The Australian Medical Council (AMC) exam has significantly increased in difficulty, requiring candidates to achieve higher performance levels than before. The exam has shifted from diagnostic questions to clinical reasoning questions that test practical decision-making in scenarios, with increased emphasis on patient safety protocols, ethical considerations, indigenous health, and epidemiology. Successful preparation requires time-mode practice under exam conditions, understanding that once an answer is marked, it cannot be reviewed. Candidates must develop comprehensive clinical reasoning skills rather than relying solely on memorization, as the exam now tests the ability to apply knowledge in complex clinical situations.
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All right, dear doctors, thank you so much for joining the session. This is Dr. Sherier, your mentor MC and I've been taking classes since last uh 9 and a half year. Under our guidance, there is 1,200 uh 1,900 plus doctors have cleared. I think very soon I think if we count I think we'll hit the 2,000 doctors and many many working in Australia what we documented it's more than 1,350 doctors are working which we know uh many we didn't trace actually at some point maybe loss in contact but I'm sure they're also doing well and some are uh into their way to make um a job in Australia it's getting competitive it True. And um how it will be in coming days. So far so good. Uh last year was good. The previous year uh was even more better actually. Uh so the lot question comes you know how about 20 this particular year 2026. This is already you know we are in June almost uh so I mean halfway. So the second round of the job application. The first round I would say it was decent. The second round I think it will go same. That question remains how it will be in 2027. Right.
So that's a bigger question like you know how will be the approach for the doctors in 2027. Yeah. So a lot of things you know a lot of speculation actually we see um that is how it is right. So I mean we have to be careful in terms of like the preparation and lot of other things and um in terms of few things which Australia in AMC website they have published few things few things they didn't publish few things from our experience we can tell as well actually with the blended things I'm going to guide you um as much as I can in the beginning and then we'll get into today we have a session also coming up on uh git so we'll also get into that one actually onto that git session actually. Now this one I think I have shown you guys. So already we have seen some changes in regarding this. So some changes has been noticed and uh these particular changes are um like quite evident since April actually right especially more clinical oriented more patient safety protocol and a lot of doctor especially psychiatric ethical things what they are thinking the right answer probably the original answer is different so and some ethical questions are quite a new at the same time which probably it's not present in any uh question bank um and even recalls within collective. So the new things keep coming original documenting especially the ethical ones are quite a difficult you can understand you imagine you know you see a full ethical question and unless someone has a photographic memory very difficult that the full ethical question someone can memorize so the uh I was talking to few doctors you know who you know appeared in April and maybe didn't get through um few probably in our academia and generally you know I take an opinion or a poll and everyone agreed The thing that you know there are more new questions, more law questions and thirdly another thing you know those people are much dependent lastly on the exam we recall things actually they did quite bad in the exam so here is the thing that you need to have a total preparation a lot of doctors compared to let's say 5 years back 6 years back I was also teaching there were a lot of students so their study hours were much more nowadays you know more content more uh question banks more like companies out there. So people think okay we have so many shortcuts and this and that and also understand one thing the the baseline and the level is no longer the same. So NC baseline increase and the candidates their total study and performance is also decreasing. That is one of the reason you know that you know passing r dropping actually but one thing is clear that MC already has raised the bar actually. Now previously you are expecting uh getting the same mark and passing it is not happening. So you have to work more hard. So summary thing is like you know officially the marking system does not show that you know you have to get more but honestly speaking you have to do much better now actually in the exam is it clear so far I mean uh what they're trying to say and say what I'm trying to say regarding on behalf that you know the parameter has increased so you have to do much better you know from now on actually so that is one thing that is fully clear actually about the summarizing thing the bar has increased so we have to do like a double performance you know that's the thing if you are studying like a let's say 6 hours you have to study now 7 8 hours okay that is the only thing you can do all right u guys you know just to hear me out like are you guys following the class just let me know in the comment section so that we can proceed to the next slide all right now here's the thing more clinical oriented more clinical reasoning questions are much more rather than the more like diagnostic question you know they give a summary what is the diagnosis those questions um becoming less Yes. Uh rather the clinical reasoning clinical oriented questions are much more actually they put you in a scenario that questions are much more. This brings us to when they give you a scenario and asking you okay what to do next you know what is the next best approach I'm talking about some medicine surgery what is the the most important emergency thing you can do what is the most uh safest approach that is this brings us to the second point patient safety protocol. So this brings us management things. This also brings us to the ethical question and the patient safety like let's say patient safety first or patients wish first or the patient parties opinion first. This kind of ethical things are more important as a doctor to safeguard yourself from a psychiatric agitated patient that is also important. All right. So these all things you know are uh more important nowadays. actually it was there but the number of questions are little bit more we found also so as the population health like epidemiology and this kind of questions another thing you know indigenous health they're giving more emphasis I think in April uh I would say um I have seen two months right I mean since February March and then there is the April and the May April was quite a different May I figured out a little bit more easier than the April it's my opinion after reviewing all the questions actually because there's lot of backlashes actually you know understand they are also a company so they want more candidate to appear so after that um April exam I think lot of people cancelled in May so that I think strikes them in any way that you know why so many people are you know cancelelling the exam and this and that you know get afraid like already they knew from the candidates okay they are not happy with the question and the pattern and so much new But it is also true they have announced. So now so many people are afraid they scheduled more into let's say September, October, November like they also want to I mean the candidates and the doctors also want to review the questions first. Actually you must be knowing one thing that MC exam is an exam where you can change the exam freely for one year. Let's say if you take a exam date in September this year till next year September I mean before September that is the August you can keep changing the exam free of cost actually exam fees is high in any way so probably they can give you at least this minimal changing option but honestly you know changing too many times is not easily healthy your time you know keep wasting but it is also true at the same time you know you should be taking the exam when you are Sure for the exam we we keep telling this thing actually. All right. So this is one of the things. So another thing is a indigenous health patient safety. I mean this slide we have shown you in past actually. So uh so reasoning over memorization. So there's another group they try to memorize things actually. There's another group they just try to go through the question bank. It's not enough. I'm telling again and again this depending on one particular question bank lot of people are talking about a question bank. It was not enough actually a lot of people have seen that one actually. Okay. I mean like 6,000 7,000 questions and you know uh so that is you you have to think your total knowledge is important. another student I was talking that you know that I'm say the um came from another course and uh she failed actually and I was talking that you know so I found okay she probably choose I mean other than us there are also courses available so she was okay it's fine you know anyone it depends on you end of the day how you study and this and that few things also depends on tutor definitely but when I asking like okay she said she took a theory thing then she took medical thing but she was not our student that she wanted to talk to me that somehow she managed to find me okay anyways uh then talking to her like I was trying to figuring out why her mark was so poor I mean it's like 201 was the mark like normally let's say even some of our candidates even they if they cannot pass the marks are at least nearly 230 240 like this kind of marking actually so I asked like what went really wrong actually you took took a theory course, she took a recall course. Anyways, it's going to be third parties. That's okay.
At least I mean she has a brain definitely. Definitely she also studied at the same time. So what went wrong?
What went wrong? Okay. Now of course like courses matters that is true but at the same time maybe something went very wrong. So I asked her later one thing that you know uh so she said that you know a lot of doctors whom they were studying her study pro appeared in last November due to some issues she couldn't appear in November all right now after the November she couldn't study much so study thing was little dropped and she was not into that group so solving the controversial one was affecting very important thing solving the controversial this brings us to the very important thing solving the controversial recall all together by a study group rather than going alone. So while talking I figured out that no she was studying alone later on actually after her study mates were studying or they finished in November actually all right now she was alone and then appeared in April that she couldn't get through and mark was poor in spite her friends past maybe want to fail that's okay but uh her mark was quite poor actually compared to any other actually then I ask another thing that Um the last thing I was also trying to figuring out that uh other than this thing okay material can matter but she said okay she finished the theories with the course um even though with the others that's okay then she did some last moment recall things but she didn't get in the last moment even though as I mentioned that these things will not work much actually even though in our courses this exam support group are given like free of course but we think you know these things may not work that much in coming days actually your total preparation will work much the last thing uh when I was talking that did you appear in 3 and 1/2 hour exams that is no never before that that's it okay now do you think this can be a important change actually see I was struggling with the time now this is things are to the point guys very very important that your this part actually your time management actually so strategies reasoning your time management because the patterns are new than the before. So lot of uh time goes in between actually and some people just quickly finish just to satisfy themsel that okay at least I finished the exam. Understand one thing even out of 150 question if you finish 120 you will be still judged your exam will be judged actually but if it's below 120 out of 150 question you you are like disqualified from the exam.
Okay. So some people like do it faster but I mean does not know makes sense actually. Okay. So the and you can one thing if anyone is hearing this thing first time MC questions you cannot review like plan. Okay. Previously MC questions you could review. It's a computerist based exam. So previously question we could review and there was an option but now it's gone actually. So once you mark something and go to the next one it's done totally. Okay. Is this point is clear so far guys? Is this point is so far clear that you know once you mark a question and go to the next one you cannot come back you you are done with that one. So some people you know in the middle part so many ethical question population health question bastard question so they be become panic they go more faster all right uh so that's one of the thing in past there used to be like in the last half of the exam more juicy question used to come that is not happening nowadays as well actually so guys it's very important in our uh academ there are time mode practice questions are available as well which I will take you know any courses and this and that recall courses has multiple you know this time mode practice almost four I think took in we took in the last batch I mean it's a big one actually with three and a half hour and in the five months courses you know we also took two big and small size a lot actually the small size let's not consider in that way all right so this is few of the things so anyone anyone whoever uh watching today as a trial maybe some may not from our academy but I want as a person all of you to pass because of small mark you could got stuck Another thing because of your uh some faulty technique you know you keep trying again and again you fail I as a doctor as a mentor of many doctors like you know I don't want anyone to get fail whoever get that mark will pass so hear me out one thing your time management has to be so no matter you are with our course and any other course make sure you know you appear with time mode practice which is like 3 and 1/2 hour okay I'm asking again one more time is that clear So for everyone other than the clinical reasoning you do experiments with your friends this and that. Now time mode practice is very important because lot of new questions and tough type of questions that might take away uh so much of your time. So very very important this time because three and a half hour it's not a 1 hour exam guys you know how when half exam goes you know you are totally lost. We all felt it you know I was I mean we have also been through this right? So I mean in half way it's very different you you need to be physically and mentally fit. So I'll recommend you guys I mean just don't keep yourself like you know eating and sleeping and studying also become little bit physically fit because you have to study like you have to sit for three and a half hour not a matter of joke actually.
