الطب فى أستراليا

[jukass]

شكرا حبيبي يا دكتور زياد

وشكر لاخوي الدكتور ايهاب

انا فاكر كلامك زمان يا دكتور زياد لما حكيت انه اذا كان عمرك تحت الـ 25 بيكون احسن لك هناك

فاكر كل كلمه حكيتها زمان

وبالنسبة لامريكا انا الحكاية لي شوية صعبة ,,, اذا بزبط هيك تحت كلامك اني اجي لاستراليا

والرزق بتاع ربنا زي ما كلنا بنحكي وحضرتك يا دكتور زياد بتجكي

الف شكر

اذا في شي تنصحني فيه وانا لسه شغال على موضوع الاسترالي ,,, كل آذن صاغية

شكرا تاني

[predrahmed]

السلام عليكم ورحمه الله وبركاته

انا الاول بشكر اى حد حط اى معلومه على المنتدى ده

وكنت بتفسح كده فى منتدى هندى لقيت ان فى دكتور حاطط معلومات نظرى عن المعادلة الاستراليه وكل المنتدى اساسا عن AMC

(على فكره الناس هناك مموتين نفسهم علشان المعادله........عايزين نشد حيلنا)انا نقلتلكم الاسئله ولو وفيش مانع عند الاداره ممكن اكتب اللينك مره تانيه

--------------------------------------------------------------------------------

SOME IMPORTANT POINTS have 2 know

GASTROENTEROLOGY

Vitamin A Night blindness, conjunctival dryness, corneal keratinization

Vitamin D Ricketts - kids, long bone bowing; Osteomalacia-adults, demineralization

Vitamin K Clotting deficiency with prolonged PT

Thiamine (B1) Beriberi - peripheral neuropathy, Cardiomyopathy - dry or wet (high output failure)

Wernicke-Korsakoff - Alcoholics, confabulation, nystagmus, confusion

Niacin Pellagra - Diarrhea, dermatitis, dementia, death

Pyroxidone (B6) Rare, neuropathy, Cheilosis (swollen cracked bright red lips)

Cobalamin (B12) Macrocytosis, Pernicious Anemia- megaloblastic, neuro chg. ataxia, Schilling test , more in Strict Vegitarian.

Folate Macrocytosis, megaloblastic anemia w/o neuro chgs., common in alcoholics

Vitamin C Scurvy, bleeding gums, Connective Tissue problems, Can manifest 1 yr post defic.

Failure to Thrive Org.= decr. wt gain w/ other disease; Nonorg.=growth failure due to neglect ßstimulation

< 80% wt for Ht

Obesity mild 20-40%, moderate 41-100, severe <101%; age, black women, low income

BMI= body wt (kg)/Ht (mm2) Normal 20-25

Pickwickian Syndrome = obesity, dyspnea, hypovent, CO2 retention, hypoxia

Boerhaave's Syndrome esophageal rupture due to forceful vomit; Gastromediastinal fistula, dyspnea w/o hemetemesis, + Hammonds sign = pneumomediastinum, L lung effusion

Dysphagia Obstructive - solids 1st; Motor -solids = liquids

Infectious Esophagitis Candida (thrush), HSV, CMV, immunocomp, diabetics, Dysphagia & odynophagia

Esophageal Atresia Proximal esophagus, blind pouch

Trachesoph Fistula Congenital defect, distal esoph, coughing & cyanosis when feeding, abd distention

Achalasia Dysphagia for solids & liquids, nocturnal cough, aspiration; Absent peristalsis & tight LES, "Beak" esoph on x-ray, 20-40 yrs old

Esophageal Cancer squamous 90% Dysphagia solids 1st, Cough & hoarse = laryngeal nerve, constricting bands = annular lesion, Risk factors= smoking, alcohol, GERD, Barretts Esoph = adeno CA

