Notifiable diseases in NSW Australia

This is quite a list. Accurate for today 31/1/2013

Putting it up for future reference:

Acquired immunodeficiency syndrome (AIDS)


Arbovirus infection – not elsewhere classified

Australian bat lyssavirus

Barmah Forest virus infection




Chlamydial infection


Creutzfeldt-Jakob disease (CJD)

Creutzfeldt-Jakob disease – variant (vCJD)


Dengue virus infection



Gonococcal infection

Haemolytic uraemic syndrome (HUS)

Haemophilus influenzae serotype b (Hib) (invasive only)

Hepatitis A

Hepatitis B newly acquired

Hepatitis B unspecified

Hepatitis C newly acquired

Hepatitis C unspecified

Hepatitis D

Hepatitis E

Hepatitis (not elsewhere classified)

Highly pathogenic avian influenza in humans (HPAIH)

Human immunodeficiency virus (HIV) infection – individuals less than 18 months of age

Human immunodeficiency virus (HIV) infection – newly acquired

Human immunodeficiency virus (HIV) infection – unspecified individuals over 18 months of age

Influenza (laboratory-confirmed)

Japanese encephalitis virus infection


Leprosy (Hansen’s disease)



Lyssavirus (not elsewhere classified)



Meningococcal infection (invasive)


Murray Valley encephalitis virus infection


Pertussis (whooping cough)


Pneumococcal disease (invasive)

Poliomyelitis (paralytic and non-paralytic infection)

Q fever


Ross River virus infection


Rubella (congenital)


Severe acute respiratory syndrome (SARS)

Shiga toxin- and verocytotoxin-producing Escherichia coli (STEC/VTEC)



Syphilis (congenital)

Syphilis (infectious (primary, secondary and early latent), less than 2 years duration)

Syphilis (more than 2 years or unknown duration)





Varicella zoster (chickenpox)

Varicella zoster (shingles)

Varicella zoster (unspecified)

Viral haemorrhagic fevers (quarantinable)

West Nile/Kunjin virus infection

Yellow fever



Also in NSW there are extras:

Adverse event following immunisation
Foodborne illness in 2 or more related cases
Gastroenteritis among people of any age, in an institution (e.g. among persons in educational or residential institutions)
Lymphogranuloma venereum
Typhus (epidemic)


Driver Qualification Test

Alright, so tomorrow I’m going to be having my Driver Qualification Test. Hopefully, I’ll graduate from being a green P to my Blacks (or full licence)

During my preparation (trawling various websites including and ) I heard that a number of people seem to have some trouble with the HPT part of the test. Whether you do or not I guess doesn’t matter because practice is always good. The most recommended website appeared to be the SA HPT website

It states that there are 34 sample questions of which each time you get 7. I hate probability and waiting for that last of the 34 samples to turn up in the sea of repeats so I just downloaded all 34 of the samples. I’ve uploaded them to dropbox for anyone else who might want them. You should be able to open them in your internet browser if you have flash installed. Also the continue to the next question button at the end does not work but it does show you the results!

Here it is:

Addit: I don’t own the copyright for these files. They are the property of the SA RTA. I simply made them available in a different formal.

Gastrointestinal Malformations


Meckel’s Diverticulum

Occurs about 1 every 50 births

This is a remnant of the vitellointestinal duct – primitive gut to yolk connection

Generally a cone or glove shaped protrusion from the antimesenteric border of the ileum

However it can be in a wide range of forms

Its contents are generally histologically the same as the ileum but can occasionally contain gastric or pancreatic tissue instead


Most common presentation is painless rectal bleeding

Generally there is presence of gastric mucosa in the diverticulum leading to ulcer formation and later bleeding

It can also cause obstruction if it invaginates

If it is present as a fibrous band to the umbilicus it can lead to extrinsic obstruction

It may also allow a communication between the umbilicus and the ileum hence causing yellowish exudate at the umbilicus