All right please keep it in mind actually. So maybe along with your studies a 30 minute you know at least walk and stretching is highly recommended actually again indigous health and AMC current keep checking the website about the uh announcements and this and that actually you know so already you know this is the basic 150 question you need to mark and I mean roughly you have to get half but now you have to get even more than this is like three and a half hour cat means computerized adaptive test you know they can monitor monitor your yeah they can monitor your um answers and the pattern actually how can you start practicing uh we will organize those actually for you so don't worry okay and the pearson like you know you can see the centers any nearby centers take a day try to take like a appropriate date okay so this important things yeah few changes like you know I mean structurally not huge changes in this exams actually not in the marks actually lot of new questions what they are trying to do actually our all of our target is this actually getting after registration actually the general registration eventually initially it's professional or limited at the end after working in Australia for one year then you can apply for the general registration when you get the general registration you can apply for the PR is it clear this brings us to the last point Dr. what is this you know you know things about registration see many doctors knows after MC part one you can get a job actually you know but it is not that easy you need to have a outstanding CV everyone is just coming and lar is it guaranteed after how come it can be guaranteed actually if you are exceptional definitely you'll get it but you need to keep trying and then another dilemma comes should I go for the NC part two or just keep trying for after NC but that is another dilemma at the same time so understand that you know you finish MC1 you apply you know job will not come immediately I've seen doctors after finishing part one they got they got the job after 2 years even all right so you can see that like recently you know there's a one doctor you know she got the job I mean I posted Dr. Nharika I mean very close uh she got this job after 2 and a half year I remember after getting the finishing the MC part one in between that she was initially trying for the job then it was not working then she finished MC2 then apply for the job now she got the job okay so this is a dilemma at the same time is it clear guys you know like why are you all stuck that you know MC1 now you are applying you're not getting the job should I go for MC2 or should I just keep trying actually that's a gamble guys actually but if you have outstanding CV let's say 3 year 4 year 5 year or experience also experience in emergency field some people also have experience in Australia for 1 month now you're a good candidate for um the job after part some people also migrate from the home country to Australia with a master's course maybe their partner is taking a like master's course and they are going there you know just to increase the chances okay so this is probably one of the last resort we say that you know you can also when things not happening you make thing happen actually because once you get a job and establish in Australia you paid really really well actually and you know all the hard works all the amount you're investing eventually pay off actually so thing is the soon you can get into Australia it's better actually so if any of your partner maybe clinical nonclinical in that way they can also get into Australia let's say nutrition course health management course any other thing you can take or your partner can take actually you know which is also PR listed. So another way you can also apply for the PR in that way. Is this information so far helpful? Let us know in the comment section guys. Is this information so far helpful for all of you? Okay, let me know in the comment section actually. All right, I'll take 2 minutes for WBA thing actually. Okay, first of all, we have a video in our YouTube channel where I was taking MC part 2 plus and there was a one doctor who was attending even though uh WBA program is different but it is quite a similar to MC part two. Okay, so WBA program is like you have to get chance into the program. Okay, but you have to be already inside Australia working after MC1 then you get matched with the WBA. Then you go to the WBA program for one year. There will be rotation. There will be small small exams. Then you cleared it. Then you get the general registration. Then you get get the general registration. Someone asked does PR holders. Yes, definitely. If you're inside Australia with PR or without PR, you know, you get some advantage. Yes.
But that's not the everything. You still have to crack the interview. Some people when they go to interview, they vomit immediately. It's not going to work actually. So first of all if if it's very close you understand my point my dear if interviews are very close like okay this candidate looks good or this candidate also looks quite good in that case you know the whoever has the peer in between the clothes the one with the peer get the job but one person going to the interview and you know talking like a like a lost or rubbish at the same time because many people get scared in the interview actually and then they're like you know speaking is not fast and at the same time you know they keep talking here and there I'm sorry I'm sorry you know they're Oy you know come on like you know there's you know pronunciation things you at least have to understand then how you deliver how is your pronunciation it's always does not matter but at least you have to understand like what they're saying actually and if you keep saying like sorry I didn't understand you know one time two time three time but they will think okay the patient will come what this person will do later then they keep working on English a lot of people I saw you know over the time you know initial they're not getting job just because their English is not Trust me on that one, you know. So, and English doesn't mean you have to be like a native speaker like an Ozie or like a British or something like that. It's not like that actually. It's just a clear English tone and your ability to understand what they're saying you know during that interview as and you know explaining a case you know so that things are more important actually and you have to be smart at the same time. All right. Is it clear everyone that you know getting that registration thing and working in a WBA program you already have to be inside Australia sitting in our home country you are not eligible for WBA workplace special assistant there are some job available in the regional areas that is not WBA that is actually you are applying regionally after MC part one or MC part 2 getting a uh job as a medical officer getting a job as a GP GP by the way I mean you know there is a interview exam that is called the pesky exam. Have you ever heard about this name? Have you ever heard about this name? That is the pesky. If not, you can Google it. Read it more about that. Actually, you know, it is basically it's AMC. You have to do AMC part one and then you can apply for the job job interview and then you are eligible for the Pisky, clear the Pesky and then join the hospital actually.
Okay. Right.
You don't have to go through the clinical in that case actually. All right. I mean you can go to the job by the pesky pesky interview is also kind of like a exam actually. Okay. There's three type of pesky interviews are available but three types of pesky things are available. You can keep following our YouTube there's more informations are given. Yeah that's a GP pathway actually in order to join as a doctor in Australia. you don't need AMC2 later if it's about the general registration you may need the WBO or you may need to go through the MC2 or any other further way that is different actually okay but in order to enter into Australia you know after MC1 you can also go to the GP route but understand one thing for the GP route you know do not think about getting a job you know as a GP if you have less than 5 years of experience I'm talking about the GP things if less than five year let's say 2 year 3 year experience then think about medical officer. Is it clear so far? Please comment me in the comment section.
Yeah, I'm trying to squeeze things. I have a nice video.
I have a nice video in my YouTube channel. If you go to my YouTube channel, what to do after MC part one, you can search that particular video by going to my channel that explains more because I was talking to all the past candidates actually.
See there's no hard and fast rule. The more the experience had the chances. Uh last month one of my uh student who got the job she uh the she had like 9 years of experience actually medical officer there's so many videos available like how to get a job. Um so that is the thing it's not a job related uh like session today I mean in future you can contact us for the job builder session or you can drop me a message in my messenger I can share you that particular video okay in that case actually you know so we already have a session video we upload interview we have upload almost everything in YouTube you can also check that one actually all right great guys so um we do have session coming up you know you must be knowing actually so anyways uh how many of you have done your very important question how How many of you have done your verification this epic verification thing guys? How many of you have done your epic verification already?
Or it's my intel it is called nowadays.
All right, you're done. It's good guys.
Please try to help each other in that case actually. Especially in the batches there are some doctors they need little help. So please help each other if it if you can. Actually it's not a like always necessary but it's a complicated process. So normally one candidate help other candidates especially those are in the batches actually. So um verification MC account making MC part one then you go for the MC part two or the WBA finally the after registration in between you can just take a shortcut you can go to the GP pathway. Is this clear so far actually?
Summary again. No structural change in the exam but the bar has increased. That is the summary.
All right.
For one minute just probably showing my face. Yeah. Just to switch over the screen. Yeah. So more things in the coming days which I'll be talking with our doctors especially about the aboriginal and the things changes is more like a intensive things actually aboriginal tourist islander related more topics we'll be discussing in coming days actually here's few change already I mentioned you know how to tackle this and that and now you see the aboriginal involvement a huge file you know I have uh prepared for you guys actually so I mean One thing I'm showing I mean those of you came for the you know this summary um session actually but you know there will be more longer session in the in the full course definitely uh guys those of you can answer some of you some of the candidates like how long it takes like a a big verification process please uh feel free to answer them will be really nice guys actually if you can just help them little bit all right because some of you already done it actually so into this Now here's a simp prediction for this is like highest areas cultural related there's a chapter already in John Mak regarded that anti-racism is new so we have to add more um notes in the SMA note regarding this um um elderly abuse or domestic violence.
All right. So this kind of topic trauma related you see trauma and emergency related thing questions are increasing now it will increase more emergency surgery related question they will increase more this is another thing all right but what type of question this and that which I will be talking definitely with our candidates in the coming days actually chronic diseases they are emphasizing a little bit more let's say let's say diabetes let's say HIV so this kind of disease related you know things should be more actually. All right.
Rheumatological things I think always been quite a favorable. Yeah. So, uh you can just keep checking. We already had a rheumatologic class, you know, can have a look on that. Um but like heart diseases. So, the cardiac and rheumatic heart diseases because it's more related to again those aborigines actually.
Okay. Aborigines has this particular problem more. So, that's the thing actually.
All right. uh next is like a hearing loss in a original. So again that part you know we're talking about this aiginal a little bit more maternal and child already there's a chapter there in John Mortan but I think you need to study a little bit more from some RSCGP guidelines which I will guide you guys even more all right so again let's say court order trials patients autonomy medical ethics related more classes would be important we have classes on medical ethics but I think we'll take extra classes on ethics in coming days actually all right so anyways Guys, I mean these are in general but I think you are getting some ideas. So these are few aboriginal related thing but emergency related thing. There will be more additional things which I'll be discussing in coming days. There'll be like few things related to hemato infections which I'll be discussing in coming days for you guys actually. All right. So anyways let's get started with our git guys. Are you guys ready? Yes. Yes. For the session. Thank you so much guys. You know those of you just attended for the updates. Thank you so much. We getting into the class now. If you want, you can go through this particular session. Yes, I have added uh new questions with the last file. Yeah. So, this is our academy. If anyone is interested, you can leave us a message in our messenger or you can save this WhatsApp number directly hotline. It will come to me and my team. So, this is my WhatsApp number.
If anyone wants to save it, you can save it actually for now actually. Okay. Now it's time to get back to GIT. GIT we have a theory which is posted already in YouTube you can check and also for the doctors which is those are in our course they have already attended and today is the recall part we were into the Eid break actually Eidasa break so we are back into the break we're feeling refreshing and you know I just put my WhatsApp number in the comment section so you can just have a look on that actually I'm just also putting it one time on my screen so that if anyone didn't have it can have it one more time.
So if you WhatsApp in the site, it come to me or my team directly actually. All right. So any of those inquiries if you have further you can WhatsApp regarding this actually. All right. You may also get chance to talk to me you know if the team couldn't answer something actually.
Yes.
All right. Yeah. Thank you. Yeah. Do not call us late night. It would be nice actually. Yeah. It remain silent in anyway that's okay. Thank you guys. Uh going with the first question let's get started. If anyone didn't save the WhatsApp that's thumbs up. New questions fresh questions blended with the last class actually. So I think the half of the file has been changed again in just 6 months actually. All right. Now a 12 year girl with a difficulty swallowing and on PP showing moderate ein inflammation and 15inophil on biopsy. Uh this question came at the last year end by the way and a very interesting one actually we collected in last November. What is the next step in the management? Come on guys it's your time now. So let's go for it guys.
First you have to make a u decision that what is the diagnosis very important that you know what is your diagnosis here actually any idea any guesses what is the diagnosis is so there's the first of all it's indicating dysphasia certainly it's dysphasia using inflammation is the so this is the diagnosis p right we read last day about this thing as a theory so of course so in this particular ular case actually.
So diagnosis is eucenophilic esophagitis. Now if it is a eucenophilic esophagitis what do you think is the what is the next step in the management? What is the right one in case of this?
All right. So the right answer is esophagitis your answer would be going for a uh first of all you know if any particular thing is causing it you stop the offending agent but nothing has mentioned in this question as a stopping offending agent. So our next step in the management is actually a steroids which is the eunophil which is inflammatory allergy condition. So you eventually need the bodessonide. Now did you remember from the theory class did I mentioned about the topic steroid or the Buddha sonide in the last theoretical class? Yes.