Gastritis Antral Creep=fundal tissue replaced by antral mucosa, Not preCA,

Risk Factors = NSAIDS, Alcohol, H.Pylori

PUD Gastric = NSAIDS, eating no help, COPD,blood type A; 25%

Duodenal = H.Pylori, better w/ food, Liver cirrhosis, Blood type O ; 75%

Cullen's Sign Periumbilical cyanosis d/t hemoperitoneum = hemorrhagic pancreatitis, ruptured ectopic, ruptured spleen

Zollinger-Ellison Synd. Gastrinoma ( incr. gastrin); recurrent ulcers, ½ are malignant

Gastric CA Adeno, H.Pylori gastritis, Virchow's Nodes, Types = ulcerating (shallow edges); polyploid (intraluminal late mets); superficial (early CA) ; Linitus Plastica (all layers decr. elasticity) Mets to ovary = Krukenberg Tumor

Diarrhea Osmotic = incr. H2O lumen incr. solutes in bowel; Secretory = electrolytes & H2O secreted not absorbed; Malabsorption; Exudative secretion of blood plasma & mucus (mucosal inflammation); decr. transit time (short bowel); incr. transit (bact. Proliferation)

Ischemic Colitis Vascular compromise (atherosclerotic or embolic); abrupt abd pain after eating, bloody diarrhea, systemic sx.; Barium X-Ray - Thumbprint = pseudo tumor

Irritable Bowel Synd. Dx of exclusion (psych?); Tx: bulk supp, anticholinergics, antidiarrheals, TCA

Colonic Polyps villous>tubular ; sessile>pedunculated for being CA; familial adeno polyps autodom.

Lactose Intolerance Lactase deficiency, bloating & explosive diarrhea after milk; Ages 10-20

Celiac Sprue Gluten sensitivity (wheat, rye, barley); amenorrhea 1st sx girls, Infants = FTT, abnormal stool, bloating, Adults = malabsorption, vit deficiency; X-ray - dilated loops of bowel with thin mucosal folds; most common cause of malbsorption

Tropical Sprue nutritional defic, small bowel mucosal abnormal; Acquired - Caribbean, India, SE Asia; Megaloblastic Anemia, glossitis, diarrhea, wt loss Tx Folic Acid & Tetracycline

Whipple's Disease Infectious; middle aged men; multi-organ; Thickened mucosal folds, Foamy macrophage with rod shaped bacilli that stain w/periodic acid (Schiff's Reagent)

Intestinal Lymphangiectasia Children & young adults; cong or acquired telangiectasia of intramucosal lymphatic

Massive extremity edema w/ diarrhea, N/V; Tx: low fat w/ triglyceride supplement

Toxic Megacolon Dilation > 6cm, Adults preceded by IBD (UC or Crohn's) Kids preceded by Hirschsprungs Ds; Sx: severely ill, incr. temp, abd pain, rebound, leukocytosis; X-ray - intraluminal gas along continuous seg of dilated bowel; Tx: NPO, IV fluids & electrolytes, Antibiotics & Steroids, Rectal tube may alleviate but can cause perforation

Inguinal Hernia Indirect = infants, persistent processus vaginalis, protrudes thru ring, lateral Inf Epig.

Direct = Adults, medial to ing ring & inf epig artery, Weakness in Hesselbach's

Ulcerative Colitis Colon & Terminal Ileum w/o skip lesions, w/ rectal bleeding, "lead Pipe" on X-ray (shortened, narrowed, loses haustrations) Tx: Sulfasalazine, steroids, Immunosuppresents; Complications=perf, hemorrhage, Toxic Megacolon, Colon CA

Diverticular Disease Diverticulosis = false diverticulae, pearl sign on xray

Diverticulitis = infection, acute abd pain usually on left, may form fistulas to bladder, vagina or skin, CT w/ water soluble contrast during acute attack

Crohn's Disease Granulomatous colitis; No bloody stools, 1st in terminal ileum, transmural, skip lesions, cobblestoning: Complications=small bowel abscess, obstruction, perianal disease, malabsorption, toxic megacolo, Colon CA. Surgery is not curative

Colon CA Right Sided=napkin ring, anemia Left Sided=Apple core, pencil stools; Genetic; Annual rectal>40, Annual Guaiac >50; Flex Sig q3-5y >50; Rectal CA-hematochezia

