Respiratory medicine
Asthma, COPD, pneumonia, pulmonary embolism, interstitial lung disease and lung cancer. Expect questions on acute severity assessment and guideline-based stepwise therapy.
High-yield points
Asthma (Australian Asthma Handbook): SABA-only treatment is no longer recommended for adults and adolescents; as-needed budesonide-formoterol is an option for mild asthma, and every patient needs a written asthma action plan.
Severe or life-threatening asthma: continuous salbutamol, ipratropium, systemic steroids, consider IV magnesium; a normal or rising CO2 is an ominous sign.
COPD (COPD-X): diagnosis requires post-bronchodilator FEV1/FVC below 0.7; target SpO2 88-92% in exacerbations to avoid hypercapnia.
COPD exacerbation: bronchodilators, oral prednisolone 5 days, antibiotics if sputum is purulent, and NIV for acute hypercapnic respiratory acidosis.
Community-acquired pneumonia: assess severity (CURB-65 or SMART-COP). eTG low-severity first line is amoxicillin, with doxycycline as the alternative or add-on for atypicals.
PE: use Wells score and PERC; D-dimer only in low pre-test probability; CTPA to confirm; thrombolyse massive PE with haemodynamic compromise.
Pneumothorax: tension is a clinical diagnosis, decompress immediately; spontaneous small primary pneumothorax can often be observed.
Occupational lung disease is examinable: asbestos (mesothelioma), silicosis and coal workers' pneumoconiosis.
India vs Australia
Where the answer the AMC marks correct differs from what’s usually taught in Indian MBBS.
| Aspect | India (MBBS)What you learn in MBBS | Australia (AMC)What the exam marks as correct |
|---|---|---|
| Chronic cough with weight loss | TB is high on the list for everyone; sputum testing under NTEP. | TB is uncommon and mostly in people born overseas. Think TB in migrants and international students; state TB services manage it and it is notifiable. |
| First-line for community-acquired pneumonia | Empirical co-amoxiclav, cephalosporins, macrolides or fluoroquinolones are common. | Per eTG: mild, oral amoxicillin and/or doxycycline; moderate, IV benzylpenicillin plus doxycycline. Fluoroquinolones are not routine first line. |
| Asthma relief and prevention | Salbutamol (sometimes oral) and theophylline/deriphyllin are still used; ICS may be underused. | Australian Asthma Handbook: SABA-only treatment is not recommended in adults. Use an ICS-containing regimen, e.g. as-needed budesonide-formoterol. Written action plan. |
| Main causes of COPD and lung disease | Smoking plus biomass smoke exposure, especially in women. | Mainly smoking; spirometry confirms diagnosis (COPD-X). High mesothelioma rates from past asbestos use; lung cancer screening program for high-risk smokers. |
Chronic cough with weight loss
India (MBBS)
TB is high on the list for everyone; sputum testing under NTEP.
Australia (AMC): what the exam expects
TB is uncommon and mostly in people born overseas. Think TB in migrants and international students; state TB services manage it and it is notifiable.
First-line for community-acquired pneumonia
India (MBBS)
Empirical co-amoxiclav, cephalosporins, macrolides or fluoroquinolones are common.
Australia (AMC): what the exam expects
Per eTG: mild, oral amoxicillin and/or doxycycline; moderate, IV benzylpenicillin plus doxycycline. Fluoroquinolones are not routine first line.
Asthma relief and prevention
India (MBBS)
Salbutamol (sometimes oral) and theophylline/deriphyllin are still used; ICS may be underused.
Australia (AMC): what the exam expects
Australian Asthma Handbook: SABA-only treatment is not recommended in adults. Use an ICS-containing regimen, e.g. as-needed budesonide-formoterol. Written action plan.
Main causes of COPD and lung disease
India (MBBS)
Smoking plus biomass smoke exposure, especially in women.
Australia (AMC): what the exam expects
Mainly smoking; spirometry confirms diagnosis (COPD-X). High mesothelioma rates from past asbestos use; lung cancer screening program for high-risk smokers.
The Australian context
TB is uncommon in Australia (around 6 per 100,000) and most cases are in people born overseas, so a new migrant or international student with cough, fever and weight loss should prompt TB testing, while an Australian-born patient usually needs other causes considered first. Salbutamol is the name used for albuterol. Australia has very high rates of mesothelioma because of past asbestos use.