Okay. Uh those ask about this six food elimination diet is an option but budon is the next step in the management among the choices. So which one is a better actually it's actually the Buddhist is better actually six that's usually a let's say when we go for the lifestyle modification. I'm telling you one thing in the past if someone is obese there so many you know suggestion comes in general so the six food exclusion diet is a in generally you know you can say like I think it's also given in John mutag like you know lot of points are included there so that's like a chart but that is not the stopping the offending agent actually because you have einophilic is you have the allergic condition now and next important question is is it a acute please check the Question one more time is this one is an acute einophilic esophagetis I repeat my in question again is it an acute einophilic esophagetis because you see 15 so it's a acute one at the same time so acute one is just stopping that you know general dieting thing will not work so most appropriate thing is definitely esophagitis here yeah so yeah so steroid would be the best possible thing here put any other those steroid actually right clear this thing it can be asserted with many allergies sometimes let's say this question is not fully complete because it is recall some question also say their family history of allergies this this type of points uh some cases they mention that you know when they drink uh or eat something like um peanut then they have this kind of problem or any specific food and that specific food is given in the question option then that has become the main step actually in that case like let's say if a nut is causing that main issue then stopping the nut is number one so six food exclusion is a general some cases when diagnosis is not sure I'm telling it some places when the diagnosis not sure then we also give this food exclusion chart when we stop And then you know we get to know okay maybe this is how it works. This kind of thing also available for celiac disease and other things you know when you are not sure with the diagnosis though some kind of exclusion chart we give and then the patient improves. Oh that's the diagnosis now is it clear everyone? So now here we can see it's already there is no such doubt actually clear yes. So summary answer taking a little time but it's we have the both thing one is left hand side some nodes IG elevated infiltration of figures there's multiple constriction is a special line you want to add you know the endoscopy will show there will be multiple constrictions this is extra line which is not written in John Mak another thing is a like Buddhist specific for this condition it's not written in John Mak but you can also add that one actually yes all Great.
So summary here six elimination diet is also is a popular diet for einophilic.
It is also mentioned but that is more popular in terms of making know the diagnosis and all these things actually but when it is a acute case when you have the 15 years in field it's better to go with the steroid therapy steroid therapy initially and then you know in generally that that particular chart because is it a uh short treatment or is it a long-term management you need long-term management right so initially you're giving the steroid to reduce inflammation And you know over the time you give a six uh food elimination chart so that it does not aggravate. Now is it clear? Final thing. Yes.
Yes.
Yeah.
So I double checked all this thing not only from the John Morta I also checked these things from the uh BMG which you probably know BMG is one of the best journal in the world actually. So let's double check that one actually.
Yeah. So this two double checking is I mean I have been done. I was also confused with the six code or this one six more. It's like a a bit later you know. Next question. Sorry for taking little more time. Uh 36 year old with a heartburn after meal and nitri no alarming sign but it's a clearcut for you. So initial management. Now this time they have cleared you. They want a initial management not a very specific or appropriate one. So in that case first of all let's go with the diagnosis. I think all of you would be agree because it's mentioned nighttime earburn. So going it's certainly with this popular condition ZED and if it is a Z certainly it is a trial PPI that is very very important. So PPI with a lifestyle but I'm not finished here yet.
So I'm going to tell you two more things which is also tested in AMC. So AMC important tips for ZD. Often you will be given option is it PPI or is it an barium investigation? PPI or barium investigation. Now question is is for the ZD you know do we always go for barium? I mean we can see if like obese person and you know that I'm having bloating I'm having night symptoms you know when I sleep I don't feel well. Are you going to do barium or you'll give the PPI? You will give the PPI actually right. So the initial treatment or initial approach is not the investigations initial approach is PPI.
Okay. Please confirm in the comment section is this information is clear to you. I gave this information in the last class in the theory guys. You need to be a little bit more supportive during the class. Yes, clear. Next one is another one which is very popular in the exam.
They will be telling you okay treatment is failed. You are trying with a 20 migram and treatment failed. What to do in that case? Going for more investigation or increase the dose into 40.
Answer increase the dose into double the dose. So double the dose. This one is like popular. Double the dose related.
More questions we'll find in future.
Actually not only z but many other conditions like let's say in future we'll find the asthma. Asthma we know we double the dose. And this is the thing.
In this case it is z gastrophial reflux disease my dear. I mean short term is the year. So it's a acid reflux because of the relaxed sphincter. If anyone didn't see the last class there there is a acid reflux thing happens actually. So we go for a trial PPI. Now is endoscopy is a choice. Now we have the test like barium that's the main thing but do we do the like endoscopy all the time for because dysphasia or these things are not present at this point actually. See they said heartburn which is the number one feature. They said ninth syndrome but they didn't mention anything about the dysphasia or any weight loss. If dysphasia is present with zerg is it a red flag? I'm asking this question.
Dysphasia present with zd is this a red flag? Yes. If it's a red flag means it can be cancer by any chance. So then we go for the endoscopic. This is a another popular question. So this thing is a another popular thing. So endoscopy if alarming features are present. These are some of the alarming features actually dysphasia weight loss GI some of anyone here having zer anyone here having z like feasure I mean because we are doctors we are eating we have to u we have so many sleepless night right caffeine is I think instead of saline I think you know we can also take caffeine it's kind of like that actually all right so I mean we don't have a choice actually you know instead of like coffee this and that actually the tea all the time coffee all the time you know I can even ask a poll like you know tea or coffee what do you like you know anyways avoid large meal at night guys whatever even if you're working at hospital I know you're hungry and this and that but uh try not to eat a lot of doctors like at 12 1 they're eating there because busy with patients actually Yeah, someone said a very nice one. I liked it. Find a do find doctor with z. Okay, good one my dear. Okay, very good one.
Uh late night meals because we all have duties. Okay, caffeine. Alcohol. Alcohol maybe we're not taking but you know uh caffeine is there actually. Yeah, someone give a nice take ice water. I mean the early you finish it's better.
Yeah, that's the main thing actually.
And eat clean it's also better. Ready for next question? Yeah. Sorry we're taking a little more time in the first two question. It'll be more faster in next one. 45 year has epigastic pain and positive area test. It was a very popular question. It has been tested all over last one year. So very high for our AMC this year actually. Act actually this year already it is tested already one time. So what is the next video test positive? I'm getting little smell about this peptic disease because of what?
because of this culprit H pylori. Okay.
So this H pyloric culprit we have to eliminate by a triple therapy.
Right? This is the John Mak line. You'll find in the John Mak. I'm giving the page number so that you can check any time later. Already we have gone through the theory. If anyone coming to the class first time we had a full theory on GIT please check in the our um YouTube channel Sher Rahmed Shuja Medical Education. you'll find that one actually. Great. All right.
So that is the thing. So here is the thing given is as a triple therapy triple therapy things extra thing on AMC some cases they give uh two question to see the prognosis and one is a treatment failure.
Guys do you mind if if I tell you the extra things which also can which can be tested or tested already? I hope we don't. Okay. So they will also ask you now this question is about the treatment. This one is about treatment.
Another question about prognosis. Okay.
One time positive now triple therapy ongoing. How to see the prognosis? So how to see the prognosis guys?
Tell me tell me. Come on guys. How to see the prognosis? Again the same thing.
URA breath test. Again the same thing. URA breath test. So, uria breath test is a test diagnostic and prognostic.
Let me clarify. URIA breath test is a test for detecting H pylori. Detecting H pylori. It's a diagnostic test and also prognostic test. Diagnosis confirmed with H pylori test. How the triple therapy working or working or not? Again test clear now? Yes. Okay. Now you give a treatment and the treatment is failed somehow this can happen and if you're living in Bangladesh, India, Pakistan even more higher chances because you know uh tell me one thing guys is antibiotic is easy in your country at least in Bangladesh it's quite easy I mean I can just go downstairs I mean doctor but it's a different but any person can go downstairs and buy the antibiotics so easy so easy here anyway so r I think I think in India at least it is difficult At least getting those antibiotic without doctor's prescriptions but at least still you can manage but difficult actually in Australia impossible like you know you get antibiotic actually all right so one tip here guys secret small tip while you go to Australia other than many of your clothes and this and that take some antibiotics sometimes you feel like you know that there is acute otitis media you are having but still the doctors are not giving you antibi antibiotics you must be had these things multiple time actually sometimes all right so anyways take some antibiotics I think just for you because you know it that you know that you are sure that there is something all right coming to this one so metronigazol is a drug that is commonly getting resistant am I right yes because that has been misused a lot yeah good question BTW can doctors prescribe themselves in Australia unfortunately you have your own GP my dear example I have I have like you know uh the last time I was there I had my own another GP I cannot prescribe myself all right yeah here it's not like doesn't matter you know I go to the shop and okay give me these drugs and this and that oh doctor himself came to the shop you know that is how they treat in the pharmacy in there it doesn't matter actually yeah it's a very basic basic thing in Australia, every area, every area there is a registered doctor. No matter what whatever you otherwise you know you might be involved in uh criminal things you know so everyone have a doctor in Australia even if you're a GP your physical health mental health the job is not yours the other doctors that is one of the reason do you agree on that point we doctors are worse patient in our country agreed on that one it is true actually you know we doctors are worse we don't listen to anyone but for even simple thing for your mental health physical help you have to go to your GP even he's a doctor you are a doctor that's okay yeah uh he will monitor you that you know you are not thinking to things too aggressively I mean you can talk to him that you know based on your clinical things but he will even if it's there like he will not give you antibiotic even if you're a doctor he'll not give you antibiotic all right guys yeah so anyways there will be a GP there are Medicare there are like lot of things anyways. So treatment failure case in that case you know uh you have to change the metronal and give a another combination. This is another popular question regarding this particular peptic answer section. Please mention as a clear so that we can go to the next segment.
Guys are you enjoying so far? I mean I hope it is all right.
Next one.
J is fun. Yes. 70 year man. This time old with a melanina. Melanina means lower GL.
Okay. Now endoscopy revealing. Um.
All right.
Now melanina can be upper GL. I'm sorry about that. Fresh bleeding would be lower bing. Melina is upper jity bing.
Okay. Endoscopy labeling uh diodenal ulcer with a bleeding ages and biopsy. I mean that's quite a information given here. Biopsy confirm that he's H pilot positive. Okay. Endoscopian biopsy. What is the appropriate next step in the management?
I think this was there in our theory class. Agreed guys?
Okay. If you know what I'm talking about then try to answer this my dear doctors.
It was there. I remember. I can tell you even the page number. Can you tell the title topic? Then some of them can understand what was the title topic of this one. Is it a uh lower GT bleeding, upper GT bleeding or what was the title topic of that one? A lot of people are answering uh because based on this like H pylori positive and if it is a H pylori positive a lot of people I think a little bit uh towards this remember last year what is it it's bamboo right you know sometimes we make fun you know what you expecting that is not happening now Hary It is true and it is given as a distractor so that you pick up the triple therapy. Now even if you get triple therapy will it work like a magic drug. Is it your first priority that you know controlling the H pyloring the bleeding is your first priority?
