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• Read the instruction clearly – ie if it is an examination, only do the examination

• If the examiner or the patient says – “no that is fine” – it means they don’t want you to focus on it and that is not where the marks are

• If the examiner or patient says anything more than once – you are missing something. Ask more questions.

• Study in a group – if  not together then over skype

• Susan Wearne’s book “clinical cases for general practice exams” is a very good resource and can be used with study groups.

• Remember the age and gender of the patient is not the same as the person sitting in front of you. circle the gender and age on your paper to remind you.

• With regard to educating about a diagnosis – ask the patient what they know about the diagnosis first.

• If you don’t want to tell the patient something – you can tell the examiner

• In management you get marks for the ability to identify, define and prioritise physical, psychological and social issues. Therefore, 1st list your management points before going into further detail. This way the examiner can give you marks even if you run out of time. After you summarise the list of management points, if appropriate, ask the patient which one they would like to address first, that way then can lead you to where the most marks are

• remember to involve patient, family and community resources in the management plan

• remember to include longer term management points.

• our job is to offer expert opinion on medical issues, not to make the patients choice for them.

• always arrange follow up

• It is useful to have a history proforma – ie

  • HPC, PMHx, Meds, Allergies, Imm, FHx, EtOH, smoking, nutrition and physical activity.

  • if one of these is missing, it is missing for a reason – therefore ask for it

• systems review – energy, appetite, weight change, sleep, CVS, Resp, GI, GU, Neuro

• surgery tests – standard tests available – WTU, BSL, ECG, spiro, preg

• physical exam – request permission to examine, show concern for patients safety, comfort and modesty

• remember to say you would wash you hands before and after examination

• musculoskeletal exam – look, feel, move. movement involves – active then passive then resisted then special tests

• copious amounts of detailed knowledge is not expected in GP exams – so becareful about going into too much detail with certain points. Giving too much detail can be negatively marked and you will lose out on time and miss other important points and marks.

• if you don’t know something it is ok to say you would look it up.

• Plan to reach your venue 30mins before the exam time.

• You will register with exam marshall and sign in for exam

• about 10min before the start time you will go with your batch for pre exam instructions given by the examiner

• necessary paper and pen is provided

• Rest station – please rest and get ready for next round. You can use that time for drink and toilet break. Exam marshal will escort you to toilet

• Each station starts with a bell, so utilise the time to read instruction and plan a strategy for the case

• The next station starts when you are still inside the exam room. So stop the previous station ASAP as soon as you hear the bell and zoom out of the room and gets started on the next station.

• look around each examination room. Generally speaking, nothing will be there by accident.

• The immunisation program includes the addition of HPV vaccine for boys which is being deliver Their conversion to a mobile casino compatible game is testament to just how popular they are and players will be thrilled with the nonstop spinning reel action. through a school based immunisation program
• The new schedule (from July 2013) forecasts availability of a new combination vaccine for MMR varicella

The New Australian Immunisation Handbook (10th edition) has just been released

•    http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook10-home

Whats new? in the Handbook is detailed in an NCIRS powerpoint

•  http://www.ncirs.edu.au/immunisation/education/tools/whats-new-immunisation-handbook-2013.pdf

ATSI children now receive their final prevenar 13 vaccination at 18 months old and not at 24 months old.
RANZCOG have recommended that all pregnant women be vaccinated against influenza.
Influenza vaccination of children – children  older than 5 years old should ONLY receive Vaxigrip or Fluarix. NOTE – Fluvax is not registered for use in children older than 5 years old.

It is estimated that up to 2% of Australians including 1 in 20 children suffer from food allergies

A food allergy is an immune system response to a food protein that the body mistakenly believes is harmful. When the food is eaten by an individual, the immune system releases massive amounts of chemicals, triggering an allergic reaction. Most allergic reactions are mild to moderate and do not cause major problems. The parts of the body involved can also vary from person to person, ie it may affect their breathing, gastrointestinal tract, skin and/or heart. A small number of people may experience a severe reaction called anaphylaxis. This is the most concerning type of allergic reaction as it can be fatal. The symptoms of anaphylaxis are: swelling of lips, face and eyes, swelling of the tongue, difficulty breathing and collapse. Anaphylaxis can occur within minutes or up to 2 hours from exposure. It must be treated as a medical emergency, requiring immediate treatment (with adrenaline) and urgent medical attention.

90% of food allergies are caused by: peanuts, tree nuts (walnuts, almonds, cashews, pistachios, pecans etc), fish, crustaceans (prawns, lobster, crab etc), eggs, milk, sesame, soy and wheat. Any food, however can cause an allergy/anaphylaxis. It is important to understand that in some people even very small amounts of food can cause a life threatening reaction
Currently there is no cure for food allergy. Avoidance of the food trigger is the only way to prevent a reaction. Individuals at risk and their carers must read food labels of every food, every time because recipes change without warning. If a product is not packaged, they must enquire about ingredients and the risk of the food coming in contact with the food they are allergic to. If they can’t access information about the ingredients it is best if they do not eat it.

Kindergarten/Pre-school/School can be a potential mine field for a child with food allergies. As we all know kids love to share and steal food and this can be fatal for a child with anaphylaxis. For this reason the majority of centres/schools now have a nut free policy (this is the most common cause of anaphylaxis). When parents send food for their children to share (eg cakes), it is also helpful to write a quick label mentioning if the food contains egg or milk (the next biggest offenders).  It is advisable that parents of a child with an allergy provide alternative treats (eg cup cakes) that can be kept at the centre/school. These treats can be given to the child when non-allergic children bring in birthday cakes/biscuits from home.

It is essential that all children who are at risk of anaphylaxis, have an anaphylaxis action plan signed by their doctor and given to centre/school staff. This gives staff a quick reference guide of what to do should the child come in contact with the offending food. The treatment for an anaphylactic reaction is adrenaline (the device containing adrenaline is called an Epipen). Parents and staff need to agree on where the child’s epipen is kept so that it can be found quickly if there is a reaction. The Epipen should be stored out of direct sunlight and be easily accessible. It must NOT be in a locked cupboard or locked room. All staff need to undertake anaphylaxis training and will need to know how and when to administer the Epipen in the event of an emergency (as per action plan). Parents need to keep staff informed about any changes or updated allergy tests that may occur during the year.

Implementation of these few simple strategies enables all children to participate in a fun environment with minimal risks to their health and safety.