Finally it can present as a diverticulitis or diverticular rupture


The most reliable test is a Tc 99m gamma scan

Bowel imaging with contrast may also show the diverticulum

If the patient is symptomatic then excision of the diverticulum is recommended


Oesophageal Atresia

Occurs about 1 every 4000 births

There is an abnormality in the separation of the trachea-oesophageal bud

This can result in several different possibilities

Type I – complete atresia where the two ends do not meet and there is no fistula

Type II – inferior blind pouch and a superior trachea-oesophageal fistula

Type III – superior blind pouch and an inferior trachea-oesophageal fistula

Type IV – superior and inferior fistula

Type V – not a true atresia H shape – Oesophagus is permeable with a trache-oesophageal fistula

Type III is the most common followed by type I



Usually patients will present with salivation, respiratory distress, coughing, choking and abdominal distension

In type I and type II there is no gastric bubble in the prenatal ultrasound

In AXR there will be no gas present in the bowel in Type I and II

In AXR there will be excess gas present and bowel distension (meteorism) in Type III, IV and V

Surgical management will be a primary anastamosis if able

Otherwise gastrostomy or jejunostomy should be formed



Hirschsprung’s disease

Not technically a malformation  – congenital gastrointestinal disease

1 in 5000 births

There is an absence of ganglion cells for variable lengths of the GIT tract

This leads to a spastic contraction of the tracts that have absent ganglions

Results from a failure of the neuroblast cells to migrate from the oesophagus to the anus

Presents with intestinal obstruction and failure to pass meconium after 24 hours

An older child with a more mild form may present with severe constipation which does not resolve

May lead to severe enterocolitis and sepsis as well as perforation

Barium enema will often give you the diagnosis

But a rectal suction biopsy will give you the gold standard for the diagnosis by noting absence of ganglion cells in the plexus and hypertrophy of the nerve fibres


Surgical management involves resection of the aganglionic portion while leaving one or two cm at the end for continence


Intestinal Malrotation

1 in 5000 births

They are very variable in their presentation

Ultimately it is an abnormal or lack of rotation that occurs when the developing guts returns into the abdominal cavity

The malrotated gut is liable to having a thinner mesentery and is likely to volve and therefore strangulate itself

This would likely only affect the midgut

As necrosis develops the risks increase: bleeding into the lumen and perforation

Barium enema will give you an idea of the lie

Prompt surgical intervention is important, it can be fatal


Exomphalos or omphalocoele

1 per 5000 births

This the protrusion of the bowel out of the umbilicus in children covered only by a thin sac of amnion

Occurs because the bowel has not reentered the abdominal cavity during the first trimester

If the membrane is still intact then fluid resuscitation and maintain euthermia

NG tube to decompress the bowel and conservative management

If it does not re-epithelialise itself or is unusually large then consider surgery

If the membrane is ruptured then if it is a small defect sterile plastic film or bag should be applied to protect the bowel and surgical repair should be performed

If it is a larger defect then the surgery should be staged and


Duodenal atresia

Occurs once every 8000 births

Incomplete canalisation of the duodenum

Obstruction is usually distal to the ampulla of Vater

Characterised by polyhydramnios or bilous vomiting

Generally this diagnosed prenatally

This can be confirmed with a postnatal ultrasound or xray


Management involves anastamosing with the rest of the bowel as well as the ampulla of vater if required




Occurs once every 5000 births

In this there is intestinal herniation without any covering

There have been multiple theories to suggest the cause but there is none that successfully explain it

Some suggest that gastroschisis is a ruptured omphalocoele but there is none of the associated defects


When identified the patient should have fluid resuscitation and maintenance of euthermia

Transfer the infant to a NICU with specialised surgical capacity

The bowel contents should be covered with a sterile plastic sheet/bag

Small defects can be performed in a singular surgery with following NG decompression to allow the bowel to recover and inflammatory peel to resolve (provide parenteral nutrition)

For larger defects a multistage procedure may be necessary

If there is an ischaemic region there may be an obstruction when feeding is restarted

Prosthetic Heart Valves

Prosthetic heart valves are able to modify the heart sounds

An aortic prosthesis would likely have a closing click at the end of systole

A mitral prosthesis would likely have a closing click at late diastole

Tissue valves are likely to imitate normal heart sounds so well they are indistinguishable