Please check it properly because most appropriate step is been asked. So controlling the bleeding is the first priority because because of bleeding the patient can later they can have serious issue but because of peptic the patient will not die for sure right and it will take some time to get rid of H pyloris so the final answer here is a it's a bleeding pepiculer if you remember the topic yeah here was the topic bleeding pepiculer was the topic they give H pil on the top to confuse you this is how MC See keep changing the question all the time. Similar kind of topic which will be happy. Oh doctor that's the same question but why it didn't pass? Yeah because you didn't see the yeah it's age p and you know you jump for triple therapy. But that was the question. So did you understand what they mean by this is the classic clinical reasoning question guys. This is the classic clinical reasoning question. Clear everyone what they mean actually by the clinical more practical approach patient can have two three conditions together am I right guys originally when we see a patient does patient have one doctor I have epical sub disease no patient come in that way patient came and tell I also have that I said this I'm feeling I think I also think this so many things they say so they're trying to be more classical actually in this time so all Right. I remember one time you know very early days in internship I went to a outside Dhaka and the I was trying to make a diagnosis and someone came like 70 years why you are taking so much time you know I look at him what you think so much just give me those vitamins you know because it's a government hospital you know so I understood it's not a real case so he came for vitamin and iron basically anyway Anyways yeah so summary thing is here this is bleeding peptic ulcer injection adrenaline last day we discussed this thing John Mortag check this thing as a reference later but check the theory class again if anyone didn't see that one next question okay switch over it says the topic this time again elderly 64 year with a new answer despia guys despia is a separate chapter in John Mak lot of people skip that chapter But I found questions started to come.
So this question I kept from the last batch class actually. Okay. Because dispsia often you guys escape. Now he reports unintentional 5 kg weight loss. He has no prior history of peptic ulcer and I know what is the best management. Next best step of management.
The question topic is disrepia.
Not really dysphasia. Dysceptia.
Now this thing with dysceptsia and weight loss. So can I say in that way this is dystopsia with red flag. Okay.
Can I say this is as a dispia with a red flag. See there are dysphasia with red flag. Dispsia with also red flag. Okay.
In both of these cases what we can do because it's been red flag. So chance of cancer or suspicion of cancer. So that is one of the reason we go for gastroscopy or endoscopy.
There's two risk factors. One is age more than 60 allowing feature and one more thing is a weight loss.
Okay. So two factors here cancer chances right yeah it can be a is esophasial cancer a gastroscopy endoscopy you can like you know in the similar way you can think alternatives yeah those of you are still not sure I have information for you yes you can see So unexplained weight loss this is one of the thing also you can add the age from another book reference the age and the investigation of choice. Now are we full? Sure guys you can check 450 like so I always mention one thing guys very important first reference you try to take from the John Mortai then come the other websites like you know or other textbook like Davidson this and that then come the all the websites actually I mean while you preparing always keep this thing in mind actually okay next 23 year old woman presents with persistent bloating ing weight loss and some labs are given with the microtic.
So young female with microtic anemia likely diagnosis it looks very easy and silly question but I don't know but they give this question very often in the exam so bloating fatigue fatigue is a see fatigue often you ignore but always remember my word this fatigue is somewhere related to lot of chronic diseases before going to the final diagnosis can you say what diseases it can a spatic thing okay like a celiac all right celiac disease cadis but age is not supporting here but generally I'm talking about fatigue then uh diabetes cases right then um things like MS cases so many other neurological condition and uh even lot of vitamin deficiency cases fatigue right many autoimmune cases as well thyroid cases. Okay. So many things started with this word fatigue. So do not ignore the fatigue. If the patient is telling for longer time I'm feeling very weak and fatigue. Okay. Now microitic anemia this one is going towards. Yes please. This is going towards the celiac disease actually because uh the anemia the weight loss fatigue bloating these are indicating towards the yeah selective and in Australian prospect in Australia see is Australian or oi women are they like Asians normally I'm just telling in generally respect to all is this typical oz people you know they are quite big in nice actually and physically very fit and they go to the sun, they run, they're very up to date with the nutrition. So in terms of this anemia thing which is very common invariably in almost all women in our countries, you know, uh is it that common in Australia?
Not really. Even their bone mineral density is also quite good in Australia.
A lot of researchers has shown actually unless genetic. All right. So in this one rather than the iron deficiency if this thing would have been an Asian woman I would have been think faster than iron deficiency anemia in this cases because of microitic anemia but from Australian context actually I think I'm thinking more about the celiac disease even though it's a recall even though it's a recall I'm expecting maybe exam will also tell you few particular things related to diet as well right means few particular dietary things actually.
Yes. So bloating, weight loss, iron deficiencia that's a triode. John Mak has lot of triodes you will find actually guys. So this is also a triode.
So it it touches all the triodes actually guys and also young person at the same. So iron deficiency anemia versus celiac disease you should double check triple check that would be these are the things you need to be master on actually that next time if this question comes is it iron deficiency or celiac how would you differentiate one by one actually right now about celiac disease I mean what is missing in this question actually that some particular food they didn't mention right like if you remember I mentioned about something brow Right. Burley, rye. This rye, not rice. Rye, oat and wheat. Okay. So, you need to avoid and yeah some of the Yes. One more thing if classic iron deficiency anemia is it associated with weight loss? Another thing guys is classic iron deficiency anemia in female nutritional deficiency does it associated usually with weight loss?
Usually answer is a no. And in this question the cancer thing is not given iron deficiency anemia with weight loss we can also think about certain cancers actually. Okay. But considering the age group we'll eliminate the cancer uh at this point actually. All right. Clear.
Now select disease. So there's some blood test there are some uh diodenal biopsy to confirm. This is very popular for the exam. Lastly we also mention small bul biopsy or dioden biopsy. This is like a normal vi but if there is uh celiac disease there are more flattened vi remember and that gives rise to mal absorption that gives rise to mal absorption and the clinical features if you see bloating weight loss iron deficiency anemia these are the classic one lifelong gluten-free diet that is the main step so summary picture Again healthy vi good for absorption.
Flattened vi bad for absorption.
Is it clear about the celiac disease guys? We have read celiac diseases already.
Yes.
Here is a link which I took nice. Are you familiar with nice guideline guys? I mean we we keep talking all the time about the RSCGP and RSCGP but I think in the MBBS I mean we all go through the Davidson and a lot places mention NICE guidelines actually. So guys you can also check the nice guideline it is also fine some cases actually. Yeah because these are very good like nice guideline BMJ these are top class in the world even Davidson book is made a lot of guidelines where NICE guideline and uh BMJ Yeah. NHS guidelines. Yeah. Anyways, few more things. So, initially are the blood tests and more accurately small blood biopsy. This is another textbook reference.
Next question. A man developed epigastric pain shortly after eating in a restaurant. Okay. So, restaurant related issues.
Has a past history of anaphylactic shock operating carrot cake. Now, carrot cake related this question recently also came up. So, I kept it. Cat. This question also came quite in past as well actually.
Carrot cakes are available in lot of places. Is it testy? Has anyone tried the carrot cake? Correct. Halua. I mean I'm sure you know about halwa, right?
Is that sound very uncommon actually?
Yeah. I think in our countries it is common the the carrot. Yes. But in the Yeah. Yes. Someone said Yeah. Gajer.
Yeah. Yeah. He said, "So anyways in uh there are shops like 7-Eleven shops, right? And there are like petrol stations in Australia. If you have seen in that one so many those carrot cakes are available. Try it very nice actually. And this carrot cake contains actually nuts, eggs and that can gives rise to this allergies. If allergies become serious, this anaphylctic shock is nothing but an allergy but it it is a severe form.
Okay. Now the question is what inside that carrot cake can leading to this thing can happen. Some points are given egg then milk then gluten then certainly is to n uh see celiacsis will not be like that much shock okay this malabsorption mostly so it's not celiac so in between these two one you have to pick up and that's the egg In Australian context you can search with egg allergy this thing.
All right there's another question MC other than this egg allergy come in MCS carrot cake.
All right. There's another version um with with the vaccine actually.
And which vaccine? MMR vaccine. A lot of people has um believe like MMR vaccine has some uh relation.
Okay. If you if you give MMR vaccine has some relation with egg allergies.
But is it true? MMR vaccine and egg perhaps this question related to immediately after eating if someone has allergy like immediately it started uh with the egg allergy. Now we're talking about another thing that you know MMR vaccine is it possible some relation with the egg allergy.
Taking one second.
Uh, next question. Can like those have egg allergy can they take MMR vaccine?
That was actually the question uh one of the pediatric question. Those of egg allergy can they take MMR vaccine? That was the question actually.
The answer is a yes.
Even with egg allergy can take MMR vaccine safely can receive MMR vaccine.
reference Allergy Australia. There's a website um in Australia, allergyaustralia.org.
You can check All right, that was a different question with the MMR vaccine because it has been tested in this question. Let's focus on this question. Eating the carrot cake and the carrot cake is containing egg.
Um carrot cake probably also containing nuts. So either of them can is causing this uh particular um anophilic condition actually.
Usually there is a special line uh how we counel the mother. There's a MC part two. One of the station is this that there's no relation between MMR vaccine and egg allergy. That is how we explain. Okay, clear now everyone. This is a very popular MC part two question and we consider the mother in that way. There is no relation between MMR vaccine and the egg allergy.
I mean mother has concern like you know if you give MR vaccine will there be egg allergies this and that no problem okay allergy related questions are popular MC it is true anaphalicis related questions like angiodma is also popular in the main exam so I brought some of the extra thing So would you like me to review them guys the articaria and there is a thing and geio edma so mild moderate severe okay so a lot of way it can be given our last case um they mention anaphilictic shock considering uh serious now serious we understood in that Okay.
So seriously understood there will be chest symptoms.
One thing that is clear the severe means there will be chest symptoms and usually we give I am adrenaline.
These things uh we consider in this way like I am adrenaline and earlier cases means mild to moderate cases. What are the treatments?
Earlier cases especially in mild in mild cases the treatment is simple anti- histamine in moderate cases we give the steroids predisolone and in severe cases is iron adrenaline I adinoline only applicable when life-threatening I adine only available when chest symptoms are present chest symptoms are present means it is life-threatening Okay. So summary thing serious reactions I am adrenaline this is extremely extremely popular in main stem exam great ready for next one 52 year old with going through epigastric discomfort despite initial treatment okay what they didn't mention anyways and upper GT endoscope is normal no answer malignancer is ais No alarm features.
Basic blood test are normal. What is the best ongoing management?
Okay, I think it's not difficult to answer this one. Best ongoing management approach. In this case, endoscopy findings are normal. No malignancy or anything noticed.
Okay.
Uh did you know or did I discuss last day there's something called functional dispia or non-answered dispia? There are certain terms like functional dispia is one thing then there is a noner dispia.
This brings us to one of the MC question. Which type of you know conditions are more common?
Yeah. What is the most common one? Is it a diodinal ulcer, gastric ulcer, noner dysfunia? Which one is a MC? MC means most common. This is how they also test you based on population health. Answer is a non ulcer dysphia.
Noner dysphia. Actually the most common like even many of us probably have this sometimes uh gastric irritation do we have ulcer not really others but it is non-alcar dysphia but not a classic dialer or a gastric ulcer I hope that is clear to all of you in those cases also treatment like z like PPI and lifestyle modification yesment Next question is coming. A patient is a known case of alcetic colitis.
Okay, they already mentioned it is a IBD.
IBD is very popular in AMC by the way with distension fever toxicity.
Imaging confirms toxic megalon. They might give you the mega colon you know imaging like setting what is the next step in the management.
Yes please.
So good news is they already clarified what is the diagnosis.
Keep going guys.
Just taking a second.
All right.
So, will the answer please? All right.