Volvulus Rotation of Bowel; Newborns & elderly; Double Bubble; Birds Beak on Barium Enema, Tx: Left Sided = decompression; Rt sided & kids = surgery

Intussusception Telescoping of large bowel into an adjacent section; most common cause of obstruction in kids under 2; Episodic Abd pain 1-2 min. Reflex = early vomit; Obstructive = omit late; Currant Jelly Stool; Small Infants = Pallor, sweating, and vomiting. Leukocytosis with hemoconcentration, BE to reduce x 2 before surgery

Necrotizing Enterocolitis Premature, decr. birth weight, older infants with malnutrition; bilious vomit, abd distention, bloody stool, lethargy; Thrombocytopenia; Small Bowel Distention; pneumatosis (air in bowel wall) TX; NG, TPN, IV antibiotics, surgical Rx necrotic part

Cholera Fecal - Oral, Rice Water Stools, Vibro Cholera; Endemic gulfcoast, Asia, Africa, Mid East; Severe dehydration, Metabolic Acidosis, Tx: Tetracycline or Doxycycline

Shigella Dysentery Small bact dose needed, Blood & mucous, Kids worse than adults, Fluid Replacement & Ciprofloxacin

Staph Enteritis Onset 3-6 hrs; "Church Picnic epidemic; N/V/D, HA, fever recovery w/in 24 hrs

Salmonella Enteritis Undercooked Poultry; nausea & cramps => watery &/or bloody diarrhea; No antibiotics prolongs excretion of the organism

Viral Enteritis Norwalk = yr round, Rota (kids) = winter; Coxsackie A1; echo, adeno

Botulism Clostridium Botulinum, neuromuscular; onset 12-36 hrs; N/V/D, cranial nerve palsy, fixed dilated pupils, resp failure, no fever, Wound induced = neuro w/o gi sx

Infants constipation 1st=> cranial nerve sx => cranial nerve Sx => Neuromuscular

Hemorrhagic Colitis E coli 157, cramps, => watery diarrhea => bloody diarrhea Complications= Hemolytic-Uremic Syndrome, thrombotic thrombocytopenic pupura

Pseudomembraneous Colitis Antibiotic induced (clindamycin, ampicillin, cephalosporin) C. Diff; mail -> severe bloody diarrhea; Tx: stop antibiotics, oral metronidazole in severe cases

Acute Pancreatitis Pain radiates to back w/ N/V; Grey Turner's Sign (blue flank) Cullen's Sign (blue at umbilicus; Amylase & Lipase incr. ;

Ranson's Criteria: 3 or more = incr mortality

Admission: >55, gluc>200, LDH >350, AST >250 WBC > 16000

Within 48 hrs: Hct decr. 10%, BUN incr. >5, Ca< 8, PaO2 < 60, Base Def > 4, Fluid Seq>6L

Chronic Pancreatitis ERCP to Dx; Alcoholics, Malabsorption & diabetes are results

Hepatitis Hep A = Fecal oral, shedding before Sx; IG to travelers & contact with HAV infected

Heb B= Blood & STD; HbsAg early if persists = carrier; HbcIGM then HbcIgG for life

HBIG for needle sticks and infants born to + moms; assoc w/ hepatocell CA

Hep C Most common post transfusion hepatitis

Hep D = Co infection with B; Hep E = fecal oral

Cholelithiasis Female, fertile, fat, forty; Ultrasound, RUQ pain after fatty meals, Calcified = preCA

Cholangitis Charcot's Triad = Biliary Colic, Jaundice, Fever; Leukocytosis, incr. Alk Phos

Hepatocellular CA Mets 2x more than primary CA (breast, lung, colon), Budd Chari-thrombosis hep V.

