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Camc Curriculum_ Final
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Caribbean Medical Council Examination Curriculum
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FOR THE CARIBBEAN ASSOCIATION OF MEDICAL
COUNCILS EXAMINATION
Curriculum for the Caribbean Association of
Medical Councils Examination
Editor : Dr. Russell Pierre
Contributors: Prof. Everard N. Barton
Dr. Althea East-Innis
Dr. John Harriot
Dr. Tomlin Paul
Dr. Joseph Plummer
Dr. Russell Pierre
Dr. Wendel Abel
Dr. Roger Gibson
Dr. Pauline Williams-Green
Prof. Archibald McDonald
Faculty of Medical Sciences, University of the West Indies, Mona Campus,
Kingston 7, Jamaica, West Indies. Tel: (876) 927-1660-9
T TA AB BL LE E O OF F C CO ON NT TE EN NT TS S
G GE EN NE ER RA AL L I IN NF FO OR RM MA AT TI IO ON N............................................................................................... 1
1.0 INTRODUCTION................................................................................................... 2
2.0 THE CAMC CURRICULUM.................................................................................. 2
2.1 AIM of the CAMC Curriculum.......................................................................... 2
2.2 OBJECTIVES of the CAMC Curriculum........................................................... 2
2.3 Summary of CAMC Curriculum........................................................................ 3
D DI IS SC CI IP PL LI IN NE E- -B BA AS SE ED D C CU UR RR RI IC CU UL LU UM M................................................................................ 4
3.0 MEDICINE.............................................................................................................. 5
3.1 System-based Guidelines.................................................................................... 5
RENAL....................................................................................................................... 5
ENDOCRINE ............................................................................................................. 5
PULMONARY........................................................................................................... 6
CARDIOLOGY.......................................................................................................... 6
NEUROLOGY............................................................................................................ 7
GASTROENTEROLOGY.......................................................................................... 8
DERMATOLOGY...................................................................................................... 9
3.2 Clinical Problems Guidelines* ......................................................................... 11
3.3 Practical Procedures.......................................................................................... 14
3.4 Useful resources ............................................................................................... 14
4.0 PAEDIATRICS...................................................................................................... 15
4.1 Aim and Objectives........................................................................................... 15
4.2 Approach to the study of Paediatrics (Selected Core Clinical Problems) ........ 15
4.3 Core Clinical Problems List (Paediatric Focus)*.............................................. 16
4.5 Useful resources................................................................................................ 20
5.0 OBSTETRICS & GYNAECOLOGY.................................................................... 22
5.1 Core Obstetric Clinical Problem List................................................................ 22
OBSTETRICS .......................................................................................................... 22
5.2 Practical Procedures in Obstetrics .................................................................... 24
5.3 Core Gynaecology Clinical Problem List ......................................................... 24
GYNAECOLOGY.................................................................................................... 24
5.4 Practical Procedures in Gynaecology ............................................................... 25
6.0 COMMUNITY HEALTH....................................................................................... 26
7.2 Core Community Health Educational Objectives............................................. 26
7.0 PSYCHIATRY....................................................................................................... 30
7.1 General Principles............................................................................................. 30
7.2 Specific Areas of Competence.......................................................................... 30
8.0 SURGERY............................................................................................................. 32
8.1 Core Clinical Problems List*............................................................................ 32
General Surgery Topics ............................................................................................ 32
Paediatric Surgery..................................................................................................... 32
Orthopaedics ............................................................................................................. 32
Urology ..................................................................................................................... 32
Cardiothoracic........................................................................................................... 32
Neurosurgery............................................................................................................. 33
Anaesthesia ............................................................................................................... 33
ENT and Ophthalmology.......................................................................................... 33
9.0 APPENDIX........................................................................................................... 34
P Pa ar rt t A A
G GE EN NE ER RA AL L I IN NF FO OR RM MA AT TI IO ON N
This curriculum was developed as a learning guide for eligible candidates preparing for the
Caribbean Association of Medical Councils Examinations. The aim of this examination is to
determine the minimum competences required for registration of medical graduates to practice
independently in the Caribbean region.
2.0 THE CAMC CURRICULUM
2.1 AIM of the CAMC Curriculum
The CAMC examination aims to assess for registration purposes, the general body of medical
knowledge and clinical skills of trained doctors whose basic medical qualifications are not
recognized by the regional Medical Councils, i.e. doctors trained in medical schools that have not
been formally reviewed and accredited by the CAMC. The successful candidate is registered to
engage in safe, independent general practice throughout the Caribbean. It aims to provide a
regional basis of ensuring standards for the profession.
2.2 OBJECTIVES of the CAMC Curriculum
The standard of the CAMC examinations is defined as the level of attainment of medical
knowledge, clinical skills and attitudes required of newly qualified graduates of accredited medical
schools (e.g. University of the West Indies) who are about to commence intern training. The
potential candidates are expected to:
1. Demonstrate knowledge and skills for the diagnosis and treatment of diseases and
application of this knowledge to solving problems presented by the patient
2. Demonstrate good oral and written communication skills
3. Demonstrate an effective team approach to health care
4. Discuss the investigation and management of common conditions encountered including
prioritization and interpretation of the results of common investigations.
5. Demonstrate competence in common procedural skills.
6. Recognize his (or her) own limitations and seek collaboration and consultation when
2.3 Summary of CAMC Curriculum
The curriculum is designed as a comprehensive overview of medical knowledge, clinical
competency and performance, in the disciplines of internal medicine, paediatrics, obstetrics,
gynaecology, surgery, community health and psychiatry. The intention is that candidates will
develop a multidisciplinary and integrated approach to clinical problems that are pertinent to the
Caribbean region. The assessments are outlined as follows:
The MCQ examination focuses on essential medical knowledge involving understanding of the
disease process, clinical examination, diagnosis, investigation, therapy and management, as well as
on the candidate's ability to exercise discrimination, judgement and reasoning in distinguishing
between the correct diagnosis and plausible alternatives.
The clinical examination also assesses the candidate's capacity to communicate with patients, their
families and other health workers.
P Pa ar rt t B B
D DI IS SC CI IP PL LI IN NE E- -B BA AS SE ED D C CU UR RR RI IC CU UL LU UM M
3.0 MEDICINE
The candidate is expected to demonstrate competence in knowledge, understanding, clinical
evaluation and relevant procedural competences in the following internal medicine
3.1 System-based Guidelines
Tests of kidney function Blood tests, 24- hour urine collection for creatinine