Use a lateral chest x ray to help identify the location of the heart valve

Split the heart roughly into four

The anterior superior portion should contain any aortic valves

The posterior superior portion should contain any pulmonary valves

The anterior inferior portion should contain the tricuspid valves

The posterior inferior portion should contain the mitral valves


AP films can also be split in a similar way

LUQ aortic

RUQ pulmonary

RLQ tricuspid

LUQ mitral



Prior to dental surgery or dental manipulation the patient should take prophylactic antibiotics

Penicillin based is favoured

Otherwise cephalosporin or macrolide

30 minutes prior to activity



Post operative complications

Split into early and late (Early =<3 months)


The most dangerous early complication would be pericardial effusion leading to cardiac tamponade

This leads to decreased stroke volume and eventually cardiogenic shock

Typically they present with Beck’s triad – hypotension, distended jugular vessels, muffled heart sounds

Echocardiography is able to give the definitive diagnosis

Needle pericardiocentesis would be the initial emergency management

However post-operative patients often have clotted blood inside

Hence a chest re-opening should be performed and the clot manually evacuated


Atrial fibrillation is another common occurrence

Should be managed with antiarrhythmatics


A post-operative pericarditis can also occur

Shortness of breath, pleuritic pain, pain worse on lying down, SOB

Late complications largely refer to the anticoagulation requirement

If the patient is inadequately anticoagulated then there may be a chance of thrombosis of the heart valve

The patient will likely enter obstructive shock

This can be diagnosed with an echocardiogram

In order to treat immediate thrombolysis should be initiated

If they are unresponsive then patient should be taken to theatre ASAP


Mechanical valves are also prone to breaking down over time or getting worn down

If a leaf has broken off or the valve has ruptured the patient may present with acute onset shortness of breath, pulmonary oedema and shock

They should be intubated and given appropriate resuscitation awaiting confirmation from echocardiogram and then urgent surgical management


In mechanical valves the anticoagulation is lifelong with an INR of between 2.5-3.5

In the older ball and cage style the anticoagulation INR is between 2.0-3.0

In the biosynthetic porcine valves there is less thrombogenic potential hence anticoagulation is only for the first three months


Physiology of Excitable Cells

An excitable cell responds to a stimulus by producing a rapid change in electrical charge

Examples are neural, muscular and sensory cells


The Membrane Potential

Cell membranes have a resting potential of negative (-) 70-80mV across them compared to externally

The potential is variable dependent largely on two factors: the permeability of the membrane and the concentrations of the ions both inside and outside of the cell

Most membranes are permeable to potassium but not sodium at rest – hence semipermeable

K usually 150mMol/L inside cells and about 5mMol/L outside – hence K diffuse down gradient hence –ve membrane potential

This is also assisted by Na+/K+ pump where 3 Na ions are pumped out for each 2 K pumped in – hence net –ve gradient

If membranes permeable to Na instead a reverse membrane potential would be formed due to the opposite concentration gradient

The membrane potential can be calculated by the Nernst equation


Maintenance of the Membrane Potential

This allows electrical communication between cells

E.g. neural impulses, muscle activation, cardiac pacemaking

Na maintained as intracellularly low and extracellularly high

Na+/K+ ATP pump is important to maintain the membrane potential since if Na is not removed then the membrane potential would dissipate since the membrane is not entirely Na impermeable

Ca is important in physiological triggering

E.g. muscles where Ca is required for contraction coupling

Hence the intracellular concentration is extremely low – active pump activated by calmodulin but during a higher intracellular calcium concentration an exchange mechanism activates swapping Ca for Na

Action Potentials

In an action potential the membrane potential reverses to a positive charge for a short period of time

This occurs in response to a stimulus threshold which is usually a 10-15mV depolarisation

An action potential is an all or nothing firing – until the threshold potential is reached it will not fire and once it fires creates a precipitous change that cannot be stopped

Essentially the action potential is formed by opening the channels for sodium equilibration