Risk Factors = HBV, HCV, Alcoholic cirrhosis, Aflatoxins (fungal metabolites)

Benign Hep Adenomas oral contraceptives

Exocrine Pancreatic CA Ductal CA, Courvoiser's Law=palpable nontender GB in a jaundiced patient is a head of Pancreas tumor. Tumor Body or Tail=splenic vein obstruction=> splenomegaly, gastritis, esoph varices

Insulinoma Insulin hypersecretion, hypoglycemic symptoms, Insulin levels still incr. after fasting

Whipple Triad: confirms hypoglycemia as source of Sx 1. Hypoglycemia, 2. Relieved with carb ingestion 3. Sx occur while fasting

VIPoma Makes Vasoactive peptide (VIP); Sx WDHA (watery diarrhea, hypokalemia, achlohydria; unexplained secretory diarrhea; laparoscopy for Dx

Glucagonoma tumor of alpha islet cells; 80% women; 80% malignant; Necrolytic Exfoliating Erythema characteristic exfoliating lesion of the extremities

Pompe's Disease a 1,4 glucosidase deficiency; fatal by age 2

VonGierke's Disease glucose-6-phosphatase def.; big liver & kidneys, growth retardation, electrolyte prob.

McArdles Disease musclephosphorylase is absent, muscle cramps & incr. myoglobin after exercise

Jaundice Prehepatic = hemolysis, gilbert's disease, Crigler Najjar; Hepatic = hepatocellular or cholestatic; Post Hepatic = Biliary obstruction, AST & LDH also incr. ;

incr. unconj prehepatic; incr. conj = intrahepatic cholestasis or post hepatic disease ; incr. all fractions = hepatocellular, hyperbilirubinuria = conj bili water soluble

ETOH Hepatic Disease Fatty liver => ETOH hepatitis => cirrhosis; AST incr. > ALT incr. ; incr. PT; decr. II, VII, IX, X Clot

Cirrhosis necrosis and fibrosis, decr. serum albumin, anemia incr. PT, Not curable or reversible

Esophageal Varices veins that expand to circumvent congested hepatic flow; Tx: vasopressin, balloon tamponade, endoscopic sclerotherapy, transjugular hepatoporto shunt (TIPS

Hepatic Encephalopathy altered consciousness, incr. ammonia incr. glutamine in CSF, EEG abnormal

Ascites Complication of hepatic disease; Paracentesis to examine ascitic fluid values should equal serum if incr. albumin = malignant; incr. LDH > 60% of serum = malig or infective;

incr. WBC = infection

GI Bleeding Upper GI = melaena (black tarry) ; Lower GI = hematochezia (bright red) decr. Lig Trietz

Intestinal Obstruction Vomiting common in small bowel, late in lg bowel, High pitched "tinkling" BS.

X-ray - prox dist = lg bowel; dilated loops of bowel with air fluid levels = sm bowel

Ileus Paralytic obstruction of bowel due to loss of peristalsis

Pyloric Stenosis Projectile vomit in neonates, visible peristaltic wave, String Sign

Meconium Ileus Abnormal thick Meconium with undigested protein, associated with CF

Hirschsprung's Disease No autonomic nerves in colon, Obstipation, late vomit, Megacolon, Toxic Enterocolitis if left untreated, BE proximal dilated & distal narrow, Colostomy

ومعلش ياجماعه انا مراجعتش المعلومات دى بس اى حد شاف فيها حاجه غلط ياريت يقول

[Balooshy]

شكرا جزيلا يا د/احمد .. يا ريت حضرتك تبعتلي الموقع الهندي على الخاص .

[دسوقي]

طيب لو أنا مشيت في طريق الامتياز

لما اكون في اول سنة الامتياز هقدم علي الاقامة الدايمة لاني معايا رخصة غير محدودة بعد اجتيازي الجزء التاني

قدامي من سنة و نص لسنتين لما يتبت في طلبي

معني كده اني عايز في خلال السنة ادور علي شغل بعد الامتياز

تفكيري كده صح ولا غلط يا دكتور ايهاب و دكتور زياد ؟؟؟؟؟؟

نصيحة للناس كلها اوعي وانت لسه في مصر تقول هذاكر للمعادلة واطنش التخصص لازم تمشي في خطين متوازيين

تحياتي

تم تعديل 18 يوليو 2009 بواسطة دسوقي

[Ihab]