Um there's a doubt uh some people are thinking as a hydro steroid. Now question is hydrogesteride can you uh control the toxic megacone and is it the right approach at this point acetic colitis confirmed with toxic m is it a complication of alcerative colitis okay let's see first what are some of the uh yeah this one I hope you remember from the last class uh left hand side is alsetic colitis and this set is chron stages initial some features git extra g features Among them um complication is a toxic mega column. When alcetic colitis with distended bowel it is suspected as a uh toxic meacolon. So they said it is alsetic politis. So we'll suspect the toxic meolon first whereas the fistula uh and obstruction those are more common with Crohn's disease. Okay, coming to this one. This um as per the NICE guideline, chlecttomy should be considered early in patient with intestinal you know um any perforation, hemorrhoid or toxic makov.
This is the exactly line I took from the nice guideline.
Okay, some people are with the option colonoscopy. Let me clarify that one. Is it safe at this point?
If toxic megaone or any other thing obstruction by any chance because it is associated with abdominal distension, it can be toxic megaolon or intestinal obstruction. Is it safe to go for colonoscopy? Absolutely no.
Okay. Toxic mega colon. Is that a small bowel like issue or a large bowel issue?
Let me clarify. Someone asked me why not NG tube. Is it related to large or small? If it's a large bowel, is NG tube your priority or not? If it's a large bowl, is that a priority? It's a priority for small B. Clear now.
Yeah.
So, clear now. Yes. See, toxic meolon is considered as an emergency, right? I repeat my thing. Toxic mega colon is that consider like any obstruction or um toxic meolon or obstruction is it considered as an emergency? Answer is a yes. So going with a a high dose of a steroid will that be enough? You cannot solve the emergency.
Clear you need surgeries at this point.
IBD which is a relapsing all the time and recurrent already we discussed earlier.
So this part is for confirmation inflammatory bile disease IBD and treatments options are given. I think checking from the John Mortag it's better. Yes. But I think uh few complications like fistula, meggaolon, cancers, obstructions you need to consider I think you can give an like yeah you know they ask what is the best step you know see first again I'm clarifying this thing are we dealing with in this question the best option or the most important option or are we discussing with an initial option we are discussing with the what is the most priority here most important thing here the one that will save the patient's life here actually okay so yeah antibiotic you can give initially not a problem but I think the again most appropriate is a urgent collectomy I hope that's clear it's an interesting question last one and these two charts like you know u yeah these two are continuation from a textbook actually that alcetative colitis Cronhn's disease very interesting alcitive colitis less less common um in smokers so those are smoker by any chance have a good news as a fun so as like Parkinson's and some of the dementias all right so if anyone smokes and this and that all right guys like so IBD is popular for AMC for very certain reasons and Learn the differences between acetic colitis can be tested very separate conditions especially one of the line that is very popular um often given in past area of friable mucosa okay and your diagnosis of ulcerative colitis this line was very important uh something presented because thick bowel or very narrow lumen for Crohn's disease so there is a more chances more chances with obstruction and the fistulas with the Crohn's disease. Actually acetyl colitis on the other hand uh the blood bloody diarrhea blood mucus very common actually crrons mostly diarrhea and also check the locations is also transm these are explosive lay all four layers are involved actually whereas acidic politis mucosa submucos that is one of the reason since it is transmoral your lumen get more narrow over the time and more chances of obstruction. So complications are more common with bronze disease honestly and the dangerous complication for alsetim is a toxic metacognar u check from the john mudak about mild moderate severe treatment of IBD if you remember I mean anyone early cases moderate cases severe cases anyone remembers it.
So the managements okay sulfa MTX has a thio print yes you can also give steroid if there is any acid flare up at the center so mild moderate several side effects let's say if it's given in a male there can be aospermia it can also have effect on the bone marrow anyways remember that and also uh check from the books like about the recurrent cases of uh IBD what to do in that case actually like more drug options like I'm giving you that floor that if you want you can read much more about the IBD IBD is a favorite topic and popular topic they can ask more and more new questions for the IBS so far is this clear to everyone guys you know we're trying to give you explanation of lot of added techniques that can be useful for exam not only this one answer is this that is not the practice this is how you should study in MC in general okay guys so for enjoying do you guys need a break guys here or two more question then give a break okay two more question then let's go for a break which of the following has the greatest impact of development of esophasial cancer I think last day we discussed about the esophasial cancer so fingers Upper 23 lower 1/3 AB so lower one/3 of the esophagus adino carcinoma also barren upper 23 squamas cell carcinoma the question is has the greatest impact on the esophasial cancer this question is more like a population healthare question it means it's more like a risk factor type of question. By the way guys, risk factor type of questions are very important. Answer is surely clear winner is a balances of figures. We already discussed 1/3 AB adenocarcinoma balance. This brings us to two more added question for AMC.
Worldwide which cancer is number one in Australia which is cancer? So worldwide it is squamous cell carcinoma in Australia it is actually adinocarcinoma I hope that's clear popular in exam you need endoscopian biopsy to confirm the esophagial cancer service often there will be red flag example dysphasia weight loss iron deficiency I Dysphasia, weight loss, iron deficiency along with some of the features related to esophagus is indicating esophageal cancer.
You see there is quite a high chances for leading to cancers.
W F which of of the following?
All right. Anyways, one more additional thing which is taken from the John Mutard. Uh they will give you some certain features of Barretts and they will ask you a prognostic question. How persistently this is is this a cancer bars? No, it's a pre-malignant condition. Am I right? So it's like a double soul we read in the pathology.
Right? So in that case they will ask you how persistently we follow up 6 months, one year, 2 year. Final answer it is a 2 yearly followup follow up with the endoscopy and the biopsy. Please confirm is it clear to all of you at this point a lot of esophasial questions in MC.
Next, a 45 year old presence with a progressive dysfiable solid liquid is a new very brand new asset with regurgitation of undigested food and weight loss. Barerium solos and dilated and this and that and yes you see the pictures as well given a picture showing bird appearance. Now I think when they say bird you know you understand what it is what is the definitive management.
So they're what they're asking that is also important. So definitive I think last you mentioned if you see the word surgery and if you see the word definitive high chances that is your answer.
So they said uh dysphasia to both solid liquid. I think let me clarify something always they will not tell you dysphasia to liquid. Did I discuss this thing last day because initial dysfasia to liquid lot of patients did not realize they have dysfasia to liquid. See dysphasia to solid anyone understood easily disfigure to liquid it's difficult to understood. So that's why a lot of patient presented with dysphasia to both solid liquid. But irony is they have started with the liquid. They didn't realize they here thing is a given is a barium. You can see clearly there's a barium given.
Yeah. So this barium is a rat tail or barbe whatever you say. And the main treatment is a surgical myiotomy. Clear everyone? Surgical myotomy. But some of the initial investigations or initial things you can do as a treatment let's say what are those you can try with drugs right like initially some drug things CCB then there you know it's a narrow end am I right guys so it's a it's a figus stomach it's it becomes yeah more tight So you make it wide by by a dilator. So CCB then heler's dilator we try to dilate but chance of perforation is high. So the best result or best actually considered is surgical myotomy considering even surgical myotomy mortality rate is highest among all the procedures like CCB dilator myotomy which one has highest mortality of course it's a surgery and it's a facial surgery remember two areas surgeons don't like to operate always one This esophasial area and another one is a any cases you can say lung that's okay but there's a more complicated area pancreatic area so huge so long surgeries whipples right guys takes so many hours yeah and many many cases prognosis is it good pancreatic cancer is it have you ever seen a good prognosis This is pancreatic cancer almost very rare. It comes back after 5 years, one year, very quickly in 6 months. My uncle died actually of pancreatic cancer.
Anyways, aia we learn it's a narrow sphincter. We'll try to relax it. Very aggressive. Lung cancer aggressive, pancreatic cancer aggressive. This isial cancer flow aggressive.
The doctors are trying scientists say still we didn't get a cure.
Okay.
All right.
A 65 year presents with a identification endoscopy normal colonoscopy uh cannot be done beyond hypotic flexure. Uh good news is the person stable. What is the next best investigation?
If you there is a certain bleeding out there because FOB is showing positive.
So that means bleeding is going on but you cannot do the further colonoscopy or endoscopy.
Okay. So solution of everything small one capsule endoscopy heard about this capsule endoscopy. By the way guys you have to return this capsule very expensive. It's not like you just see digest and flush into the toilet.
Capsulandoscopy reference is taken from the Davidson's medicine. So see bleeding diagnosis of a chronic disease which is also related to bleeding celiac disease some cases. Yes. But if you have any history of obstruction or any sign of obstruction you cannot give capsule.
All right. So obscure bleeding, hidden bleeding, this bleeding back bleeding, capsule endoscopy.
Okay. 58 year with a history of gastric cancer. Now this time it is given stomach cancer, gastric cancer and already done in more advanced grow and y probably like anyways like partial gasterectomy.
Now he reports after one or he develops palpitation this that issues. Uh I think we talked about it a little bit.
If there is a history of gastric bypass surgery, I repeat, if there is a history of gastric bypass surgery, very commonly they develop dumping syndrome. Now if they develop dumping syndrome, there's two type of dumping syndrome. One early and one is a late.
They don't have a abdominal distension feature. So it's not a obstruction not really gastritis.
All right. Uh not significant.
So 1 hour we are going for a late dumping. So early dumping syndrome is usually like 15 minute to 30 minute even up to an hour but 1 hour is considered late. So this is late dumping syndrome. Early dumping late dumping I'm giving you 30 seconds to answer this mainly it's the time duration it's a time time duration and all cases history of gastric bypass or stomach or many major surgeries involved.
So one more thing is common for both of them. This dietary modification uh smaller you know meal okay strictly monitoring blood sugar level lifestyle modification. So these are very very important things actually multiple diets instead of like uh two three diets also supplements vitamins these are important uh clear about dumping syndrome everyone I mentioned dumping restaurant like why you wrote that see imagine your early days internship or some of you are already internship you know we like to eat that time a lot it's applicable for doctors like at some point we don't have much money to eat I mean not like in that way I mean anywhere we go or any buffet all the time and there is a point will come I mean because of degrees practice this that we'll become 45 50 then our degrees are finished and then that time you have money but you really can't eat as much as you can right I mean so there's a funny quote for doctors actually because of lack of money you can can't eat in early life doctors and in later life yeah because of money you can cannot eat actually because you you have to keep running all right now coming to this one next one a patient with perforated diverticulatis free fluid um on the imaging Okay. And treated with antibiotic fluid. What is the management? Interesting.
It's a new question as always on 2026.
Last day our last topic was diverticulitis and I have shown you guys a CT scan if you remember. So CT will be given of diverticulitis.
The pouch of diverticula will be visible in the sitting. The pouch of diverticula you can check.
Now coming to this one like what we can do some IV antibiotic like so ABCs are given look like like initial resuscitation is done and they're asking for what's next step in the management.
free food suggest generalize peronitis.
Okay.
So peronitis normally it's a IV antibiotic IV fluid that is the main thing. The next step would be very important is uh the source control.
All right.
So, everyone What do you think? It's a little complicated one. Okay. Uh let's see. Reference. This is a nice website made bullets. You can also check it some cases.
Okay. We recommend the Hartman's procedure for managing diffused perinatitis in critically ill patient.
Okay. That was the guideline line.
Uh laparoscopic lover should be used only in very selective patients as a first line.
some question will keep us thinking.
This is one of the that question and in orthopedics you will find another one which is the tibial fracture related and there's another complicated question.
It's okay to have complications here so that you can do well uh in the main exam.
Keep thinking guys.
It's okay. It's a new one, tough one.
So, it's better you do your brainstorming.
