Vascular surgery
Aneurysms, peripheral arterial disease, acute limb ischaemia, carotid disease and venous disease. Time-critical presentations are the focus.
High-yield points
Ruptured AAA: pain, hypotension and pulsatile mass; permissive hypotension and straight to theatre or endovascular repair.
Elective AAA repair is usually offered at 5.5 cm in men (lower thresholds for women) or rapid growth.
Acute limb ischaemia (6 Ps: pain, pallor, pulselessness, paraesthesia, paralysis, perishing cold): heparin and urgent vascular surgery.
Peripheral arterial disease: ABI below 0.9; manage with smoking cessation, supervised exercise, statin and antiplatelet.
Symptomatic carotid stenosis of 50-99% (especially 70-99%): early carotid endarterectomy within 2 weeks.
Diabetic foot: check sensation and pulses, urgent referral for ulcers with infection or ischaemia.
Venous ulcers: confirm ABI before compression bandaging.
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 |
|---|---|---|
| Diabetic foot | Very common, often late presentation. | Much higher amputation rates in First Nations people. Regular foot checks, podiatry and high-risk foot services are expected. |
| Peripheral arterial disease | Thromboangiitis obliterans (Buerger's) gets heavy textbook emphasis. | Atherosclerosis is the usual cause; Buerger's is rare. |
| VTE anticoagulation | Warfarin or acenocoumarol, often on cost grounds. | DOACs (apixaban, rivaroxaban) are usually first line. Acenocoumarol is not available. |
| AAA screening | No program. | No national program either; targeted ultrasound for higher-risk older people, e.g. older men who smoke. |
Diabetic foot
India (MBBS)
Very common, often late presentation.
Australia (AMC): what the exam expects
Much higher amputation rates in First Nations people. Regular foot checks, podiatry and high-risk foot services are expected.
Peripheral arterial disease
India (MBBS)
Thromboangiitis obliterans (Buerger's) gets heavy textbook emphasis.
Australia (AMC): what the exam expects
Atherosclerosis is the usual cause; Buerger's is rare.
VTE anticoagulation
India (MBBS)
Warfarin or acenocoumarol, often on cost grounds.
Australia (AMC): what the exam expects
DOACs (apixaban, rivaroxaban) are usually first line. Acenocoumarol is not available.
AAA screening
India (MBBS)
No program.
Australia (AMC): what the exam expects
No national program either; targeted ultrasound for higher-risk older people, e.g. older men who smoke.
The Australian context
Diabetes-related foot disease and lower limb amputation rates are much higher among Aboriginal and Torres Strait Islander people. There is no national AAA screening program in Australia.