I got this message on the private messages and i thought i would put it here as i think this is a common issue

السلام عليكم ورحمه الله وبركاته

اولا احب اشكرك د\ايهاب على المعلومات الى اكيد ربنا حيجازيك بيها خير

انا بقالى 9 شهور تقريبا بقرا فى الاسئله ولاجابات الى حضراتكم بتعرضوها

انا طالب فى سنه 6 وحاخد امتيازى ان شاء الله فى 1\3\2010

انا كنت ناوى مع شله من اصحابى اننا نعمل المعادله الاستراليه بس كلام حضرتك والدكتور ايهاب عن فرص الشغل رعبنا خصوصا ان احنا كنا مسافرين علشان

1- انها جزء نظرى واحد فنعمله قبل مانتمنع من السفر علشان الجيش وان شاء الله آخد اعفاء فنعمل الجزء التانى بعد الكشف الطبى فى 11\2011

2-ان فى استراليا التخصصات مش صعبه زى كندا و انجلترا لان انا سمعت ان كندا آخرها معانا حتدينا family doctor

اسئلتى 3 اسئله

1-هل الفرص حتبقى كدة على 2012 (الى هو السنه الى لو مشت كل حاجه تمام حنسافر فية) فى areas of needولا الفرص الشغل الصعبه دى فى المدن الكبيره بس؟

I want to clarify that issue again as it is an important issue,

No one can tell you what the job situation will be like in 2010

No one can tell you what to do in your life

All any one can do is give advice and try and convey the actual situation in here that you can't see in Egypt

I was initally going to the UK and i finished all the PLAB and around 2005 we started hearing about the difficulties in getting jobs, as i have already finished the first part by that time i decided to continue and do the second though it was very draining finiancially, I did the second part in march 2006 and in april 2006 the new laws were out and no one from outside the UK and the EU could find a job.

Pretty much around this time i got a job opportunity in Australia and i am sure the PLAB played an important role in me getting the job.

What i am trying to say is that if i didn't finish the PLAB i probably wouldn't have got the job in australia,

SO if i have listened to the advice i was given that jobs are difficult i would probably be still in Egypt now

It is pretty much the same situation now in Australia

things are getting tighter but there are still job opportunities, what will happen in 2012 , i have no idea

but should you do it or not? that is really a personal and individual question

Imagine yourself when you are 35 years old, you have one of three scenarios, either you would be outside Egypt practicing medicine the proper way, OR you have tried and did everything you could bas mafeesh naseeb, OR you would have done nothing bas 2a3ed teseb w tel3an fe kol 7aga

I would go for the first or second choices, I don't like being negative, so be positive and do what you can and the rest is for rabena sob7ano w ta3ala to decide what is best for you,

I would be much more satisfied if i got no where after doing all i can and so it will be what God wanted for me and it will definitely be better even if i couldn't see it at the time

All i am trying to do here is to give you the information that you lack in Egypt, and i can only give the current information i can't predict the future

What you have to do is to think what you wanna do in your life and where you wanna be in 10 years and start working towards that goal by the best possible means you can at that time

2-انا ليا ابن خالتى ICU registrar فى لندن هل ده يساعدنى انى ألاقى شغل (يدورلى يعنى)لو قررت انى اعمل الplap بدل amc ولا برضه حيقولو هناك اولويه الشغل للاتحاد الاوروبى واحنا آخر ناس فى الاختيار

Exactly, the problem with the UK is not in the jobs it is in the LAW, the law doesn't permit any employer to give you the job UNLESS there is no one from the UK or the EU to fill that job which as you can imagine a pretty slim chance

3-ومعلش هو فعلا آخر كندا تدينا فى التخصص family doctor؟؟لان فى دكتور قاللى انه عادى ممكن تاخد التخصص الى انت عايزه وان كندا احسن من استراليا علشان سهوله الهجره وكمان رعبنى من العنصريه فى استراليا

I spoke about racism in australia before and it is definitely nothing to be scared of, you will find the odd racist person on the streets but in terms of work and living every one is equal,