See initial what is the main supposed to be the treatment? It has been given because uh in our mind like perforated a particular IV fluid and the antipotic that is the main but they are asking about one step ahead.
Okay. Uh, one thing we can clarify.
Okay. First of all, is your patient is stable? Because this is the important question here. Is my patient is hemodynamically stable?
I mean at this point stable now or not?
uh treated with IV fluids.
Okay, we take few lines from the guideline. Let's say Hartman procedure.
Okay, for the diffuse uh peronitis.
But the question is uh the heart percentage is nothing but you know is this one like colosttomy. The question is is this one applicable for uh our particular question.
Okay, let's assume because not clearly everything written your your patient is stable. Okay, because unstable patient they always tell in the MC question first of all is isn't it? If unstability they always tell in the question.
Great. Now this is nothing colostomy like this colostomy procedure they use the hardman procedure hard.
Question is is this one the right one?
Oh, answer is a we do it in a unstable uh patience.
Okay, that is one.
Another question is coming is about the eyelos to me. These are little new actually because I mean see they started asking a little bit more surgical procedural thing which is usually not common inc telling you that I have been teaching for very long I mean so procedural questions are very lessly they ask but this time I found one of these question they ask like you know in depth of the procedures actually surgical procedures you know it's quite difficult but there so many surgeries so many conditions and now IOTY. Now in iostomy of course it is done also for the diverticulitis. If you see the main bullets you'll see alostom is also mentioned but question is alostomy is in which case can alostomy can uh correct the source.
All right so it's mostly like if it is a sigmoid particularly then that is actually okay.
But here it is mentioned perforated diverticulism. What is the real source?
It's difficult in that case.
Uh actually because of this condition this patient has been treated with this.
So resuscitation is probably done initially. Let's assume uh we already mentioned let's assume recall that's why you know hypothetical see perforation or the free gas this thing eventually need a surgery so observing in ICU may not be best idea in this case.
So in my opinion you know here uh one of the best option it can be as long as considering patient is stable I mean stability is done that will be given in the main exam for sure yeah I mean I'm also with someone mentioned in between D and the A but let's assume after this procedure if your patient is stable they will be definitely mentioning in the question in that case you So the source controlling laparoscopic lavage would be the best choice.
Okay, it's like a wash out actually when you give the lage.
Okay, clear guys? If stable if the same question considering unstability then a if the question assume stability then laparoscopic lapas. Okay everyone okay it's bit advanced I think all right everyone so I think Uh what we can do we can go for a break now because a lot of things and then come back. You guys can keep thinking about this one in between. It's okay. We also need little fuel. Yes. Yeah. It's okay. Some complexities came up uh with the divertic colitis. Maybe we have to study a little bit more in coming days. So no worries guys. Let's take a break at this point.
So considering D I mean considering D considering after resuscitation the patient is stable and then we're doing the lapus thing. If unstable definitely we are going for the colosttomy via Hartman procedure.
Okay. So everyone we'll see you after 10 minutes.
Foreign speech. Foreign speech. Foreign speech.
for me.
All right, everyone. Let's get it started.
All right, I'll post an article regarding that. All right, guys. Yeah, I mean the last topic.
So that was a bit controversial one. we picked up D but I mean the question has little complexity and I would say a bit incomplete so that we couldn't get into a um exact um management considering this thing as a stable I mean laposcopic lab but we can also do the staging I think it would be better like there's a staging thing which I will share the article uh in our video channel later so no worries Next one. Uh 62 year old man presents with two days abdominal pain distension based hemodynamic is stable with no patent. See this question is a little bit better because stability is mentioned with no like patrononitis abnor shows large ball loops with a large ball obstruction. Okay. What is the next step in the management? We have a ready loic. Let me zoom this one.
1 2 3. I hope you got a clear feel. Here we go.
Okay. So it's clear it's a large hole obstruction acute large hole obstruction. So in this case what to do?
Um, it's been 2 days.
Patient stable obstruction.
Okay.
All right. Let's double think.
Ultimately, we need surgery. Ultimately, we need surgery. No doubt on that one.
For a stable patient, can we go for a CT scan if you're going for a surgery?
There's a one thing about city scan.
Stable patient is always like you know you can send for a city scan.
Correct.
Every obstruction is not same. I mean always patient is dying this and that.
Okay. Says the differentiating point between small ball obstruction and large ball obstruction. Luckily in our question it is already mentioned that is it is a large ball obstruction actually.
Okay.
Yeah. So some question arises like that's why they like you know confusing that we made you think twice or thrice.
We can have a like extra checking it's okay but the recalls are like that so many questions are like that that is how if you do more brainstorming and this and that things would be and very close I mean this kind of veganities whether to go for a city whether to go for a surgery we know I mean things but they will not clarify audio lower because I'm talking in low pitch resting the voice my dear. Okay, it will be up over the time.
Okay. uh option B I mean let's just uh exclude the option B because that was the most close one. Option B it's a laparotomy. So lapotomy is indicated especially just following the particular actually like let's say unstable unstability case uh peronitis perforation strangulation yeah u all these are the red flags. Since red flags are not the present, we have time of course we'll go for a city scan. Clear? Yes.
This one of the thing in our country we um think too much about doing a city scan in those countries like city scan is quite a easy uh doing it's available everywhere. That's another thing.
All right. So C is the right one and it's the difference between small B large coin and small B large B related lot question keep coming in the main exam. All right we're moving forward. So again stable patient suspected lateral obstruction by abdominal X-ray. So next step would be city scan to confirm further obstruction and all these things actually alo you can also check out if there is any complication in this and that when you do the sitting I think we're thinking too complexely I mean X has been done patient has been stable sending for sitting it's that common example I'll give you another compact compost question let's say there's a thing called foul chest okay um somebody in orthopedics will learn or emergency Let's see that uh you heard about this file chest. It's another kind of emergency. So file chest also has you know stable and the unstable situation.
Most of the fest cases we started with the painkiller that is the initial and the you know stable cases we send them for CT scan that is the thing. In unstable cases we don't send them for the city scan.
Clear now? So these kind of things are quite a common like like a compare and the contrast.
All right. 55 year truck driver follow this thing as a truck driver. Yes certainly this complaints with a chronic diarrhea and dias for 3 months. Good news he does not have a weight loss or GI bleed. A colonoscopy performed a year ago which was normal. What is appropriate appropriate next step?
So guys, what do you think about this thing?
We're suspecting this thing in between two things. I mean, can anyone get tell me a diagnosis here?
Okay, two diagnosis. one ZRD another one probably HIV actually all right posible of occupation but patient does not have any lower GT bleeding so you can exclude the IBD one more thing very important IBD because it is also chronic diarrhea so here are some of the you know related things for chronic diarrhea there are certain malabsion celiac cysticate but these are more like early days actually so for us like IBS IB PD CRD lactose these are more important or even cancers so since the occupation is supporting here so we'll think more about the uh stool for over because they go into different places if it's have been HIV they would have been give us a little bit more hint okay like fatigue this and that they'll give you a little bit more hint so why not HIV first like they'll tell you starting this question again see fatigue is a very important fatigue, weakness, weight loss and some of the infections immune compromised and some cases in the lab CD4 count can be but in HIV these are some of the lines are also expected. Coming to the question are we clear about this? I think most of you answered this one successfully without double portraitable thinking also understand like Z is also important from the aboriginal point of view because product going in different different places into in including Perth and many aboriginal areas by driving this thing actually. So when they go to the remote areas the chances of Zardia increases.
Next one young child with increasing vomiting in past 3 days. The child with the vomiting case he has been gaining weight previously but has not gained weight in last one week. The child is cheerful, alert and happy but not dehydrated. What is the likely diagnosis? Very interesting question. You have to consider know V versus pilot is very popular for MC part two as well. So your child is cheerful, alert and happy and not dehydrated.
Quick question is pilotic stenosis cases these patients are uh dehydrated is a important thing in parenthesis cases. Yes. So after massive vomiting projectile vomiting they started feeling dehydrated some cases in pate distances they'll be given like a mass like a olive shaped mass. Okay. So those points are not given neither were radiology given. Um anyways some cases they might also tell you milk froze freely from the mouth especially in uh infant cases or up to one year cases right so this one is clearly a z we already discussed about z we're not going into detail discussion are we clear about the uh z guys so z cases they remain active and careful even after The vomiting zodic cases they remain active cheerful and not dehydrated even after vomiting incidences.
All right.
So Z and the pilot is Z already discussed. There's another thing I mean additionally you can remember other than the paleocinosis this is more paleocus is more common with the children's version or adolescence child this version whereas gastric outlet obstruction is more popular for the adult version line hear me out vomiting may be intermittent and usually occurs within 1 hour of meal this is classic for the gastric this has been tested long I just add that reference so that if next time uh this time palist came maybe by the end of the year gastric outlet obstruction they might give you as well. So for gastric outlet obstruction similar kind of things like pyonosis but you know here's special line and this has been tested not recently but in past but I added that slide for you. So vomiting may be intermittent and usually occurs within 1 hour of they ask a statement type of question in past.
Is it clear everyone?
Pepticuler versus gas cert.
Everyone okay?
Don't worry. Pepic py stances we'll again learn in our pediatric. So don't worry about that one. Young man maybe 30 years presence with a mix mucus with a mixed similar episodes. So it's again happening second time and unintentional weight loss history of travel 2 years ago otherwise well what's the likely diagnosis very interesting question this kind of question very common in MC all looks correct so this is what do you think yes it is ulcerative colitis it is ulcerative so mucus just mixed with this stool and the weight loss thing can happen because there are also they don't like to eat much. So it is also politis.
All right. Great.
solitive politics you know we have these two things um already checked about IBD I mean already discussed previously so I don't want to go into more details so initials of acute flare up cases cauticide uh I took these lines from John Morta and refractory or treatment failure case which I think I think the last one I left over if you remember so this was the you know relapse case can I say like This guys you know you can see this is a recurrent guys. So it's a relapsing case right?
Relapsing case of inflammatory bowel disease. So refractory case relapsing case treatment of so finally asothoprint your treatment of choice. This one I didn't answer in the last slide. So here is your answer.
IBD is getting more popular.
So for ulcerative colitis more close recurrent episodes are quite a common chronic mucus and blood weight loss long time to have since travel. Yeah. So this is too long for amibic colitis actually you know if you think about um antibiotica amibolitis there will be more shorter history not like a two years history.
Clear everyone why it is not amic colitis. Yes.
And zodia has a whole different features. Stoodia those are the main things.
Great.
Next one. A middle-aged man with a history of surgery for echalashia. Okay.
Horsesense of voice for one month.
Dysphasia for 2 weeks.
on examinations of voc paralysis noted and it must shown in the torsic inlet.
What is the diagnosis? Interesting question popular question. This is a question I kept from the last B slide as well because this question has been tested couple of years in past.
A lot of people answer this thing as a cancer lings. A lot of people answer this thing as a cancer of the esophagus.
Now you have to decide which one is the right answer. It's a very close call by the way.
Because we going through the git a lot of people will think uh this is related to cancer of the esophagus. Actually a lot of people but is it cancer of the esophagus? Not really. It's a cancer of the larynx. We think first cancer of the thyroid will have will have thyroid features. So first of all let's exclude the D from here. They don't have any thyroid features. First of all, cancer of the lung has other paranoplastic feature which I will tell you in the respiratory class. Cancer lung has a different features plus paranoplastic other features. That's another thing.
