44

Which of following is not notifiable disease in Australia?

1. Tuberculosis
2. Measles
3. Malaria
4. Gonorrhoea
5. Norovirus gastroenteritis

MCQ 43

50 y.o male who migrated to Australia from central Africa 10 years ago presented with 2 weeks history of cough and lethargy. FBC, CRP and EUC - unremarkable. CXR showed circular mass in right apex. What will be your next step for investigation?

1. Commence on AKT (antituberculosis treatment)
2. Arrange sputum AFB staining and if negative reassure patient
3. Arrange culture for tuberculosis and await result before embarking on treatment
4. It is likely that it is old tuberculosis and don't need to do anything
5. Treat him as community acquired pneumonia

MCQ 42

Commonest cause of unilateral painful red eye in general practice?

1. Acute angle glaucoma
2. Foreign body
3. Conjuctivitis
4. Uveitis
5. Corneal ulceration

MCQ 41

Which type of dementia respond well to AchE (according to available evidence so far)?

1. Alzheimer's dementia
2. Frontal dementia
3. Vascular dementia
4. Lewi Body dementia
5. Mix dementia

MCQ 40

What will be your next step to manage patient in MCQ 39?

1. Admit patient for endoscopy
2. Discharge patient with GP follow up
3. Admit for serial ECG and troponin
4. Commence patient on PPI
5. Advise patient that he can go home without any further intervention

MCQ 39

56 year old male presented with 10 min epigastric pain which relieved with rest. He has recently been diagnosed with hypertension. He is exsmoker. He presented as his wife wanted him to present to ED. He is not painfree. Examination is unremarkable. Initial ECG and troponin were unremarkable. What will be the likely diagnose?

1. Aortic dissection
2. Pneumonia
3. NSTEMI
4. Gastritis
5. Peptic ulcer disease

MCQ 38

70 year old female presented with sudden onset of right sided weakness and aphasia. What will be like cause of her presentation?

1. Somatoform disorder
2. Left MCA territory stroke
3. Right MCA territory stroke
4. Left PICA territory stroke
5. Left vertebral artery stroke

PMCT bridging course

Hello Everyone,

Due to many requests for a full weekend PMCT Bridging Course, PMCT are now scheduling a 2 day course for the 8^th & 9^th of September 2012 in Launceston Tasmania. The 2 day course will incorporate a 16 station trial exam. (Places for this course are limited to 18 candidates only).

To enrol in the 8^th & 9^th of September 2012 PMCT Clinical Bridging Course contact Sandy.McManus@dhhs.tas.gov.au

ACT jobs

Application for job as Intern in ACT has been commenced and RMO will commence in July 2012. Please visit http://health.act.gov.au/employment/medical-officer-training-recruitment/ for further information and application process

MCQ 37

Most common cause of tiredness in general practise of Australia

1. Diabetes Mellitus
2. Anaemia
3. Depression
4. Thyroid abnormality
5. Cancer

Tasmania Jobs

Tasmania Health has launched his campaign for RMO today. Please visit this link for further information.  http://www.dhhs.tas.gov.au/career/home/medical/junior_docs/current_campaign

Western Australia Job

Western Australia Health has also started process for application. Please visit this link http://www.pmcwa.health.wa.gov.au/doctors/recruitment.cfm for further information.
Remember application closes on 8th of June 2012.

Victoria Jobs

This is season for hospital job application. Usually it runs between May to Aug. Different state has different system and dates. If you are looking for junior medical officer job in Australia this is the time for central application. I would advise you to make a nice resume with current referee and get ready.

Victoria Health has application open for intern and RMO. Please visit http://computermatching.pmcv.com.au/public/howto/index.cfm for further information. 

Question 36

All of following are direct complications of diabetes mellitus (more than one answer is correct)

1. Atrial fibrillation
2. Neuropathy
3. Renal failure
4. Heart failure
5. Gastroparesis

Question 35

Which is most likely diagnose in 6 year old girl who presented with headache and vomiting for 2 weeks?

1. Neuroblastoma
2. Migraine
3. Meduloblastoma
4. Will's tumour
5. Viral infection

Question 34

4 year old boy bought in to emergency department by his mother with concern about his gait. He has been limping on left side for about 2 week and complaining on and off pain in his left knee. On examination, he is afebrile and well looking child. No tenderness on knee and ankle.He has full ROM in knee and ankle, but has pain and reduced ROM in left hip. What would be the most likely diagnose?

1. Septic arthritis in hip
2. Perthes' disease
3. Irritable hip joint
4. Toddler's fracture
5. He has nothing, but he is just trying to seek attention.  

Question 33

50 y.o male presented with 1 episode of painless frank haematuria. What would be the next step for investigation?

1. Urine MCS and US
2. Urine MCS and MRI
3. FBC, US and CT scan
4. Do nothing and advised him to return if it happens again
5. Arrange cystoscopy 

Question 32

4 days after Normal Vaginal Delivery came with 38oC fever, what would be the like cause of her fever?