clearance, urine protein; urine protein/ creatinine ratio, spot Na, urine microscopy
Imaging Studies - Ultrasound , IVP, Renal nuclear scan
Diagnosis & management of acute renal failure
Management of acute glomerulonephritis: Poststreptococcal and lupus nephritis
Diagnosis & management of nephrotic syndrome
Management of haematuria
Diagnosis & management of chronic renal failure
Slowing progression to endstage renal failure
Management of urinary tract infections
Diet modification in renal failure
Hereditary renal diseases
Renal neoplasms
t therapy
ation.
Renal replacemen
o peritoneal dialysis
o haemodialysis
o renal transplant
Ind t
ica ions for renal biopsy
lassification, and treatment
d hyperosmolar coma
o Diagnosis, c
o Management of diabetic ketoacidosis, an
End r oc ine causes of hypertension
Cushings syndrome
ciency. Adrenocortical insuffi
toxicosis Diagnosis & treatment of thyro
Diagnosis & treatment of hypothyroidism
Hypercalcaemia & hyperparathyroidism
Panhypopituitarism
ma Pituitary tumours - acromegaly, and prolactino
Hyponatremia Diabetes insipidus, SIADH
Genetic abnormalities
CAMC Examination Curriculum
LMONARY
Classification of lung diseases - Obstructive vs Restrictive
Pulmonary Function Tests Spirometry, FEV 1, PEFR
Obstructive Lung Diseases
o Asthma : diagnosis, classification & management
o Emphysema & chronic bronchitis: diagnosis & management
Restrictive Lung Diseases
o Sarcoidosis
o Idiopathic pulmonary fibrosis
o Collagen vascular diseases & the lung
Occupational Lung Disease
Diagnosis & management of acute pulmonary embolism
o Classification
o Staging
o Treatment
Pulmonary infections
o Community acquired pneumonia
o Nosocomial pneumonia.
o Lung abscess
o Bronchiectasis
o Presentation
o Mantoux testing
o Latent tuberculosis infection
Causes of haemoptysis
Causes of pleural effusion
Opportunistic lung infections e.g. PCP
Principles of Fiberoptic Bronchoscopy
Interpretation of chest X-rays
Interpretation of arterial blood gas
Hypertension: diagnosis & management
Congestive Cardiac Failure
o Symptoms & signs
o Aetiology
o Diagnosis
o Management
Diagnosis & management of Rheumatic fever & Rheumatic heart disease
Cardiomyopathies: definition & management
Diagnosis & management of infective endocarditis
o Chronic stable angina
romes o Acute coronary synd
Non ST myocardial infarction
is & management o Acute MI diagnos
Management of hypercholesterolemia
Drug Therapy in cardiac diseases
Cardiac imaging: Invasive modes vs Non-invasive
Basic ECG in r te pretation
on of strokes: ischaemic, embolic, haemorrhagic Definition & classificati
nagement Transie Is nt chaemic Attacks: definition & ma
Demen tia: diagnosis & classification
Epileps c y: lassification & treatment
Headac ne; other types of headache he: definition of migrai
ension: diagnosis & management Benign Intracranial Hypert
gnosis & treatment Parkins s on Disease: dia
Optic N r eu itis causes
Polymyositis HTLV-1 syndromes: TSP,
erpes simplex, and other viruses
CNS Infections
o Meningitis
o Encephalitis - H
o Brain abscess
gement Optic Neuritis: causes & mana
anagement Transverse Myelitis: diagnosis & m
Myelopathies
rential diagnosis
o Investigation & management
o Diffe
o Vitamin B12 deficiency
o Cervical spondylosis
v o HAM /TSP (see abo
Guillain Barre Syndrome
Sci a atic
Neu l ations due to Vitamin B 12 deficiency ro ogical complic
Peripheral Neuropathies
causes of syncope Neurological
. Polymyositis Proximal Myopathies e.g
My h ast enia Gravis
Bra MRI; Angiography in imaging modalities: CT Scan;
Mis l
gical effects
cel aneous
o Sickle Cell Disease and CNS
o Collagen Vascular Diseases - neurolo
ction - neurological effect o HIV Infe
ENTEROLOGY
o disorders, gastroesophageal reflux disease
ophageal neoplasms
ophageal varices
wing o Physiology of swallo
Dysphagia, motility
o Oes
testinal bleeding
Physiology of gastric secretion o
Gastric ulcer disease, Helicobacter pylori infectio o
o Neoplasms of the stomach
o Dyspepsia and upper gastroin
utrient absorption
rritable Bowel Syndrome
o Duodenal ulcer disease
o Physiology of water, electrolyte, and n
o Gut hormone
o Malabsorption, I
o Lower gastrointestinal bleeding
s of the colon o Neoplasm
o Diverticula
o Inflammatory bowel disease
e and chronic diarrhoea o Causes of acut
Biliary Tree
o Physiology of biliary secretion
nes o Gallsto
creatitis.
Pan a cre s
o Physiology of pancreatic secre
ic pan o Acute pancreatitis, chron
o Pancreatic neoplasms
o Inflammatory bowel dise
ubin metabolism
Physiology of bilir o
V o iral Hepatitis
o Leptospirosis
auses and complications; including
mochromatosis
sons disease
1 antitrypsin deficiency
ty liver disease
o Cirrhosis and its c
lpha-
Non-Alcoholic fat
Vaso-Occlusive Disease
Candid s e skin; to diagnose
and be fam atological
disorders in the Caribbean.
GI imaging: Endoscopy, Radiographic imaging, ERCP
RMAT L O OGY
ate should be able to conduct a proper examination of th
nt of common derm iliar with the principles of manageme
hanges in skin color C
rmal skin color melanin, oxyhaemoglobin,
Determinants of no
xyhaemoglobin, carotene etc.
Differences between black and white skin
Changes in skin color: hypo- or hyperpigmentation
Pigmented lesions
Approach the study of changes in skin colour
ous lesions
herited conditions, skin
systemic diseases and exposure to chemical agents or drugs
ences of changes in skin color
o Be able to recognize normal pigmentary skin change
o Be able to recognize suspici
o List causes of changes in skin color including in
diseases,
o Consider social consequ
Wh s at i pruritus?
presentation of systemic or skin disease Itch as a
Com o m n causes of itching
His y cerning the common causes tor -taking as a means of dis
Ma atic (b) underlying cause of itch nagement of patients: (a) symptom
App a
w how to investigate them
iliar with the suppression of itch: Use of sedative antihistamines,
iton cream, anti-itch
taining lotions, topical steroids
Clinical Ap o
You should
ro ch the study of pruritus
o List the systemic causes of itch and kno
o Be fam
topical cooling agents, calamine lotion, crotam
menthol-con
pr ach to Skin Diseases
be able to define a rash using basic terminology.
o Symmetrical lesions are usually endogenous
genous
o Asymmetrical lesions are usually exo
ction for certain
site .g titis, psoriasis.
tribution
o You should be able to discern dermatoses with predile
s e . seborrhoeic derma
Arrangeme
o Gro e
o Dissem rete lesions)
o Linear
nt of lesions
up d
inated (widespread disc
o Generalized
o Annular
Morphology of lesions
o Color
o Size
Shape o
marcation
o Border de
dules
Types of lesions:
o Flat: macules, patches
o Solid elevated: papules, plaques, no
o Fluid filled: vesicles, bullae, pustules
ucosae, scalp or nails
Involvement of m
Suggest relevant investigations
o Formulate a treatment plan
Ch i
Chronic leg ulcers are a common problem
eco m
to approach skin rashes
o Take an appropriate history
o Describe a patients rash in terms of distribution, morphology and
associated findings
o Suggest a differential diagnosis
ron c Leg Ulcers
in the Caribbean and pose a major socio-
no ic problem.
Approach leg ulcers
o Definition
o Clinical assessment
o Investigations
Skin changes in systemic disease
Genodermatoses: Neurofibromatosis, tuberous sclerosis
Collagen vascular diseases: systemic lupus erythematosus, dermatomyositis,
lerosis systemic sc
Skin m ycosis fungoides (cutaneous
T-c l .
arkers of malignancy: Acanthosis nigricans, m
ell ymphoma), erythroderma, acquired ichthyosis
Skin manifestations of HIV and HTLV 1 infections
3.2 Cli
nical Problems Guidelines*
Clin l ica Problems
Key Diagnosis
Anaemia Haematological
cell disease
GI bleed
GI malignancies
Collagen vascular disease
Malignancies.
Che a Cardiac
Chronic stable angina
Lower respiratory tract infection
Pleuritis
usculoskeletal
Costochondritis
st p in
Cough Cardiac
Congestive cardiac failure.
Drug induced e.g. ACE
Fatigue Endocrine
Collagen vascular (see above)
Chronic infection
Fever Infections
Acute pneumonia, UTI
Chronic TB, HIV
Collagen vascular diseases
Haemoptysis Cardiac
TB / Bronchiectasis
ell carcinoma
Bladder lesions.
maturia Renal
Glomerulo
tic Polycys
Renal c
Headache Vascular
hnoid haemorrhage
Raised ICP
rhage
Infe n
litis
Ten n
Subarac
Intracranial haemor
Meningitis /encepha
sio headache
Hypertension ary / Essential.
Renal disease
Endocri
Jaundice Hem ol
titides
at ogical
Hepatic failure
Biliary obstruction.
Viral hepa
Infla m
Collagen vascular
m atory
Muscle weakness Neu o
End n
abetes
Para op
rol gical
Myopath
Neuropathies
ocri e
Thryotoxicosis
ne lastic
Numbness & tingling Neu o
eripheral neuropathy
Palpitations Card va
rhythmias
ochromocytoma
io scular
Phae
Paraparesis Infection
Nut on
ency
HTLV 1
riti al
Vit B 12 defici
Polydypsia End ne
Psyc g
ocri
ho enic.
Pruritus End ne
e jaundice
Obstructiv
onic renal failure Chr
Alle c rgi reaction.
Dyspnoea Card va
Res t
pira ory
ogica Haematol
Vas ag
Card va io scular
o v al
Swollen feet Cardiovascular
Hep c ati
Tremor Endocrine
Wheezing Respiratory
Weight loss n
*This is not meant to be exhaustive
3.3 Practical Procedures
Completing a death certificate
Completing a discharge summary for Med al ic Records
Complete a disease notification form f th rom u P blic Heal
Pass a nasogastric tube
Perform an arterial puncture for arterial blood gas and interpret the blood gas
Interpret urine microscopy
Perform a lumbar puncture and interpret the results on investigations
Plan and appropriately administer insulin
Plan and write up a fluid balance chart
Report on a Chest X-Ray