When i first came to australia my salary was higher than the australians doing the same job because i had 2 years experience as a resident, and i think comparing that to KSA for instance you can judge who is racist and who is not

انا آسف انى طولت وحضرتك لو مردتش فأنا مقدر ان حضرتك مشغول وربنا يوفقك يارب

Wala yehemak , i am always happy to help if i can

[Dr.mmfriend]

السلام عليكم

شكرا جزيلا لكل من ساهم وبيساهم فى هذا الموضوع الاكتر من رائع

تسجيل متابعه واهتمااااااااااااااام جدا

[Dr.mmfriend]

يا شباب ان شاء الله ناوى ادخل الامتحان فى سبتمبر 24 فى اليونان

الى ناوى يدخل معايا فى اليونان يبعتلى على الخاص لو ننسق سوا

وبالتوفيق للجميع

[ziad]

بالتوفيق يا باشا

ربنا يوفقك

[Dr.mmfriend]

الله يكرمك يا دكتور

كله بتوجيهاتك

[magdeaaa]

متابعة شكر وتقدير للجميع

[Dr.mmfriend]

الدنيا نامت مش عارف ليه

فين النااااااااااااااس

[icehell]

الدنيا نامت مش عارف ليه

فين النااااااااااااااس

what are subjects you stress on it now?

what are your study plan for next month?

did you found good MCQ source?

[predrahmed]

اهلا ياجماعه

انا لقيت موقع بيدى تجربه لامتحانات IELTS مجانا انا كان ليا سؤالين

1-هل التقييم الى بيديه الموقع زى التقييم الفعلى للامتحانات الموجوده

يعنى مثلا انا عملت امتحان LISTENING فيه وخدت8 هل ده مقياس لقدراتى كويس ولا الامتحانات دى سهله ومش ذى الحقيقه

2-ياريت يا جماعه اى حد دخل الايلتس يشوف الموقع ده ويقول إذا كان نظام الموقع ده مفيد ولا حيلغبطنا

والموقع اهو

http://www.canadavisa.com/ielts/free-practice-tests.html

[jukass]

:roseop:

تسجيل متابعة للدكاترة

سلام

[magdeaaa]

بسم الله الرحمن الرحيم

نعتذر عن هذه الغيبة الطويلة اشوي وذلك بس الامتحانات

والحمد الله الواحد فينا اتخرج وصار دكتور قد الدنيا

:wub: :lol:

واليوم انا جايب حلوان التخرج معي انا والدكتور انس ( جوكاز)

عشان ما حدا يقول عنا بخلاء

اتفضلوا هي اسئلة البردجن كورس يلي وعدناكم بها

http://www.BLOCKED77/file/121209553/f5b9.../___online.html

معلش الاسئلة ما اقدرنا انعيد ترتيبها زي ما اعلمنا في اول اسبوع بسبب خلل فني في الحاسوب

ولكن اقدرنا نرفعها زي ما هي

[annas]

الاخوه الاعزاااااااااااااااااااااااااااااااااااااااااء د|مجدي د|جوكاز

مليـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ

ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــار

مبرووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووك

الحق تستاهلو كل الخير

wst:: :lol: bv:-

[Ihab]

Alf mabrook for passing the exams guys

w rabena yewafa2ko insha2allah in your next steps

[magdeaaa]

شكراً للجميع وانشاء الله عقبال عند اولادكوا

ههههههههههه

:) B)

[nardeen]

مبرررررررروك ليك يادكتور ماجدى انت والدكتور انس الرب يبارككم

لانكم من اكتر الناس الي بتفيد الناس هنا في المنتدى

نتمنىلكم جميعا التوفيق في طريقكم

[jukass]

الاخوه الاعزاااااااااااااااااااااااااااااااااااااااااء د|مجدي د|جوكاز

مليـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــ

ـــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــــار

مبرووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووووك

الحق تستاهلو كل الخير

:wub: :waf: :D

يسلمووووووووووووووووو يا احلا دكتور وعقبال ما نشوفكم مبسوطيين زينا واكتر ان شاء الرحمن

cr((: cr((: cr((: