Benign Paroxysmal Positional Vertigo (BPPV)

BPPV refers to a condition when you get dizziness on a certain position such as rolling in the bed or waking up from sleep.

While studying for this condition, I found out a nice claymation video showing Hallpike manouevre and Eppley's Manoeuvre.

Below is a nice diagram showing what is happening in the ear canal.

Credit to Merck Manual

SHR Written paper 2

Six 5 marks questions

1. Side effects of haloperidol
2. Football player hit at head. GCS 3. Describe assessment, initial management and investigation
3. Key features of delirium
4. Key features of obsessive-compulsive disorder
5. Describe 3 risk factors of fall and give example for each factor.
6. Elderly men with recent cognitive impairment. Given diazepam to treat his ‘nerve’ problem. Give comment on his diazepam usage.

Six 15 marks questions

1. Elderly Italian lady with mental impairment. Lives in Shared Supported Accommodation. Unable to speak in English. Has diabetes, obesity and history of falls. List 5 issues in this lady. Describe your management.
2. Men with paracetamol overdose and found with empty whisky. Slightly intoxicated. Describe initial management, investigation. Mechanism of paracetamol toxicity. Tool to assess paracetamol toxicity. Management of paracetamol toxicity and route of administration. [Guidelines for the management of paracetamol poisoning]
3. Elderly women with advanced lung cancer. Want to die at home and family happy to support her. Describe your discharge planning.
4. Women present to GP with symptoms of 8 years history of binge eating and purging. Normal physical exam. Describe management of this patient.
5. 40 year old women with MS. Work as a telephonist and need to access computer as part of her job. Describe clinical features of MS that may interfere with her job (4 marks). Describe your assessment on finding out what are available at work to overcome this issue (4 marks). Recommendations on how to cope with work difficulty due to her MS-related disability (7 marks).
6. Elderly men with long history of ischaemic heart disease and now presents with depressive symptoms. Describe the relationship between medical illness and depression.
   

In this paper, there were few questions asking on DSM IV criteria of several psychiatry disorders. DSM IV is the manual published by the American Psychiatric Association and covers all mental health disorders for both children and adults. It tells you how to diagnose any mental illness and describe the relevant differential diagnosis. Most, if not all, psychiatrist were able to recite the DSM IV criteria for any mental illness. So, it is necessary for medical students, to memorise the DSM IV criteria for major mental disorders.

I'm not sure how to answer the question on MS. It is asking for specific answers related to work-related issues. I randomly put anything that might be relevant in answering this question. Hopefully, I could gain at least several points from this question.

Overall, I'm glad that the written exam is over. Now, I could look forward for my OSCE and the short winter break after that

Update 27/9/2009: Thanks to Intan for telling me the other questions.

SHR Written paper 1

Six 5 marks questions and six 15 marks questions.

5 marks questions

1. List symptoms faced by an elderly widow, few weeks after the death of her husband.
2. Describe the differences between vasovagal collapse and syncope.
3. Describe anorexia nervosa
4. 5 causes of constipation in bed-bound cancer patient
5. 5 components of CBT in managing major depressive disorder
6. A young boy falls on outstretched hand. Presents with pain in anatomical snuffbox. Normal plain X-ray. Diagnosis, management and complication.
   

15 marks questions

1. Differences between acute, chronic and cancer pain. Answer in table form
2. 87 year old female, lives alone, presents with decline in function over the last 6 weeks. Has multiple co morbidities and lots of medications. Still driving. Has slightly reduced score in MMSE. Describe your management of this patient.
3. A young tourist poisoned by bright-coloured octopus. Presents to ED. Which organism (blue-ringed octopus), what type of toxin and mechanism of toxin. Initial assessment and management. Treatment and expected outcome
4. 38 year old women, previously well, presents to ED with back pain. Normal neuro exam and MRI. Has relationship problem with her partner but has resolved. 3 differential diagnosis. How to assess the different diagnosis in Hx and MSE.
5. 40 year old train driver, presents with history of frequent alcohol drinking. In the last few weeks, he had panic attacks while driving the train and this is alleviated by drinking alcohol. DDx (6 marks). How to assess him in hx and MSE (9 marks)
6. 40 year old policeman, presents with delusion and hallucination. He needs to do something to protect himself. Describe a thorough risk assessment (11 marks). Ethical principles faces by GP in this patient (4 marks)

Few of the questions were a bit difficult to answer. Those questions test the capacity of your memory.

The question on octopus was in a way interesting. I knew the type of the octopus but I didn't know the toxin nor its mechanism of action. In fact, I wrongly guessed the management in this question. There goes my 15 marks.

15 days later

The title refers the number of days this blog last updated. Lots of things has happened in the last two weeks.

1. Swine flu is now officially an epidemic. Malaysia currently has more 90 cases of swine flu and the reaction from the Malaysian newspapers has managed to over exaggerate the severity of the swine flu. In fact, many of my friends who are going back to Malaysia for winter holiday are quite worried that they will be under home quarantine too, since few cases of swine flu in Malaysia originate from here. Go read this; Swine flu's not that bad.
2. Riot in Iran. I wonder what will happen to Iran in the next few months. Hopefully, if there is any chaos in the future, it won't lead to lots of unnecessary killing among the citizens and disrupting the petroleum production. Petrol prices has already been increasing and we don't need another riot to push up the petrol price.
3. New operators for tram and train in Melbourne. Hopefully this will improve the quality of public transport in Melbourne in the future.
   
4. Exams. I have finished two written exams and will be sitting for OSCE next week. Will write more about those written exam later.
5. Firefox has released the third Firefox 3.5 release candidate. I am patiently waiting for the next version of Firefox . Read this; Firefox 3.5 memory usage, Top 10 features in Firefox 3.5

Update

It has been more than a week since I last updated this blog. Currently, there are about two more weeks before my semester exam.

At this time of the year, many medical students are busy applying for the intern job in Victoria or interstates. Most of my groupmates were having lots of stress and worries since it is not an easy process to apply for a job here in Victoria. They have to sit for many interviews and few of the interviews will be during the exam period. They have to balance between revising for the exam and preparing for the interviews.

As the only person in the group who is not applying to get a job in Australia, my role for the last few weeks has been to calm them down and help them with possible interview questions. Interestingly, we are doing psychiatry rotation and it has been useful to put all of those relaxation techniques into practice. I hope that all of my groupmates and my friends will get a job in Victoria.

In term of psychiatry rotation, I don't think it has been a useful rotation for me. It was not properly taught and most of the students are not really interested in choosing psychiatry as their future career.

Swine flu in Victoria has been infected many people in the last few weeks, and of last night, there has been at least 1011 persons infected in this state and the total number of swine flu cases in Australia is 1260. If the number of cases in Australia especially Victoria keeps on increasing, WHO might have to declare the swine flu as a pandemic.

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