3.4 Useful resources
A Clinical Guide to the Cardiovascular Examination s E. Denbow
Principles & Practice of Medicine by Davidson
Macleods Clinical Examination, 10
Edition; unro and Ian W
Hutchinsons Clinical Methods, 21
Edition;
Clinical Dermatology: An illustrated textbook
press, 2003
Graham-Brown R, Burns T. Lecture Notes in Dermatology; 8th ed., Blackwell
ng, 2002
Marks R. Roxburghs Common Skin Diseases; 17 d rsity Press, 2003
Harrisons Principles of Internal Medicine
Journals: West Indian Medical Journal, New England Journal Medicine, Annals of
edicine, Postgraduate Doctor, etc.
Charle
ed d ite by John F. M
edited by Michael Sw
ed., Oxford University
Mackie R.
publishi
e ., Oxford Unive
Internal M
4.0 PAEDIATRICS
4.1 Aim and Objectives
The n
d scientific methods of
interpreted through an
ural history and treatment of disease in children,
al response to disease and injury; nutrition and immunisation status in
appropriate anticipatory guidance
hich are
on procedural skills in paediatrics
with paediatric patients and their
nt of presenting problems,
. unicate effectively with relevant healthcare personnel
. les of counselling parents and children in emotionally
ca didate should be able to:
1. Establish rapport with a child / parent and use logical an
history taking and physical examination and how these are
understanding of the nat
2. Assess normal growth and developmental processes and the principles of
abnorm
children of all ages; provide
3. Manage a wide and representational variety of paediatric conditions w
commonly encountered in practice,
m 4. Perform and interpret the results of com
timely and accurately 5. Communicate sensitively,
families, in the manageme
6 Collaborate and comm
7 Understand the princip
distressing situations e.g. life threatening illness, chronic disease, dea
4.2 Approach to the study of Paediatrics (Selected Core Clinical
Problems)
Paediatric Foundation Principles: Growth, Development, Nutrition and feeding practices,
Immunisations, Accident Prevention, Anticipatory Guidance
The child with sickle cell disease
Behavioural and emotional problems in children and adolescents
The dehydrated child
The febrile child
Malnutrition and failure to thrive
The child with red urine
The child with fits
The short child
Sepsis in the newborn & the ill newborn
The child with respiratory distress
The child with heart failure
The child with a rash
The child with developmental delay
4.3 Core Clinical Problems List (Paediatric Focus)*
Core Clinical Problems in Paediatrics
Key Diagnoses in Children
Abdo al Pain min Acute: Appendicitis
ial stress
Gastritis/ PUD
Gastroenteritis/ Mesenteric adenitis
Basal Pneumonia
Abdominal painful crisis (SCD)
Chronic: Functional Constipation
Non-organic- psychosoc
(Exp
child wit isease
Leukemia/Lymphoma
emia/ pallor *
anded core problem in Haematology The
h Sickle Cell Disease)
Poor perfusion: CCF, shock
Anemia: Sickle Cell D
Nutritional Anemias-
Anemia of inflammation
Other haemolytic anemias
Behavio
(Expand n Developmental and
Behaviou
Emo n
adolesce
Primary Care Problems:
Sleeping, feeding and toileting in infants and children
isruptive disorders e.g. ADHD, Conduct
ral problems*
ed core problem i
ral paediatrics Behavioural and
tio al Problems in Children and
nts)
Parent-Adolescent Conflict
PTSD, grief and loss
Blee g telet Disorders:
uantitative: ITP, Leukaemia, DIC
Qualitative:
Coagulation Disorders:
din Pla
Che a : LRTI
Acute Chest Syndrome
Cardiac: Pericarditis
wall: Costochondritis
Rib pain- Leukaemia
Sickle Cell Bony crisis
st P in Res
piratory
Chronic Illness Asthma, Cerebral Palsy, Diabetes, Developmental Delay,
Rheumatic Fever/Carditis, Sickle Cell Disease
Coma Head Injury- Accidental
Non-accidental
Metabolic- Hypoglycemia
lycemic agents
Reyes syndrom
Poisoning: Sedatives
Hypog
Status Epilepticus/ Post-ictal
litis/ Infectious: Encepha
ng lesion Space occupyi
Constipation Functional
Hirschprungs
ypothyroidism H
Upper respiratory: URI
Lower respiratory: LRTI
est Syndro Acute Ch
Bronchiolit
LIP (HIV)
Cardiac: CCF
GI: GE reflux
Cyanosis maticus
Atresia
Respiratory: Status Asth
Severe LRTI
Cardiac: TOF
Tricuspid
Dehydration *
(Expanded core problem in Gastroenterology
The Dehydrated Child)
s Polyuria eg. Diabetis Mellitus/ Insipidu
Developmental problems*
(Expanded core problem in General Paediatrics
h to Developmental Delay)
rders
Approac
Global: Mental retard
Degenerative
Selective: Cerebral Palsy
Pervasive Developmental Diso
: increased juice intake
d- penicillins
Acute:
Infectious: Gastro
Osmotic
Drug- relate
Extra-intestinal Infection U
Chronic: Parasitic Infectio
Dysuria UTI
Vaginitis- Child Abuse
pruritus Pinworms with
Enuresis Neurogenic bladder
Voiding Dysfunction
Infantile Bladder
Psychosocial stressors
Failure to thrive*
(Expanded core problem in Nutrition The
child with Failure to Thrive)
somal abnormalities
al stressors
Organic: Malnutrition
Chronic Lung Disea
Chromo
Non-organic: Psychosoci
Faints
Fever*
(Expanded core problem in Infectious Diseases
The febrile child)
I, Urinary tract
Infectious: Respiratory, G
Skin, CNS
Inflammatory: Rheumatic
Malignancy: Leukaemia/ lymphom
Fever and acute infection
Migraine, Cluster and Tension Headache
hritis
Acute Leukemia
Rheumatoid Art
Irritability Meningitis
Jaundice Haemolytic : Sickle Cell Disease
axone
Infections/sepsis
Hepatic:
Drug- Bactrim, ceftri
Post Hepatic: Gall stones
Neck swellings ction, malignancy,
isorders
Lymph nodes: infe
Collagen Vascular D
Thyroid swelling
Oliguria Dehydration
Glomerular disease: AGN
Nephrotic Synd
Acute Renal failure
Obesity Nutritional
ne- Hypothyroidism, Cushings Endocri
Syndromic- Prader Willi
Pain in the limbs
Bone pain- SCD, osteomyelitis,
Maligana
Muscle: Myositis, abscess
s tissue: cellulitis
llagen vascular
SUFE
Subcutaneou
Joints: septic arthritis, co
e of AGN
Diabetis Mellitus
Diabetis Insipidus
Psychogenic polydipsia
Recovery phas
Recurrent Infection Acquired Immunodeficiency
Congenital Immunodeficiencies
Red Urine*
(Expanded core problem in Nephrology The
child with red urine)
N, UTI, stones
ion, diet
Haematuria- AG
Discolored urine- bilirubinuria, medicat
Seizures*
d core problem in Neurology The
eningitis
(Expande
child with fits)
Short stature*
(Expanded core problem in Endocrinology
The Child with Short Stature or Growth
Failure)
lver
ypothyroidism
Pathological- Syndromic- Russell Si
Endocrine- h
Non-pathological - genetic
- constitutional
Sick Child *
(Expanded core problem in Neonatology
Sepsis in the Newborn)
auses (Sepsis)
Infectious c
Skin rash sles, Rubella, Roseola Infantum,
Infective Dermatitis, Tinea
Allergic urticaria,
Infectious: Mea
Varicella,
Allergic: Eczema,
Papular urtic
Vasculitis: S
Shortness of breath * *
(Expanded core problem in Pulmonology The
child with respiratory distress)
ore problem in Cardiology - The
child with cardiac failure)
iac Failure
ratory- Pneumonia
tracheobronchitis
(Expanded c
Cardiac- Card
Respi
Asthm
Laryngo
Sore throat Tonsillitis
Stridor Laryngotracheomalacia
Foreign Body Aspiration
Swelling of feet/face
atic Carditis
er Disease- Biliary Cirrhosis
Renal- Nephrotic Syn
Cardiac CCF: Rheum
Hepatic: Chronic Liv
Vomiting GI: nteritis
Gastro-e
CNS: Meningitis
Space-occupying les
Respiratory: Acute Otitis Media
Cough-related: Asthma
GU: UTI
Uraemia
Wheezing Respiratory:
Foreign Body
Candidates are expected to demonstrate competence in the following areas:
Correctly establish breastfeeding technique in a new mother
Perform examination of a well newborn
Perform neonatal resuscitation
Practice of immunisations
Obtain consent for a procedure
Venepuncture for blood specimen n IV infusion and setting up a
Perform a supra pubic aspiration
Obtain a mid-stream urine sample from a child
Perform urethral catheterisation
Perform a lumbar puncture
Plot growth parameters on age and wth charts gender appropriate gro
Administer salbutamol (ventolin) by nebuliser
Demonstrate the use of an inhale
their parent
r to an asthmatic patient or and a peak flow meter
Interpret an arterial blood gas, electrocardiogram
Completion of post-mortem and death notification forms
Completion of disease notification a notifiable disease form for
Competence in CPR in an older ch
diatrics: A Primary Ca
lustrated textbook of Paediatrics Tom Lissauer and Graham Clayden
ehrman RE, Kliegman RM: Nelson Esse ers
udolph AM, Kamei RK (Eds.): Rudolph
s Clinical Examination, 10
Edi hn F. Munro and Ian W
Editi ichael Swash
Berkowitz CD: Pe re Approach, Saunders
B ntial Paediatrics, Saund
R s Fundamentals of Pediatrics, Appleton &
Macleod tion; edited by Jo
on; edited by M
Behrman RE (Ed.): Nelsons Textbook of Paediatrics
Algranati P: The Paediatric Patient: An A istory and Examination. 1992,
ilkins
Hay WW, Groothuis JR, Hayward AR, Le trics Diagnosis &
Treatment, Appleton & Lange
Siberry GK, Iannone R: The Harriet Lane Handbook Ed., 2000, Mosby
Paediatrics in Review Journa
urnals:
aediatrics in Review, Paediatric Clinics of North America, Archives of Diseases in
h dical Journal, Lancet, New England Journal of
, Saunders
pproach to H
Williams & W
vin MJ: Current Pedia
Child ood, Paediatrics, British Me
5.0 OBSTETRICS & GYNAECOLOGY
The candidate is expected to demonstrate competence in knowledge, understanding,
clinical evaluation and relevant procedural competences in the following Obstetrics and
Gynaecological discip
cal Problem List
5.1 Core Obstetric Clini
Clinical anatomy of the pelvis
Pelvimetry
Preterm labour and delivery
Prolonged pregnancy and management
rinciples of Preconception care P