All right.
So one more thing you know here is a vocal cord that can probably get involved anyways. Um but main feature is here like what we how we solve this question. So langial cancer horarsseness is early and the prominent symptom. So based on the horarsseness horarsseness first horarsseness over dysphasia. So few things just write as a formula horseness over dysphasia. This will help you in the exam. Horarseness duration is over.
Dysphasia duration diagnosis lingial cancer. Dysphasia duration over the horarsseness then that would be esophasial cancer. So few things you know exam wise I mean you can think so many thing as a DD we know this we are also physicians.
But thing is actually few things for exam we have to remember in that way. So horarsseness thing because it's an early and prominent symptom for langal cancer even langel cancer has many other symptoms too that which I will teach you in the ent for for this one this a very important and differential. So esophasial cancer versus you always need to double think about the laryial cancer. Okay. So final diagnosis cancer of the lines.
So cancer lens.
All right. I'm sorry I put that answer prior. 30 year old underwent appendicctomy and hystopathology of 2 mm adinocar on the appendix.
Okay. What is the most appropriate next step in the management?
So I think again a similar one I think as like stable. So you see this is again clinical reasoning type of question. Have you realized like this kind of pattern they're following more? If anyone has followed previous question uh so they are going for either you are going for a surgery or either you are going for a investigation. So more these are called more clinical reasoning question those are more uh expert physician or expert thinking based on the Australian not expert in our countries expert thinking in on the basis of those guidelines we'll able to crack this more faster.
Right. So, so you need the city scan because you need to rule out like more st Yes. More staging is important. You need to do more staging and this and the city scan is important here.
Yeah. So based on the AFP Yeah, that's one of the popular society for suspected highrade. Yeah. this situations.
All right. This will decide the mode of the treatment. Yct. This will decide the mode of treatment. Am I right? Yes.
uh clear everyone.
I think this one looks easy because last one was looking dark but now it's easy for us. If this cames first, I mean would have been troublesome.
A AFP it's a physician thing. So certain points are given which probably you can take a screenshot or maybe you can check a AFP and you can check the this particular topic of obstruction.
Few lines are given. Closed lube obstruction should be treated at surgical emergency. Abdominal red loss is appropriate initial. So x-ray for git cases always been considered initial although city has greater sensitive specificity plane radi always considered as an initial diagnostics option who are yeah unstable to go for further imaging actually then you do like some cases x-ray and quickly go for a surgeries but CT scan you have to send him to a city scan machine city scan room. Uh so unstable patient you cannot do actually.
Okay.
Anyways, few more lines are given. Um you can check it by going to that particular site. This is how you can enhance your knowledge more.
Severe pain and out of proportion and atrial fibrillation history and lactate increase. Best test in this case.
Yes, please.
A lot of people with C, a lot of people are with D. Severe abdominal pain. Let me clarify that. Severe abdominal pain progression and there is atroofination history. Can anyone tell me what can be the diagnosis in that case? Abdal pain is a big term that is include medicine that include surgery. Someday when we go to the surgery then we will be already knowing this medicine topic will be more easy. So this is mainly a abdominal pain topic with a special you know thrombomolic manifestation history like atrial fibrillation which is a thrombbo emolic manifestation history with that one you know there is a thing given lactic when the lactic thing is given this is considering when with a abdominal pain and uh let me tell you original exam tell you this will be a severe abdominal pain almost 9 on 10 pain or a very severe pain. So this is nothing but a meantic is heard about this meantic. Yes. So it's a meantic iskeemic pain. In meantic is pain there will be history of other trombolic like atrial fibrillation and there'll be severe abdominal pain and there will be increase amount of lact.
Another thing u it's not given in this question but pain increase after eating.
Is that true in meanticia?
pain uh increases. Yeah. Because when you eat the blood flow get hampered in the and when this messenger so means arteries are already affected and now you eat more pressure more pain. Okay.
So this is another thing. Can I also tell another thing? The pain is specifically common in which part of the colon? If this is the colon colon there are two areas which is called flexures. So pain is particularly more in the flexures because this part has constrictions.
So hypotic flexures, spanning flexures these areas the pain is even more. But the question is what is the best test?
In this case they ask best.
So in this case I think the city um is considered why not dimer like some people are choosing dimer but it is a non-specific test. Am I right? Dimer as a support you can do but it's a non-specific test so specific is a CTN clear everyone same goes with the pulmonary emolism compare contrast another thing what is the confirmatory test for pulmonary emolism can anyone tell me there's a x-ray initially later you can do dimer but how how to confirm again so CTPa to confirm right so is similar kind of question thrombolic type of questions.
Actually you see one thing this is so lactate increase in messentic. Lactate is something which increase in messentic estim. They can have a history of other heart issues. They have abdominal pain.
They have lactate issues. Yes. So some other test like heart checking is important and also mentary angography eventually what you need. Yes.
What is the gold standard of the treatment? Guys, if I ask you since this is meanticia, what is the gold standard treatment?
Treatment of meanticia. Ultimate treatment of meanticia is a urgent is it an emergency? Yes, that is a gold standard treatment.
That is a gold standard treatment. So they have uh a lot abdominal pain. Some cases they can have vomiting, a little flush of diarrhea and also some places bloody stool. It can be but not a classic bloody stool case.
Next young boy pres with nausea vomiting diarrhea after 24 hours of a camping trip. Now this is more related to travel. This is related to medicine.
This is related to pets. This is related to I mean population health and many other things like infections. Many thing many category you can put. Now which is the likely microorganism in this case?
Okay. Very young boy.
Okay. Understand one thing. This young boy is traveling inside Australia.
Again very young boy let's say um 10 years boy traveling inside Australia.
Now young boy traveling outside Australia and going to let's say Asian countries. Now you will think more about the ecoli as a first first choice that is out. It's not common in all in Australia very like you know strict about food and all these things.
Now they said 24hour. Okay, a lot of people are Let's see. I'm very happy for you guys to draw this for you.
Some people are quickly changing their answers. Now what is this? It's a little therapy for you guys which time to time I'll give you guys. All right. Now coming this one as a virus. Viruses are quite common in those countries instead of the bacteria. Very interesting.
Viruses are more common in those countries. I mean outbreaks other than the bacteria because uh the hygiene is so good in those countries. So young boy with no say vomiting direct they say 24 hours after. Now your question is salmonella is salmonella is 24 hours after. No way.
Salmonella is like 6 hours 2 to 6 hour.
Salmonella is like 2 to 6 hours. Please check the Vson Medicine intubation periods.
Right guys? Can it be Zadia? Zadia is a case of chronic diar in one short trip you are not expecting.
Yeah Steph is like you know up to 24 hours this time. This is like you know after 24hour actually. So I think I would prefer more towards the neuro virus and it's also very contagious. They also say the other children also has the similar kind of issues. Now let's say is the bacterial are you expecting the same?
The other children also have the similar all of them kind of other children also have similar symptoms. So the viral outbreaks especially in the camps are more common. The viral outbreaks especially in the camps are more common in Australia. Food related things are less common like the bacterial because even if you go little outside the food regulations are very high actually all right so here is a little bit thing uh I think 30 more 30 questions so I think eight more left all right be patience my dear it's called or you don't have the patient to stay in a class for 3 hours no point of going for MC every time those people left classes fail in the exam trust me. All right. So, need to have that mentality and the habit. You have kids, you have like small babies, you have large babies, whatever it is. Large baby means you know that big ones your partner. All right. So, anyways, whatever it is, keep them aside. Focus on the glasses.
All right. So, anyways, so you can see.
Yeah. So that's best state actually.
So ZRT much later it's a chronic salmonella you see it's given sixes as possible but normally we count salmonella is like up to 24 hour practically speaking so shijella like 1 to 7 days. So shela it can be but they didn't mention about bloody diarrhea. So Shijela is out. No blood in right. Shijela is out. Actually E.oli it can happen. Uh but expecting more serious situations more serious situation with E.coli and at the same time traveling inside the Australia I mean it's less common with E.oli rather than the virus we think.
Okay guys uh clear the concept is it clear the concept?
The reference I took from the CDC. So CDC is good. You know about CDC's.
So I could vomiting diarrhea outbreak after the camp nor virus think more prolong greasy diary after um so then it is zdrm all good.
Okay. Here is a little reference for the handbook guys.
I recommend you to study the handbook side by side of the class. So you know MC handbook which is also known as the this color book blue book. So there are certain sections given and but G is not given separately. So class to class I'll tell you the numbers.
Okay. So please take a picture of this one or I'll post this one in the group.
So no worries on that one. So classtoclass study is important the handbook. So I'll help you you know reading that book because otherwise separately reading can be a little bit time consuming for you. So keep that in mind it clear okay next one we'll try to finish the remaining uh 48 year old woman admitted to the emergency department. So it's a question emergency productive cough fever and central chest pain.
Yeah rema but no worries. Okay. And regurgitation of undetyp does not suffer from acid reflux.
The symptoms have been present for quite a time. Affects the food and the drink.
Okay. So dysphasia for like a solid liquid level. um behind a normal size heart. What is the likely diagnosis?
Interesting question.
So they have a productive cough and a fever and certain points actually showing every level uh behind a normal.
Okay.
Okay. Patient presents with the central chest pain. Now if patient is present with a chest pain or a hard burn, can it be aalashia? Like some of you are thinking about acalia. Could it be acalia by any chance? In that case I don't think in that case so the diagnosis is going more towards the fangial pouch. Actually diagnosis is going more towards the fangial the pouch. Actually we already discussed about acalia things. Actually um it can be acalia is a good one actually even some acalia cases it is possible like little heartburn or chest pain that is possible right next one. A 50 male and his father died of colon cancer. 57. We do have a screening session. So don't worry. First of all, his maternal aunt has colon cancer too. It seems a little incomplete question but yet we can how will you screen him? Original questions are four five nights. First of all there is a family history positive.
So father died of colon cancer and his maternal aunt also has col. So there's a colon cancer runs in the family. Our patient is a 50year person.
So I think at this point for him uh let's say how to screening him okay I think it's a colon cancer now is better I think best option is missing yeah I think this is for previous question follow exclusion method when the others are not supporting then it's going towards the fangial pouch actually I mean it's not a straightforward but haynia you need a obstruction z features bulber pulsy is like more like neurological things So it does not related to this question. TB is not even related anywhere and acalia already mentioned it's not matching. If these are not matching it's a parangial option. So going for next one patient is given amoxicilian genty metronol and prostadium deficially positive. What is the next step in the management?
So there's a thing called antibiotic associated diarrhea. Now in antibiotic associated diarrhea what do you think is the next step in the management of so I think final answer would be veno m final answer would be so antibiotic associated diarrhea clustium deficiency the final answer is a yeah so initially we try with metronidazol as well I mean controlling this situation and if metro not working in that case vancomyin oh This question situation also known as sudo membranous colitis.
The question is what is the first line?
They can also ask you this question I have seen in MC in various way.
What is actually the first line for this one?
Any idea?
So first line would be withdraw offending agent. In this case, this is a straightforward.
This is a culprit drug. So, withdraw that offending agent. This is the first thing to do. Then the second thing that is coming you can try with a metro which has been already tried and then coming with the van.
It is often because of a secondary antibiotic use like cleaner or this thing.