Communication of information is not through amplitude of the action potential but the frequency of the potentials




Low Calcium increases muscle and nerve excitability

Due to effect on the local charges on the cell membrane

Propagation of Action potentials

In nerves the action potential travels down the axon as a wave of membrane permeability

During the 1ms after the action potential there is an absolute refractory period here no action potential can be initiated

In the following 10-15ms period of relative refractory period (a greater stimulus is required)

In smaller nerves continuous conduction is typical but in myelinated nerves the conduction process is saltatory

There are patches of myelin with intermittent nodes of ranvier

At the nodes of ranvier there are high concentrations of voltage dependent Na channels which mediate the action potential

The myelin prevent leakage hence increases the resistance of the membrane and reduces the capacitance = increased conduction speed and effectiveness

Intravenous Anaesthetics

Comparatively IV anaesthetics are far more rapid acting (20 seconds versus 5 minutes)

Hence they are frequently used in induction rather than the inhalation agents

It is also possible to use them for maintenance as well




This is the probably the only IV agent that is appropriate for total IV anaesthesia

Due to its rapid metabolism, redistribution, elimination and hence rapid recovery

Has comparatively low N&V


Some anticonvulsant properties

Can also be used as a light sedative

However it may cause pain on injection

May sometimes cause seizure-like movements in 1in 47000 cases

Causes a drop in mean arterial pressure and SVR which can be quite marked in elderly and hypovolaemic

Also can lead to apnoea

Be aware of any soy bean or egg allergies which preclude usage


Thiopentone/Thiopental sodium

This is a barbiturate used in the induction of anaesthesia and is also a potent anticonvulsant

It usually lasts about 5-15 minutes

There is no pain on injection

This can only be used as an induction drug mainly because the drug accumulates within the body meaning after every subsequent injection the plateau in blood concentration progressively gets longer

This is also a risky drug if it extravasates as it may lead to tissue necrosis (If this occurs administer procaine immediately

Accidental intra-arterial injection may lead to severe contriction and distal limb gangrene

Has a higher incidence of post-operative nausea and vomiting when compared with propofol

Use with caution in those with asthma as it may lead to bronchoconstriction




Typically used in patients with an unstable CVS such as those in shock or with known cardiovascular disease

However the evidence on this is not clear cut

Also reduces ICP and IOP

But can cause pain on injection

Can cause involuntary movements more frequently

Leads to adreno-cortical suppression

Can cause extremely severe nausea and vomiting (greater than thiopentone)

May have thrombophlebitis due to its solvent (propylene glycol)




Ketamine is another induction agent but it is unique in that it produces a dissociative state

The patient may have eyes open but cannot be communicated to

Sensory loss + strong analgesia +amnesia + paralysis of movement but no LOC

Very effective analgesic

Preserves cardiac output and also leads to an increased HR and BP (which may not be appropriate for those with e.g. uncontrolled HTN)

Causes bronchodilation

Can be given IM

Onset may be slow and also pain may occur on injection

Raises ICP

May lead to some involuntary movements during anaesthesia

Hallucinations, delirium, vivid dreams (may be unpleasant), confusion and irrational behaviours can occur during recovery and for up to 24 hours

Said to be less severe in children hence sometimes used in children with benzodiazepine pre-medication



This is a beznodiazapine which in comparison to the rest of its class is fast acting and has a short duration (takes longer than most other IV anaesthetics – 3-5 min and lasts for about 1 hour)

Useful as a premedication for sedation, amnesia and anxiolysis

Can be used as sedative for small procedures such as endoscopy when combined with fentanyl and propofol

Seizure control

Can be used to potentiate other local anesthetics intrathecally

Does not lead to respiratory or cardiovascular depression


Defines as serum <135 mmol/L

Severe is <120 mmol/L

ECF volume and serum osmolality is crucial in determining abnormality

Generally hyponatraemia is a free water abnormality rather than sodium imbalance



Nausea, Vomiting, Lethargy, confusion, seizures, central herniation due to cerebral oedema, muscle cramps, ataxia, psychosis, agitation, respiratory depression -> failure, coma and death

Subsequent neurological sequealae frequently occur in women but neurological effects (secondary to cerebral oedema) will only occur in an acute occurrence when the cell volume regulation of the brain is overcome.