Optimization of maternal health status - folic acid supplementation, correction of
anaemia, control of diabetes mellitus
Screening for comorbid conditions
Causes and management of recurrent miscarriage
First and second trimester screening for fetal anomalies
o Serum
o Ultrasonography
Invasive procedures for antenatal diagnosis
Critical evaluation of the Obstetric examination
o Maternal and fetal parameters
o Calculation of gestational age
Assessment of fetal well-being
Role of ultrasonography in obstetrics
Management of fetal distress
Determinants of fetal growth
o Indirect Methods
o Direct methods
Fetal growth disorders
o Causes and management of small for gestational age fetuses
o Causes and management of large for gestational age fetuses
Diagnosis and management of multiple pregnancies
Management of Rhesus negative mother
Management of Rhesus isoimmunization
Non-immune and immune causes of fetal hydrops and management
Amniotic Fluid
o Causes and management of polyhydramnios and oligohydramnios
Management of prelabour rupture of membranes
Causation and management antepartum and postpartum haemorrhage
Causes and management of infections in pregnancy
o TORCH infections
ns in pregnancy: hepatitis virus
infection, herpes virus infection, cytomegalovirus, human papilloma virus,
easles, mumps, rubella, varicella and
an immunodeficiency virus infection
Int a
o Management of common viral infectio
adenovirus, coxsackie virus, m
rap rtum Management
of maternal and fetal well being Assessment
f normal labour and delivery
o Indications, methods, management and complications of induction of
Diagnosis and management o
o Stages of labour
Management of failure to progress
Protraction and arrest disorders
ntations and malpositions Management of unstable lie, malprese
Precipitate labour
nal delivery
o Caesarean section
Operative deliveries
o Assisted vagi
Vaginal birth after caesarean section
Pos a t P rtum
Pro m third stage of labour ble s of the
o Postpartum haemorrhage
o Uterine inversion
o Retained placenta
Cau epsis ses and management of puerperal s
Principles of breast feeding
Me a
Ma rders in pregnancy
Resuscitation of the newborn
dic l conditions
nagement of common medical diso
obinopathies Sickle cell disease, thalassemia
matological disorders
o Anaemia in preg
Haemogl
Nutritional Iron deficiency, folate, B12 deficiency
Thrombocytopenia in pregnancy
Collagen Vascular disorders
Cardiac disease in pregnancy
Hypertensive disorders of pregnancy
Respiratory disorders in pregnancy
ers in pregnancy Endocrine disord
o Diabetes Mellitus: Pregestational, Gestational
o Thyroid disease
o Pituitary and adrenal disease
Hepatic and Gastrointestinal disease
Renal disease in Pregnancy
Neu l ro ogical disorders in pregnancy
Malignant disease in pregnancy
Psychiatric disorders in pregnancy
Substan
entification a
stetric haemorrhage
intravascular coagulation
ce abuse in pregnancy
nd management of obstetric emergencies Id
Management of the major ob
Management of disseminated
Practical Procedures in Obstetrics
Abdom n of
inal examination using Leopolds manoeuvres and vaginal examinatio
ob tetric patient
Insertion of cervical cerclage
cervix and vagina Repair of episiotomy, lacerations to
Interpretation of cardiotocograph
Interpretation of the partogram
ewborn
5.3 Core Gynaecology Clinical Problem List
YNAECOLOGY
Gen a
Resuscitation of the n
er l Gynaecology
Dia ign conditions- fibroids, endometriosis, ovarian
gnosis and management of ben
Ma ammatory disease nagement of pelvic infl
Management of abnormal uterine bleeding
prolapse Management of uterovaginal
Management of menopause
Diagnosis and management of ectopic pregnancies
Diagnosis and management of sexually transmitted diseases
Common adolescent gynaecological problems
Management of hirsuitism
bosis Man e ag ment of deep vein throm
Principles of preoperative surgical management
Post operat iv e complications in common gynaecological procedures
On o col gy
dnexal masses Principles of management of a
gynaecological malignancies: uterine, ovarian, Diagnosis and management of
cervical, vagina, vulval
astic disease
Infertility a
Management of gestational trophobl
nd Reproductive Endocrinology
Dis e ord rs of puberty
ycle Physiology of the normal menstrual c
y amenorrhoea Management of primary and secondar
enstrual dysfunction
Management of endocrinopathies causing m
Hyperprolactinaemia o
Polycystic ovarian syndro o m
e infertile couple Investigation and management of th
rsible vs. permanent methods) Methods of Contraception (reve
Minimally invasive surgical techniques
Causes and Management of chronic pelvic pain
Assisted reproduction treatments
o Intrauterine insemination
Uro n
o In-vitro fertilization techniques
aecology gy
Classification and diagnosis of urinary incontinence
e Management of stress incontinenc
ce Management of urge incontinen
5.4 Practical Procedures in Gynaecology
Cervical cytological screening
Dilatation and curettage
Marsupialization
Interpretation of hysterosalpingogram
5.5 l resources
Ob tr
Gy c
Tex o
Bas G
OB Y
Usefu
ste ics by Ten Teachers
nae ology by Ten Teachers
tb ok of Obstetrics by Roopnarinesingh
tb ok of Gynaecology by Roopnarinesingh
ic ynaecology by Ramsewak
/G N Secrets by Fredericjson WilkinsHaug
ste ics Illustrated
nae ology Illustrated
6.0 COMMUNITY HEALTH
The candidate is expected to integrate and apply the appropriate knowledge and skills in
add s the individual in the ambulatory
are setting.
Can d
f individuals
s seen in an
counsel persons in individual and
health promotion principles,
4. dem s ctice medicine in a patient-centred manner
integrating preventive and curative approaches;
personal, social and environmental conditions existing in a particular
ay contribute to ill-health.
7.2 ives
Am l
res ing community health problems and in caring for
di ates should be able to:
1. develop and effectively communicate plans for solving problems o
and m setting; fa ilies in a community
2. trea e of common problem
ambulatory setting;
t effectively and efficiently a rang
3. demonstrate the competence to teach and
community settings using counselling skills and
strategies and techniques;
on trate the confidence to pra
5. identify the
community which m
Core Community Health Educational Object
bu atory Care
recognise the value of the team approach in Primary Care
the individuals problems use the holistic approach in the management of
recognize disease processes in their early or latent phases
mmon health problems seen in an ambulatory effectively manage a range of co
-oriented approach to patient care in a manner suited to the
re setting in which doctor-patient interaction time is often limited
utilize the problem
ambulatory ca
cho-social factors on the health of the
general population
appreciate the significant impact of psy
ounselling and health promotion in ambulatory care appropriately utilize c
Ambulatory Therapeutics
become familiar with the pharmaceutical
available drug formularies
agents commonly used in ambulatory
(eg MIMS and The British National care and with
Formulary)
be able to write appropriate prescriptions for use in the ambulatory care setting
apply knowledge to the specific treatment of common ambulatory care problems
while bearing costs in mind
recognize important similarities and differences in drug utilization in the
ambulatory versus the hospital setting
explain and justify strategies for increasing patient compliance in the ambulatory
recognize and use where appropriate the non-drug aspects of therapeutics to the
benefit of the patient
become familiar with the range of emergencies common to the ambulatory care
apply the principles of triage, resuscitation and first aid to these common
apply knowledge from other areas of the medical curriculum to the management
of common emergencies
recognize the need, where applicable, for referral to a secondary care unit and
make an appropriate referral
Social Issues in Patient Management
recognize the patient with social problems
recognize the role of the Social Worker as part of the health team
counsel patients appropriately and recommend practical solutions to common
demonstrate the use of correct referral procedures to counselling and social
discuss the use of social science behaviour change theories in improving patient
Management of Diabetes and Hypertension
discuss risk factors for diabetes and hypertension
discuss early recognition, diagnosis and management of patients with diabetes and
demonstrate the examination, investigation, management of ambulatory patients
with diabetes and or hypertension
be able to recognize end organ damage in patients with diabetes and or
demonstrate the appropriate use of lifestyle changes and or medication in the
management of patients with diabetes and or hypertension
accurately identify:
o the prim ical manifestations of STIs which cause
lar rashes or warts
o other common skin rashes caused by STIs
ary external clin
ulcerations, vesicu
describe normal and abnormal discharges from the male and female genitalia
discuss management plans for male and female patients with suspected STIs
counsel appropriately:-
o someone who is requesting an HIV antibody test,
o someone whose HIV antibody test is confirmed to be positive
say how you would elicit (directly or indirectly) specific information about the
sexual contacts of an index case of STI
elicit in a simulated or real situation the essential elements of a patients sexual
write appropriate prescriptions for patients with common STIs
for health promotion activities and define the role of the