Okay, one more extra question which some of you some cases should know this diarrhea pattern is what type of diarrhea watery diarrhea bloody diarrhea or um what do you think you should know this information this diarrhea claustrdium deficially acid diarrhea is a watery type of diarrhea okay so John Mak you can follow the page watery diarrhea profuse watery diarrhea within 2 days of taking antibiotic most cases. So your priority will be seizing yeah antibiotic so antibiotic metro and then van also concepted special is important be of toxic mega colon. So it is a possibility that this question in future can come also as a mega colon. So mega column toxic meloum we have seen with alcitic colitis but megacolum can be given as a part of clustically as well clear everyone here's one line I want to address fal microbial transplant it's a new name for you considered for recurrent infections so deficiency usually it's not common for recurrence but if it's a recurrent by any Then fal microbial transplant.
Okay everyone clear now cluster deficially or antibiotic assetated diia.
So metro metro metro then the fan one thing long back I've seen a thing giving vancomy there was side effects. What side effect? Red man syndrome. Please remember this vancomy. Ever heard this thing? Red man synrome extra.
Next one.
25 years have asthma. Child with Z now he feels trouble with certain foods.
Endoscopy is showing mild.
So uh thing is given. Now what to do in this case? I think it's a similar sort of questions. What is it?
Okay, everyone. So, let's get for let's go for this one.
Uh, some of you choose this one, but if you remember slide, I mean from the last one. Yeah.
So I think this thing was given fluticasum if you remember Buddhistonite you know I mentioned last time and there's the flutas was mentioned okay is fluticason has been mentioned actually in the johnbo in the last slide we have shown you so going for next one sudden vomiting dysphasia we all are tired yeah so just uh two three more sudden vomiting dysphasia Epigastic pain patient who had previous gastric pondation. This is uncommon one. What is the investigation you want to do?
Interesting one after fund application.
Uh this one I didn't taught previously but I I'm sure you guys are smart enough. And one line I mentioned like all these particular cases the initial is always a barium actually. Okay. So it's a barium solo. So any other uh procedures you do like like a gast funation or LA GB procedure. You see if you're suspecting any sort of complication like say sudden vomiting and dysphasia and you know considered as a complication after this surgery. You see surgical procedures they are asking more which previously they were not asking more. So more clinical reasoning more surgical procedures. This is an update. You need to learn about some surgical procedures also now actually. So barium solo. Yeah, it's the investigation here. So in this case you see this one is the vomiting and the regurgitation. So this one is a uh barium. So there's another option can be given which is a gastroscopy much later and some other you know uh complication then you can go for gastroscopy or endoscopic thing. But here in this case the barrier they also didn't offer you the gastroscopy. So you don't have to worry. Clear everyone this thing uh things are getting little uncommon by the end. That's okay.
Uh okay next one thing patient given this some drugs and okay sorry about a repeat one claustrdium deficially positive I think oralis I'm sorry about that. Okay. Metro already given.
Okay. Severe also colitis fever tacking and colon dilotation. What is the next step?
All right. So again a IBD question.
Again one particular IBD question since severe ulcerative colitis because not mild moderate severe case or much recurrent cases you need a surgery. All right and before to going for a surgery when it is severe or if it is acute you need to control the situation of situation with steroid and go for a surgery.
In this case avoid colonoscopy because they can already have complications.
So IB steroids and urgent surgical consideration.
There's a higher chances they can also develop mega column or this and that.
All right. After a conference meal I think this one maybe I have shown you as a separate question. uh feel floated and force vomiting then suddenly pain in the retropest and got iskeemic heart disease before. Okay, keyword guys conference meal force vomiting and after resuscitation was the appropriate step.
This one I think you remember anyone remember the diagnosis?
Anyone remembers the diagnosis?
Yes. Well done. If you're thinking about the the two esophicial conditions if you remember which can happen after four vomiting often after a binge eating. Binge eating means when you're eating a lot amount right.
So two of them can be one is a boy have one is a maloribus. Which one is more dangerous? Boys is more dangerous if you remember. So it can be Yeah. So in boy's cases what we can do we can go for a lateral chest extract. Boys cases we can go for lateral chest X-ray.
Yeah if you remember this boy's case after initial resuscitation we can go for a lateral chest extent. patient can develop a certain pneumothorax type of situation and in this neo I mean you can see in the habs it's actually yeah this one is deviated so extreme nether cases your midline shifting it is possible the same one so have you know I only found this one particular question so I kept it Actually this one is not a new one. I kept it in this file. Yeah. So anyways otherwise solving this one can be difficult if you don't know how to solve it. So lateral X-ray please remember it.
Lateral X-ray. If they ask you about the treatment if they ask you about the treatment like let's say they didn't give you investigation. They ask you about treatment. What will be the treatment for the boilups? It's an emergency but ultimate treatment is after resuscitation definitely you need surgical repair.
Definitely you need surgical repair.
Okay.
40ear patient travel to Indonesia central abdop transformed to this that now she has diffused ab pain chill driver no sign of peronial irritation I mean not peronitis otherwise normal except for painful diar. So with the painful digital rectal examination is the most common was a primary symptom.
Come on guys.
Painful. There is a special line.
So we are going for the chron disease.
There's a special line actually crown disease has a a lot involvement upper part of the j the lower part of the jhro disease involvement right. So you can see a lot areas are involved involves other areas of the git whereas ulcerative colitis involves does not involve the other areas of the git mainly in the red tongue. So now is it clear everyone why this is crowns?
Okay.
Patient with varicesses uh previously repaired twice. Now again this topic I will teach you in future again no worries but it came up which approach is better for him as well as lessen the chance of hepatitis which I haven't taught you guys yet but since part of the git sometimes this esophasial thing came up actually it's it's okay you can think about this thing as a lower glee lower gle can aggravate you know hypatic and catalopathy million in our country recently influencer died because of like encapopathy liver failure and followed by not the same exactly.
So here's the question which approaches to lessens the chance of incaping.
A lot of people are answering tips. All right. Now many of you don't know probably this one tips itself is a big procedure and in tips while doing the tips it will aggravate the encapalopathy so certainly tips is not the procedure actually instead what is the procedure actually is yeah is a spino prenal so this one I think is new things which you need to learn from us so spino renalion also known as the warian this is one of the thing which actually you know low incidence of hepatit any other procedure increase the chance of hepatitic and capillopathy. Don't worry in future I'll teach you guys the hypertopathy thing so leave I mean this one warian or spino renalion so distal spino renalion also known as the war this is new to you so don't be frustrated we are learning okay so is it clear guys so far One more a 40 18 year very young bloody diarrhea and you made sigmoidoscopy and 30 cm fable mucosa. I think I this line I separately mentioned frial mucosa. So if I talk about the fraal mucosa it is certainly going towards one particular diagnosis fibal mucosa certainly going towards yeah area of fal alsitis if alcetic politis your treatment is sulfin If also politis then it is sulfain.
We already discussed right IBD cases early cases it is always sulfate. We also discussed if acid flare up steroid we also discussed refractory cases we can go for as a thibrin.
All right. So here few things about the alset colitis the management exactly lines from the jet.
So sulfasylazine steroid aspin there also surgical options available but that is reserved for complicated cases.
Example alset colitis can leading to you know emergency situation like toxic miracle.
Okay.
So, young man coming from a trip and blood mucus. It's a little um I think similar with one of the question.
I think we choose this one as a as politis. It's too long history for this one to be called amic politis. a similar kind of epsin.
This one is a repeat. We uh choose SC.
Don't worry, we're almost finishing here.
Okay, please check this question. I'm not trading this one.
Read this one and go for an answer.
A clue for this one is all like some of the test serum amias liposine all are in normal parameter pain which is radating towards the back that's probably one of the early you know symptom Let's go for it.
All right everyone. So I think in this case actually this is abdominal pain related. Another question bit mixed of medicine surgical hepatic uh special line serum amias lip can be normal in early stage. I repeat ami lip. So from your practice guys, so again this is a clinical reasoning question. Am I right guys? Like your amiless and these things can be normal in early stage of pancreatitis. Yes. But the main thing is yet like you know pain which can radiate to the back. Pain which can radiate to the back.
Clear everyone? So it is a pancreatitis.
Yet it is a pancreatitis.
Now almost there a patient has been given investigation of ZD.
I think it's a uh similar one just a little bit different variation with a bleeding peptic also question. So it's a bleeding peptic also question. I think uh this one injection adrenaline into the directly into the place that is one of the main one. So bleeding peptic ulcer is the answer. I think to this last question old do with calcium and other blood report and what is her cause of having low calcium does not really mention that you know Asian background or Australian background let's go for it guys let's finish it I think it's a dietary deficiency until low calcium or low vitamin D these particular things are you know especially low calcium is a dietary deficiency until it's a it's elderly persons elderly person automatically they have very high chances because of the bone loss low calcium so it's a dietary deficiency until another version perilical pain migrating to the uh this particular right fossa anorexia what is the best next step pumbilical pain migrating to this particular. So what do you think?
So I think it's a surgical review and we should think about probably appendicitis. So surgical assessment and imaging is more important at this point.
Abdominal pain related. So the more information it can be appendicitis as like this particular pain radiation where pancreatit is radiating directly towards the back. It's important diverticulitis hasated with lower git bleed. That's another important thing.
Also some cases fal infection can be a key point for diverticulitis.
CT scan will show bout of diverticula uh folid in appendicitis cases you can see choleic statitis you know that four female fertile fatty all these words so and pain relating to the tip of the shoulder okay so this is how we can differentiate and after the g we'll have the cardio you'll see the chest pain related we'll also talk about a lot of things actually abdominal pain related we'll also talk about in future there will be surgeries there will Gyne all will have abdominal pain related thing.
Is abdominal pain is easy or more complex? Yes, you know the typically abdominal pain it's it's usually more complex abdominal pain. Not all abdominal pain are so simple actually but the following is the first test to be performed in a patient with a lower GI bleeding.
Yeah, this kind of question they love lot nowadays.
A test they prefer to perform in lower GIT breeding.
It's a colonoscopy.
If lower G bleeding is a fresh bleeding, we may not perform all the popcy. So it's a colonoscopy. It's a colonoscopy.
We would prefer more. All right. So here we go with the lower JT bleeding already discussed in the last class. Sorry we had to rush a little bit at the end. So there's lower JT like diabetic angisplacia then the colonic cancers and some of the conditions like IBD needed to be considered. Actually this part you know we have shown in the theory class. If anyone missed the theory class, please go and check in our YouTube or I will post or share it in from my Facebook profile again in guideline group and other groups again in any case in case anyone missed that one can double check this one again. We started today's class with some of the second grade updates you know with some aboriginal and this and that revenue of journal. Earlier we discussed few things and some of these topics for aborigine you know we have to study more and already mentioned about few things like clinical reasoning more some examples already I have shown some patient safety more protocol like ethical cases we see more and already you know indigenous health and aboriginal health aboriginal there was a slide and uh things I will discuss more like even anti-racism like you know we have to study these things. All right.
So, thank you so much guys for attending this session. I hope you enjoyed the chit things. I will upload the recording tomorrow. So, thank you so much guys for understanding. Good luck. If anyone is left over for admission or if you have some friends feel free to mention them.
We are still in the early stage. So, still people can take admission. So, tell your friends if you like the classes. Thank you so much guys.
Again lastly if anyone looking forward to contact this is the WhatsApp number you can save it.
Thank you again. Hope you enjoyed the session.
Yes, of course. We'll upload the PDF.
Thank you everyone. This is the end of the session of the Jook.
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