Isotonic hyponatraemia is a pseudohyponatraemia due to proteins or lipids occupying a larger portion of plasma volume.

Hyperglycaemia causes a water shift into extracellular fluid hence diluting sodium

Same as mannitol and radiocontrast (osmotically active)

SIADH = hyponatraemia + decreased osmolality + Increased Urine osmolality + absences of renal, cardiac, liver, thyroid and adrenal disease + High urinary sodium

Post op hyponatraemia ≤2 days post op – nausea, headache seizures (due to excessive hypotonic postop fluids)



Management is determined by several factors:


-Severity of symptoms

-Time course of hyponatraemia

-Response to management


In an acute symptomatic hyponatraemia give 3% Na with Furosemide

Target an increase of 1-2 mMol/hr reassess after 2 hours


An increase of greater than this is liable to cause osmotically induced demyelination

Found to be more likely in anoxic patients

Give oxygen and ventilator support


If chronic or asymptomatic then correct at about 0.5 mMol/hr

Use 0.9% saline


If SIADH then fludrocortisone


In hypovolaemic or psuedohyponatraemia then give Half N/S/ other isotonic solution to return volume


In hypervolaemic hyponatraemic then water restriction to reduce retained fluid

Treat the underlying cause

Consider diuretics

Remember to monitor Na levels every 2 hours



>145 mmol/L

In general there is an underlying disorder where there is excess water loss to water intake

Otherwise there may be excessive sodium intake (rarer)


Typically causes a contracted ICF volume = neurological symptoms such as altered mental status, neuromuscular irritability, focal neurological deficits and eventually coma and seizures

May also have other symptoms relating to the cause such as orthostatic hypotension, oliguria, polyuria, diarrhea


The most common cause of hypernatraemia would be free fluid loss.

Frequently this is due to excessive renal losses

Can occur in diabetes insipidus or some other osmotic diuresis – hyperglycaemia due to poorly controlled diabetes (hyperosmolar hyperglycaemic state/ketoacidosis), abuse of loop diuretics, post-obstructive dieresis or increased urea (e.g. high protein diet)

In these cases however there will be a high urine osmolality

In the case of a low urine osmolality then the likely cause would be diabetes insipidus


The treatment as with hyponatraemia should be performed with caution

Corrected too rapidly may cause brain oedema

Aim to decrease a maximum of 1mmol/l/hr

Continue to monitor all electrolytes frequently

In hypernatraemia with hypovolaemia 0.45% Saline or 4% dex 0.18% saline

In hypernatraemia with euvolaemia 5% dex

In hypernatraemia with hypervolaemia 5% dex with furosemide


Brochiectasis is the permanent dilatation of the bronchi as well as a inflammation of the walls and surrounding lung tissue

It may be limited/focal or diffuse/widespread

Typically affects elderly and women

It is a significant disease amongst the developed countries (doesn’t occur as often in the less developed countries)

In developed countries the causes tend to be obstructive in nature such as a tumor or foreign body or associated with cystic fibrosis

However in a lot of cases they are found to be idiopathic

In developing countries the main cause would be severe pulmonary infections particularly Staph aureus, Klebsiella, adenovirus and influenza

Tuberculosis is a major cause of bronchiectasis worldwide

Patients typically present with a chronic or recurrent cough and chronic purulent sputum production

If the patient also frequently has repeated respiratory tract infections then consider this as well

Haemoptysis is also fairly frequent and can be due to bleeding from friable/inflamed airways

Fatigue, weight loss and myalgias are also common

As it becomes exacerbated with infections then there will likely be more sputum being produced

O/E any number of wheezing, ronchi, and crackles may be heard

Investigation-wise HRCT is the standard method

It provides an excellent view of the airways

They should be overly dilated

If it is focal then consider a bronchoscopy to look for an underlying obstruction

Therapy has several targets

Treat infections

Improve the clearance of sputum

Reduce inflammation

If there is an underlying problem then fix it!