physician in the process
interpret framework
integrate concepts and practice relevant to health, wellness and fitness in
managing patients and community problems
tegies to health issues stated in the Caribbean Charter
The Bu
apply health promotion stra
for Health Promotion document
rden of Chronic Diseases
describe the epidemiology of chronic diseases
ity and mortality discuss the impact of chronic diseases in morbid
interpret the economic impact of chronic diseases
and Obesity
develop and implement a rational approach to the control of
Nutrition, Health
isease appreciate the role of nutrition and exercise in health and d
relate obesity as a health risk in patient care
apply an approach to the patient who needs to lose weight
identify and carry out duties and obligations of physician to patient
identify the duties and obligations of physician to colleagues
Me o
identify the duties and obligations of physicians in general and to society
dic -legal considerations
tion of the following in delivery of
patient care: negligence, consent, record keeping/disclosure of records,
confidentiality and communication.
appreciate the significance of and applica
identify the role and functions of the Registrar General Office
petence in filling out forms for vital registration (Birth, death develop com
certificate etc)
to appreciate the value of accuracy for statistical and epidemiological purposes
7.0 PSYCHIATRY
7.1 Ge r
Candidates o g a psychiatric history and
per m
inv ig andidates should utilize a holistic and multidisciplinary
approach to e emonstrate an
understand effectively
on l
nowledge in the following areas:
ne al Principles
sh uld demonstrate the essential skills for takin
for ing a mental status examination. They should show competence in making
m n psychiatric diagnoses and in making appropriate recommendations for
est ations and treatment. C
th practice of psychiatry. To this end, they should d
ing of Bio-Psycho-Social principles and should be able to function
mu ti-disciplinary teams comprised of various health professionals and allied staff.
Specific Areas of Competence
di ates should be able to demonstrate:
ing (the list is not exhaustive and is
menology
cence
er Cognitive Disorders
sychotic Disorders
o Mood Disorders Depressive Disorders & Bipolar Disorders
Effective level of knowledge and understand
not meant to be exclusive)-
o Psychiatric pheno
o Disorders usually first diagnosed in Infancy, Childhood, or Adoles
o Delirium, Dementia, Amnestic and oth
o Substance-Related Disorders
o Schizophrenia and other P
o Anxiety Disorders
o Common drugs used in Psychiatry
The Mental Health Referral System o
Suicide and Para suicide o
Child Abuse o
o Rape
Basic knowledge and understanding (the list is not exhaustive and is not meant to
exual and Gender Identity Disorders
o rders
o Psychotherapy and Case Formulation
o Psychological Assessment
o Mental Health Services in the Caribbean
be exclusive)-
o Personality Disorders
o Somatoform Disorders
o Factitious Disorders
Eating Diso
o Sleep Disorders
o Impulse-Control Disorders
o Adjustment Disorders
Clinical skills as follows:
To elicit a history that is relevant, accurate and appropriate to the patients
status examination To conduct a comprehensive mental
To formulate differential and working diagnoses for patients seen
To use a multiaxial diagnostic system such as the one used in the Diagnostic and
Statistical Manual of Mental Disorders
To demonstrate an ability to initiate appropriate investigations of different
psychiatric disorders and interpret results in the context of the specific clini
biopsychosocial model
To demonstrate an ability to plan psychiatric treatment using the integrated
To explain and discuss the diagnosis and treatment with the patient and family
To work within a multidisciplinary health care team including psychiatric nurses,
social workers, psychologists and occupational therapists
To demonstrate a basic ability to establish appropriate psychotherapeutic
relationships with patients
To demonstrate a basic knowledge of groups of drugs commonly used in
psychiatry, e.g. dosage, therapeutic effects, side effects, length of treatment and
factors influencing the choice of a particular drug
To demonstrate knowledge of psychological treatments such as supportive and
insight-oriented psychodynamic psychotherapy, behavioural therapy, cognitive
therapy, hypnosis and biofeedback
Appropriate attitudes as follows:
Maintaining a professional non-judgemental attitude, and showing respect for
their patients
Respecting the confidentiality of information provided by the patient
Identifying important ethical issues relevant to the patient and his/her family
Valuing the importance of multidisciplinary teamwork
Valuing constructive, non-judgmental evaluation by clinical supervisors, along
with peer evaluation and self-evaluation
8.0 SURGERY
l competences in the following surgical disciplines. evaluation and relevant procedura
8.1 Core Clinical Problems List*
General Surgery Topics
Thyroid and parathyroid abnormalities
Peripheral arterial disease, venous disease and aneurysms
Biliary tract disease
Pancreatitis and pancreatic cancer
Peptic ulcer disease and gastric cancer
Colonic cancer, Inflammatory bowel disease and diverticulitis
Paedi
Perianal disorders (haemorroids, fistulas, fissures and abscesses)
atric Surgery
Abdominal masses (including Wilms tumour and neuroblastoma)
Pae t orsion of
test a
dia ric surgical emergencies (including volvulus, intussusception, t
es, ppendicitis)
Com o ias,
Orthopae
m n congenital problems of surgical significance (including hern
escended testis and posterion urethral valves)
dics
Prin tures ciples of management of frac
Prin ment of benign and malignant bone tumours ciples of manage
Principles of management of degenerative joint disease
Principles of management of bone and joint infections
Hae ary retention maturia/ Stone disease/ Urin
Gen u
Cardioth a
ito rinary neoplasms including prostate
or cic
Dysphagia (including oesophageal cancer and achalasia
Che t st rauma/ Lung cancer
y/ Spinal syndromes Head injur
Cerebral Tumours/ Cerebrovascular disease
An s
Congenital Neurosurgical Problems
ae thesia
Management of upper airway obstruction
Discuss & demonstrate rapid sequence intubation
Care of the unconscious patient
Cardio-pulmonary resuscitation and its end-points ( including vital signs, urine
output, CVP, ABG )
Common anaethetic drugs (including analgesics)
nd Ophthalmology
T a
aring Investigations and management common problems encountered such as he
loss, ear discharge, epistaxis, hoarseness and neoplasms of this region
Principles of management of eye trauma
Principles of management of sudden or gradual loss of vision
Management of the red eye
ustive
N. B w rgical Diseases
Rus l,
Management of foreign body in eyes, ear, nose
* This list is not meant to be exha
ro se: Browses Introduction to Symptoms and Signs of Su
se Williams and Bulstrode: Bailey and Loves Short Practice of Surgery
9.0 APPENDIX
PRACTICE Extended Matching Questions (EMQs)
THEME: DYSPNOEA
A. Pulmonary Embolism D. Asthma G. Pleural effusion
E. COPD H. Pneumothorax
C. Pulmonary Fibrosis F. Pneumonia I. Tuberculosis.
For c s below. Each
1. ezing. PFTs
s). H s actual FVC was 3.8 litres. The
. A 50 - year old female one week post chemotherapy in hospital presents with a
3. ma,
trachea. His CXRay is
abnormal.
4. RNP
2 on room air
eard.
. A 25 - year old male with oral candidiasis and a history of weight loss of some
B. PCP
se the most likely option for the problem ea h options above, choo
ion may be used once, more than once or not at all.
A 45 - year old male, a previous smoker presents with SOB and whe
FEV1.0 of 2.52 litres (Predicted 3.4 litre i
predicted was 4.0 litres. His DLCO was Normal.
high fever, cough and respiratory distress.
A 15 - year old male with a history of amputation a year ago for osteosarco
presents with SOB. Examination shows a deviated
A 45 - year old female with SOB known to be ANA positive, anti
noea. SaO positive for about 5 years. Presents with worsening dysp
h was 88%. On auscultation, coarse bibasal crackles are
fifteen pounds associated with fever and haemoptysis.
PRACTICE EMQS
ctoris D. Pericarditis G. Aortic dissection
ster E. Oesophagitis H. Costochondritis
bolism I. Fibrocystic disease.
after moving to her new house. Physical examination
al edge on palpation.
. e retrosternal chest pain at
nights. Pains are severe on lying flat and worse after a heavy meal, and taking
ith a low grade fever, and band like chest pain quite
nature. Localized to a band just below the sternal angle.
No radiation.
5. A 55 - year old male brought to A&E found collapsed in his office.
Significant findings on examination - peripheral cyanosis, PaO2 of 80% on room
air. ABG shows a pO2 of 50 mmHg, pCO2 of 25 mmHg, pH of 7.47, HCO3 -
of 22mols/l.
EME: CHEST PAIN
A. Angina Pe
B. Herpes Zo
C. Pneumonia F. Pulmonary em
A 50 - year old housewife with no history of any chronic illnesses, complains of
chest pains one week
unremarkable, other than tenderness along the stern
A 24 - year old female with a history of chest pain associated with SOB
worse when lying flat. CXRay shows a globular heart. 12 lead ECG is
voltage with diffuse ST elevation.
3 A 46 - year old diabetic businessman with sever
a few drinks with his friends.
4. A 60 - year old male w
severe and burning in
PRACTICE MCQs
ll the followin pt:
(a) Migratory polyarthritis
d es.
etence except:
(d) Austin Flint murmur