1. Unsutured vaginal tear. 
2. DVT 
3. Endometritis 
4. Mastitis 
5. Breast Engorgement 

Registration

Again, this is common and interesting question about registration.Received reply from Dr A about previous post. 

Thank you for your frank reply. I am planning to give my clinical in July and waiting for exam date from AMC. I would like to know about the pathway to get full registration if I take up this GP job? I am aware that even after passing clinical its necessary to do rotation to get full registration, how will I get full registration if i become GP?

Hi Dr A, 


This is interesting question. If you go on rural pathway without passing clinical exam and necessary rotation, you will not be eligible for general registration, you will get conditional registration until you passed your GP exam (FRACGP or similar). Once you have passed your specialist exam, you will get registration as a specialist (GP is specialist in Australia), not general registration. Although nothing much changes from that except few other specialty will need general registration if you want to change your career, otherwise there is not much restriction what you can and cannot do as GP.

You can pass your clinical exam and either apply for exemption or do necessary rotation to get full registration. There is not other way around for OTD/IMG from developing countries (!!!???). Doctors from few countries will be eligible for competent pathway, but it is another point of discussion.

Hope this answers your question. 

Question 31

55 year old presented after having unconscious collapse. No prior warning. He recovered in few seconds without any residual post event deficit. Initial investigations including ECG and troponin were unremarkable. You have organised him to have all cardiac work up, but you are expecting that you will find nothing. He presented for his blood test result and he mentioned that he is still driving. What would be your reaction?

1. He can drive without any restriction.
2. He can continue to drive as long as someone sitting next to him.
3. He cannot drive forever.
4. He should not drive until we get all the work up done.
5. He can drive his normal car, but he cannot drive commercial vehicle. 

Query about job from an IMG

I was recently contacted by a doctor and asked me following question (name has been removed for privacy). I am posting this as it is a general question.

Hello sir

how are you? I am Dr A  living in Sydney. Hope you remember me, as you had told me about DCH course in Westmead I have enrolled and its really helping me to boost my confidence.  I recently passed my amc part1 exam and language test. I have been offered a position as gp in one of the rural areas of brisbane. i ve only 2years experience as gp in india and the employer is ready to give me position but im concerned about my future and also im not sure whether the AHPRA would give me registration even after passing PESCI. could you please tell me what would be the right step and whether AHPRA would give me registration?

Hi Dr A,
Of course I remember you. First answer about your last question.

AHPRA usually do not have any problem about your registration as long as you have registrable degree and good character (no problem in past registrations) in past. If it is sponsored visa and registration then they would like to have job contract. In general, they are making sure that you are real doctor, nothing more than that.

First question is bit complex and difficult to answer in straight yes or now. If depends upon you what you want to do in future. If you are planning to do GP in future then it is good opportunity as otherwise it will take few more years for you to get entry in GP training ( full registration, PR and required experience in ED, Gen Med and Paed).

If you are not sure or thinking about doing hospital specialisation then you should look for job in hospital, although you can always come back in hospital system but it is bit hard.

In general, I would if you are unsure then take the opportunity as getting in the system is getting more and more difficult. You can always change your mind later on if situation change.

Hope this answer your question.
Regards,

Fitness to drive

I strongly advised you to read through this publication for free. Often question comes regarding fitness to drive and restriction regarding driving. You can rely on this publication for all those questions.

http://www.austroads.com.au/assessing-fitness-to-drive/assessing-fitness-to-drive

I will make question and publish from this publication.

Question 30

A patient with diabetes  and CRF on dialysis presented with acute fever, no glucose or ketones in urine

what would be your next management plan:

1. admission to hospital for Rx
2.  ring dialysis unit
3. increase insulin
4. decrease insulin
5. give antibiotics

Question 29

40 years old obese patient, smoker (20 cigarettes a day) presents with 3 hours of retrosternal chest pain which improves with rest. He has a past history of intermittent chest pain, which improved with rest or nitroglycerine. His pain is improving as you see him. He belched and felt better. Initial cardiac enzymes are normal. What is the next step in management (this would be mastery question):

1.  refer to gastroenterologist
2. send him home with reassurance asking him to come next day
3. arrange an immediate exercise stress test
4. admit him to CCU and monitor his ECG and do serial cardiac enzymes
5. send him home and ask him to come when worse

Question 28

Prolonged QT interval is caused by:

a) digoxin

b) procainamide

c) propranolol

d) hecainauride

e) atenolol

Female Genital Mutilation (FMG)/Female circumcision

Guys this is recent "hot topic" in Australia and I think you should have knowledge about this. Just to spark your thinking about this topic I have created this question.
Which is true from following?
1. FMG is legal in Australia and recommended procedure for all female.
2. FMG is illegal but recommended by most of the surgeons in Australia.
3. Australian Citizen can travel legally for this procedure and have that done overseas as there are not lots of expertise available in Australia.
4. FMG and male circumcision is not recommended in normal circumstances by College of Surgeon in Australia at this stage.
5. Male circumcision is illegal in Australia.

Hi all, Sorry for not posting anything for a long time. I have been busy with lots of things in life. I will start posting again very soon.