Antibiotics are the mainstay of management – the main concern is infection with Pseudomonas Aeruginosa

Inhalation Anaesthesia

These are typically used in the maintenance of anaesthesia

However it can also be used for the induction of anaethesia pending on the situation

(e.g. predicted difficult airway, needle phobia, children)

In an inhaled anaesthetic drug you would want the following characteristics: –

  • Pleasant or no odour
  • Inert
  • Not irritating
  • Non flammable
  • Potent
  • Non toxic
  • Minimal cardiovascular and respiratory depression
  • Low or not metabolised

Nitrous Oxide

Sweet smelling non irritant gas

This drug is of relatively low potency and is usually used in combination with another agent

Has more analgesic properties than anaesthetic

Can be used to supplement general anaesthesia

Also used as an analgesic for labour

Effective at sedation without causing respiratory depression


Rapid onset and offset


Causes an increased incidence of N&V

May also cause subacute combined degeneration of the spinal cord or megalobastic anaemia after prolonged use (>6 hours) and thismay also apply to recurrent users

Also increases the size of any air filled spaces –risky for air embolus and pneumothorax (Should not be used after ocular surgery due to risk of bubbles intra-ocularly)

Due to rapid dissolution may cause Fink effect – diffusion hypoxia


This is the 50:50 mixture that may be used in the field

Often for dressing changes and contractions

Premixed in cylinder


This is a fruity smelling volatile agent which is frequently used by the ambulance staff and first aid personnel in Australia

It has been largely discontinued overseas due to its tendency to produce fluoride when metabolized resulting in high output renal insufficiency

At extremely high doses (those once used for anaesthesia) hepatic impairment also occurs

However it has very strong analgesic effects

May cause sedation and sometimes confusion

In current form (green whistle) it is self administered with supervision- in effect a PCA

Given in 3mL ampoules into a breathing device which lasts 30 min if continuous breathing

Pain relief usually beings at 6-8 breaths

Wanes after several minutes

Max of 6mL per day and 15 mL per week – not for use on consecutive days


This is an older inhalant agent which is declining greatly in usage due to newer versions such as isoflurane

One of the few usages is for induction anaesthesia

The properties which initially made it popular are its non irritant and non explosive properties

It also onsets quickly and is highly potent

Yet due to its potency it is able to cause cardiovascular and respiratory depression so must be titrated carefully

Has also been linked with ventricular arrhythmias

Though rare can lead to fulminant hepatic failure (especially common if repeated exposure over short period)

Also prolongs QT


This is an older agent which is similar to halothane

Like halothane has largely been superseded

It was used as an alternative to methoxyflurane

Main issue with this was its likelihood to cause a seizure either during induction or post-recovery


This is frequently used form of anaesthesia

Used in maintenance

However it can be irritating hence may lead to coughing, breath holding and laryngospasm so not frequently used in induction

It is also difficult and costly to produce

It can lead to hypotension as well as being a coronary vasodilator (which can cause coronary steal esp if there is an obstruction i.e. CAD)


This is also a frequently used form of anaesthetic for maintenance

Induction and recovery is quicker than isoflurane

Virtually no metabolism

Less potent – requires greater concentrations

Can cause respiratory irritation hence no recommended for induction – coughing, breath holding, occasionally bronchospasm in children


This is another form of commonly used anaesthetic for induction and maintenance

Its main benefit is the fact that it is non-irritating for induction

However it is metabolized to some degree resulting in a slight production of fluoride

This is not believed to be at levels high enough to be harmful, however

Rarely it can cause some involuntary movements in light anaesthesia

Also prolongs QT

Older forms of gaseous anaesthesia have usually been phased out due to flammability or due to toxicity

Chloroform (hepatotoxic, cardiac dysrhythmias)

Diethyl ether (explosive and extreme irritant to airways)

Vinyl ether (explosive)

Cyclopropane (explosive, respiratory depressant and hypotensive)

Trichloroethylene (unstable)