(e) Duroziezs sign.
(a) oxin
(b) Amiodarone
(c) Lignocaine
A g are major criteria to diagnose acute Rheumatic fever exce
(b) Sydenhams chorea
(c) Erythema nodosum
(d) Carditis
e) Subcutaneous no ul (
ll the following may be associated with aortic incomp A
Displaced apex beat
Corrigans pulse
Opening snap
All the following may be used to treat atrial fibrillation except:
Calcium channel blockers.
select one answer only.
) Prophylaxis against opportunistic infections is advised when the CD4 count falls
b) 300 cells / mm
c) 250 cells / mm
d) 200 cells / mm
Answe
b) anti-nuclear antibody
c) anti-cardiolipin antibody
d) C
a) bladder squamous cell carcinoma
tional cell bladder carcinoma
Answer: e
In these questions, candidates must
a) 500 cells / mm
e) 100 cells / mm
r: d
2) The most useful initial test for SLE is:
a) anti-ds DNA antibody
e) anti-extractable nuclear antigen (ENA) antibody
r: b
The most common cause of painless frank haematuria in male patients over 50
years is:
b) carcinoma of the prostrate
c) hypernephroma
d) transitional cell carcinoma of the kidney
e) transi
SHOR ONS
40Kg. On post admission ward round, he is noted to be very drowsy and difficult to
use. An ABG is done and comes back with the following results:
pO 48 0 mmHg, HCO3 = 34 mols/l, pH = 7.31
What is your diagnosis based on this ABG?
T ANSWER QUESTI
A forty year old obese truck driver is admitted to the medical wards. He weighs
2 = mmHg, pCO2 = 12
List e (3 is problem?
thre ) possible causes of th
What other complications may you expect in this patient?
List 4 investigations you would carry out:
SAMPLE EXAMINAT
MCQ (Choose the single correct answer)
ffusion from other
Decreased breath sounds
Absent breath sounds
Bronchial breath sounds
2. Hae
resence of > 1+ blood on dipstick analysis of urine
resence of any blood on dipstick analysis of urine
c. the presence of red cell casts on microscopy
d. the presence of > 5 red cells per high power field
e. ylic acid test on urine
3. A 10 m with a five day history of high fever and a 2 day
hist lity. On the morning of presentation he develops
jerky m his childs seizures are most likely due to
a. feb
b. me
c. seiz
um abnormality
n abscess
uestions 4-6 relate to the following vignette:
about his development. He is not able to sit up and is not babbling. On motor
examin rky movements of proximal limbs and
twistin tongue. The tone is increased, with
reduced power and hyperreflexia in all groups.
4. The to determine the likely cause of
ily history of mental retardation
history of asphyxia
c. past medical history of meningitis
d. neonatal history of blood group incompatibility
e. antenatal history of maternal infections
5. The likely site of the lesion is
a. The anterior horn
ION QUESTIONS
1. The following clinical finding distinguishes pleural e
pathological processes which may occur in the lung or pleural space
a. Tachypnoea
c. y dullness
maturia is defined as
a. the p
b. the p
the presence of a positive Sulphur salic
onth old infant presents
i ory of vomiting and irritab
ovements of all 4 limbs. T
n n rile co vulsio s
ningitis
ure disorder
d. sodi
e. brai
0 month old infant is referred to neurology clinic because of mothers concern
ation he is found to have involuntary je
rotrude g of mouth with a tendency to p
m st important aspect of the history re
problem is
o quired
a. fam
b. birth
b. The posterior horn
c. The thalamus
d. The basal ganglia
a. features of mental retardation
c. global delay
d. global regression
NSWERS
.c, 2d, 3b, 4d, 5d, 6e
. SAMPLE TEST QUESTIONS
. SHORT ANSWER QUESTIONS
. A 22 year old female presents at your clinic with a history of a white vaginal
ischarge that is itching and occurring soon after her menses.
hat would you prescribe for her for this condition?
. A 35 year old female presents for a check up. She is found to have pale mucous
y other than diet that you would probe initially based on this
nding.
. The following lab results are obtained for a 72 year old slim female who you are
eing for the first time at your health centre:
BS 11.2 mmol/L and 2Hr pp blood glucose 14.3 mmol/L
oice for treating this patient.
tate one other lab investigation (blood tests) that you would like to order for this patient
nd give a short rationale for doing so.
e. The cerebellum
6. From the information given, this child demonstrates
b. selective regression
e. selective delay
membranes.
List one aspect of her histor
List one drug that you would be your first ch
B. MULTIPLE CHOICE QUESTIONS
1. following
EXC P
a. isease c ctly leading to death
b. signific o death
c. the date on which the patient passed away
d. the occ ased
e. the reg hysician
2. o empathetic response to a
Doctor, I dont know what to do again but this pain in my back has stopped me from
b. h
c. Th
e. edication
3. T ition in the Caribbean refers to:
ases than infectious diseases
e. T
The following conditions are skin problem
5. h
6. herpes zoster
The physicians task of writing a death certificate involves listing all of the
E T:
d or ondition dire
ant condition(s) contributing t
upational status of the dece
istered qualifications of the p
Ch ose from the options below what would be your best
ent who says:
king for more than a week now.
a I see what you mean.
W ere exactly is the pain?
at must be difficult for you!
rk is piling up! So it means all your wo
Well I could give you a stronger pain m
he epidemiological trans
a. The fact that there are now more chronic dise
. The fact that there are more epidemics now than ever before b
c substantial change in the pattern of disease over time
The fact that the populations is ageing rapidly
he fact that there has been a large reduction in the burden of disease overall
EXTENDED MATCHING QUESTIONS C
s that can be seen in a primary care setting:
cabies
p to ic eczema
p er es simplex
Match one of the above conditions with one of the following scenarios by entering the
relevant number at the end of the scenario. A condition can only be used once.
a. es not feel well and has a low grade fever and headaches. She
otes a few tiny blisters on different parts of her chest. ____
b. tory of rash all over her body which almost looks in
par i as not responded to known effective ringworm treatment.
c. itchy bumps in the groin and buttocks area. Itching is worse at
ights. ____
estions:
Fluconazole 150 mg stat or any other appropriate
f vaginal candidiasis.
be an option.
E CHOICE
eek history of onset of a mildly
B. Seborrhoeic dermatitis
C. sea
D. topic dermatitis
20 yr old female do
17 yr old female with a 2 week his
ts l ke ring worm but h
12 yr old male with
Answers to sample qu
A. SHORT ANSWER
. Clotrimazole pessaries and cream or 1
antifungal regime used in the treatment o
2. Menstrual history is the most obvious aspect to history for initial probing.
. A sulfonylurea such as glibenclamide. Metformin will also 3
Lipid profile this can be impaired in diabetics and also poses an additional risk for
nwanted outcomes. u
or assessment of renal function (BUN, creatinine, electrolytes) as this assesses status of
one of the end organs for damage from diabetes mellitus.
. MULTIPL B
1. d
EXTENDED MATCHING C.
SAMPLE MULTIPLE CHOICE QUESTIONS
. An otherwise well 12-year old boy presents with a 2-w 1
pruritic rash involving his trunk and proximal limbs. The lesions are oval shaped or
annular papules or plaques with peripheral scales.
The most likely diagnosis is:
A. Acute tinea corporis
Pityriasis ro
he age of the boy makes pityriasis rosea likely. The relatively rapid onset and the
quite uncommon and with such rapid onset would suggest an underlying
lness. The distribution is not in keeping with seborrhoeic dermatitis or atopic dermatitis.
ring disorders:
ly to moderate doses of oral corticosteroids.
nse intact blisters.
C. Bullous pemphigoid has a predilection for the face and trunk.
D. Bullous pemphigoid affects the oral cavity in over 50% of cases.
emphigus vulgaris usually requires high doses of corticosteroids for control and even
ement of the face is rare. Involvement of the oral
in bullous pemphigoid and may indicate an underlying
iaceus rarely presents with intact blisters as the split in the
anular layer. Blisters, therefore, are flaccid and rupture
distribution and types of lesion are all in keeping with pityriasis rosea. Generalized tinea
corporis is
2. The following statement is true regarding bliste
A. Pemphigus vulgaris responds prompt
B. Pemphigus foliaceus rarely presents with te
then usually responds slowly. Bullous pemphigoid has a predilection for the limbs and in
severe cases involves the trunk. Involv
cavity is also uncommon
malignancy. Pemphigus fol
skin occurs superficially in the gr
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text:
The Piscataqua Press
Aggie Moresey: Water and Stone
Francoise Jean
You've never met a girl quite like Aggie before. Life hasn't been easy for her, but Aggie has a special optimism and intelligence that makes every thing seem possible, for her and for those around her. But it's more than just a sunny disposition. Aggie is truly different. Is it her Nativbe American ancestry? Maybe. Living in the city Aggie hasn't had much chance to explore her roots, but now that she and her mother have fled the city for a small New England town, old truths, strange dreams, and new talents come to light.
Follow Aggie as she finds excitement, mystery, and magic.
Note: This book comes in two volumes, sold separately.
Part One: $19.99 plus $3 shipping
Part Two: $17.99 plus $3 shipping
© 2020 The Piscataqua Press

redpajama_set_name: RedPajamaCommonCrawl


39 EBEN X "I am the great grandson of Malcolm X, I will never trust a white man." MR. X. "I did this, I sowed this seed...may I talk to him?" HEAD COUNSELOR "If he wishes..." EBEN X "He can talk to me...I want to talk to him." Malcolm approaches...they go off to the right side of the stage. MR. LINCOLN "Sowing seeds of hate and to be silent in the face of prejudice, reminds me much of those Mexican jumping beans that I played with as a child, they were never quite dead or without life." Voice interrupting...the static of a mike...begin tapped by giners...then... VOICE (off stage--series, echo cahmber--thrundering through the hollowness) "Hear this! Hear this! All you who are dead and those who have died the death." Spotlight begins to sweep around with a small spot...hunting...suspense...the spectators are left, the council center and Malcom and Eben X right. 2ND SPECTATOR (speaking after search light finds them) "It's Mr. Death's Assistant. I've never like him. He tries to be funny, treating death, like the dead are insensitive and don't yearn to live. Like...like it's a natural occurence, without design.


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Spectacular new construction, March of Anger and Linky is on its way.
By Ab Kuijer in Blog with 0 Comments
This week, everyone on Earth was a little tense; would humanity succeed to land on Mars? In Nice more than eight hundred stars stargazing experts gathered together to watch the landing live together with local dignitaries on a big screen. If it could happen, it would completely change our lives. I was watching the landing on National Geographic TV. Unfortunately nothing changed on Mars. But in Nice, on the French Riviera things are getting really spectacular with real estate.
This week the city unveiled plans for a spectacular new building between the Nice train station and the longest shopping street; the Rue Jean Medicin. The museum like building over 19,000 M2 offers apartments, shops, offices and a theater with six hundred places. The important thing is that the ugly and old corner is going to be a young and dynamic neighborhood.
And so something beautiful is happening on the Côte d'Azur, though the police in Nice disagrees on that topic. They feel their work is no fun anymore due to the heavy load caused by additional security work. In addition, they find low appreciation by the government. You saw it coming; the police wants more money and so there was a demonstration. There even comes a 'March of Anger' on oktober 26th. You be warned, like the migrants that started a refugee camp in Saint Dalmas de Tende, above Nice, to the Italian border. Within three days the new camp was dismantled and African migrants brought back across the border to Italy.
Another border was crossed by local soccer team OCG Nice to play football against Salzburg. Without Mario Balotelli, Salzurg was beaten 1-0 in front of 1,500 fans Niçoise. That result will go down as true history.
Historic is also the intervention of the Prefecture at municipality Tourettes sur Loup. The opposition wanted to publish a map where risk areas are indicated in case of flooding. Through years of construction without thinking about stormwater management, some areas are dangerous with much rainfall. However, the prefecture decided that 'the people' should not get that much insight into this dangerous information. Dangerous for the value of the house and grounds and the image of the Cote d'Azur.
Angelina Jolie and Brad Pitt do not have to think about reputational damage; they have something else on their minds; to sell the Pitt-Jolie French Riviera property now. Over 35 rooms and 45 hectares of vineyard for your own wine come are suddenly within reach. Ordinary mortals will not have sixty million to spend, but if you can and have always dreamed of a private vineyard, you can call us for a tour on the domain.
Finally, still an innovative landing, this time in our technical cupboard. Throughout France, all electricity meters are replaced by Linky; a smarter version where you as a user unfortunately can do nothing inter-active such as light commands with your phone. Such luxury is not for us citizens to have. But for France in general, Linky is a big step forward to modernisation. Mars can wait a while; we have Linky!
Fun events to do on the Côte d'Azur
In addition to a weekly look back, we offer now a preview on the calendar.
Salon de Vin et Gastronomie
Antibes – 28, 29 and 30 October
Open daily from 10:00 to 19:00.
Location Azur Arena. Admission 5 euros including a glass of wine.
La Grande Braderie de St. Tropez
The entire village and surrounding area has emptied their attics for the annual flea market. Conviviality for a whole day.
Free entrance.
brad pitt angelina jolie,
braderie de st tropez,
linky,
nice thiers,
Ab Kuijer
Experienced communicator and marketeer. Former radio, TV and advertising producer in Amsterdam. Author of 'Think Small, Grow Big' that explains why advertising is dead. Owner of an international marketing agency specialised in real estate. Lives in the South of France since 2006 for obvious reasons: sun, sea, wine and healthy food. Became on the Cote d'Azur the first Dutch President of the British Chamber of Commerce, later rebranded the Riviera Business Club. Happily married to Jojo. Ab reads and writes 2000 words per day about different topics.Living on the Côte d'Azur is the first real estate portal with a personal service. A daily fresh collection of more than 1400 high-value luxury properties and new construction projects along the French Riviera; from Menton to Saint Tropez. Clients recommend us for being responsive, professional, honest and accurate.With local multi-lingual teams, Living on the Côte d'Azur provides a 'Good old Dutch' Service for foreign buyers, helping them on the journey from a long-list selection towards visiting the short-list. We explain how French real estate law works, and guide the buyers through the impressive French paperwork and are finally present at the notary for the final deed.
Running a business on the Côte d'Azur: Peter and Elsie de Mik in Nice
French Riviera news: windfalls, name buying and houses rebound.
Search for sunny properties
Our latest real estate under the sun


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Dustin Guy Defa is an American independent filmmaker and actor. He is best known for directing the feature films Bad Fever and Person to Person and writing the screenplay for The Mountain.

Early Life

Dustin Guy Defa was born in Salt Lake City, Utah in 1978.

Career
Defa wrote and directed his first feature film Bad Fever in 2011. It starred Kentucker Audley and Eleonore Hendricks and focused on the story of a socially inept wannabe stand up comic who becomes infatuated with a drifter he meets outside of a gas station. The film premiered at South by Southwest to positive reviews, commending the film's paired down naturalism and the direction of the actors.

The New Yorker'''s Richard Brody praised the film, saying "Defa exerts delicate control over his incendiary material and evokes emotional terrors with a sympathetic directness; his raw-toned drama is quietly hectic and brutally poignant."

Defa then made two short films, Person to Person and Family Nightmare which both premiered at the Sundance Film Festival

In 2015, the Film Society of Lincoln Center programmed a retrospective of his short work.

Defa wrote a screenplay for a feature length version of Person to Person. The film follows a series of characters living in New York City as they navigate a myriad of complex human relationships. He cast actors including Abbi Jacobson, Michael Cera, Tavi Gevinson, Philip Baker Hall and director Josh Safdie to fill in the ensemble cast. The film premiered in the NEXT Section at the 2017 Sundance Film Festival and later had a full theatrical run.

In 2018, Defa co-wrote the subversive 1950's period film The Mountain with director Rick Alverson and Colm O'Leary.

In 2023, he directed a film The Adults, which was screened in Encounter at the 73rd Berlin International Film Festival, for its world premiere on 18 February 2023.

 Acting
Defa acted in the feature films Computer Chess, Summer of Blood, Swim Little Fish Swim, and the TV show Easy.

He did the voiceover for the short film Family Tree.Starting in 2015, Defa began to portray the character of Aziz on The Show About the Show.
Filmography

 2011 - Family Nightmare; short film
 2012 - Bad Fever
 2013 - The Sixth Year; segment director
 2013 - Declaration of War; short film
 2013 - Lydia Hoffman Lydia Hofman; short film
 2014 - Person to Person; short film
 2015 - Review; short film
 2015 - God Is an Artist; short film
 2016 - Dramatic Relationships; short film
 2017 - Person to Person 2021 - Editing; short film
 2023 - The Adults'' (director)

References

External links

1978 births
American filmmakers
Living people

redpajama_set_name: RedPajamaWikipedia


I had always done this particular silhouette only in pastels, so doing this one in black was interesting for me. I get a whole new perspective on it—and I like it!
How many "tools" do you use in cutting these ? Love them.
Just a small pair of Gingher scissors. They have very sharp pointed blades. I'll try to show a photo of them next time. I did try an Exacto knife one time, but couldn't get the hang of it. Kept ripping the paper, so I stuck with the scissors.
Wonderful. I could never get the hang of simple people chains!
I can't wait for next time because I can't imagine how you get the hair cuts, the little clown. I'm sure that if I tried it they'd all have pumpkin heads. This one is charming!


Sergei Eisenstein's classic epic commissioned in 1927 to celebrate the 10th anniversary of the Russian Revolution, uses montage and a documentary style to present the events of the Bolshevik uprising in 1917.
Original silent film presentation on rare a 35mm print (with thanks to Contemporary Films) with piano accompaniment. We are delighted to welcome back silent pianist expert John Sweeney who gave us an exciting piano accompaniment for Eisenstein's 'Battleship Potemkin' in St Johns Chapel in 2015. Expect more fireworks!


My training in insulation and power conservation came from the very cold northern New York. The concept was always to maintain the warmth in. Now that I reside in Central Florida the goal is reversed and remaining awesome – keeping the heat out – is paramount.
Get plenty of air flow. Open up windows and doors and blow followers on the moist area till the walls are dry. Just be careful about plugging in electrical appliances close to drinking water. Also run the air conditioner in the summer.
Heat pumps have an advantage more than all other types of heating such as gasoline, oil, coal, log burners, open up fires and electrical energy in that they do not need heating components to produce heat. These all burn power to produce heat with varying levels of efficiency. Heat pumps only need enough energy to operate the warmth transfer and heat air distribution process.
Unplug low voltage energy provides for cell telephones and digital appliances when not in use charging. Much of your electric power utilization really requires location when these appliances are not in use.
You can set up recessed fixtures sandwiched in between the ceiling joists of a new developing. You can do this even if a house is being majorly remodeled. You can obtain recessed fixtures that are meant for structures already in place. These fixtures can be slipped into the existing ceiling space, after creating holes to accommodate the wiring. The fixtures provided by us are IC housing rated, and so these can be utilized securely even when green batts australia is present. When your ceiling is not insulated, you can choose a non-IC housing rated fixture.
Since then we have listened to story following story of how radiant barrier lowers the temperature of a home throughout construction. We've listened to stories from framers where they would rather consume lunch within the house because it's cooler than outside. Even the framers operating next doorway eat lunch with them simply because it's cooler.
If your Scorching water tank is more mature or in an unheated region install an insulation jacket. These jackets can be purchased at home facilities and components shops.
The tips outlined in this article will give you an concept of how you can arrange your funds. It is important that you have contemporary, power-effective appliances. You can use these month-to-month financial savings to spend your other bills, open up a savings account or make other buys.


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Criminal Law A to Z
Crimes by NRS Section
In this section, our attorneys explain Nevada's criminal laws and legal concepts, A to Z
Nevada Crimes A to Z
Every crime in Nevada is based in a section of the Nevada Revised Statutes (NRS). For each crime, our attorneys explain the laws, penalties and best defenses to fight the charge.
Nevada Crimes by NRS Section
Nevada DUI
Getting arrested for DUI does not mean you will be convicted. Police misconduct, defective breathalyzers and crime lab mistakes may be enough to get your charges lessened or dismissed. Visit our page on Nevada DUI Laws to learn more.
Nevada DUI Laws A to Z
The DUI Court Process
Clearing a DUI Record
Even if you've already been convicted of a crime, there is still much you can do to seal your record and restore your rights. Our attorneys explain how.
Nevada Post-Conviction
Record Seals
NRS 207.190 – Nevada Coercion Laws
Las Vegas Criminal Defense Attorneys » Nevada Crimes by NRS Section » Coercion
Falsely Accused of Sexual Coercion in Nevada?
Under NRS 207.190, the Nevada crime of coercion is defined as intentionally using intimidation, deprivation, or violence to compel another person to do something that he or she is not legally obligated to do. Prosecutors may file this charge as a misdemeanor or a felony.
Coercion is a misdemeanor in Nevada as long as no physical force was used or threatened, carrying a penalty of:
up to six (6) months in jail, and/or
up to $1,000 in fines
But if the coercer did commit or threaten to use physical force, then it is prosecuted as a category B felony in Nevada. The penalty carries:
one to six (1 – 6) years in Nevada State Prison, and
possibly up to $5,000 in fines3
It may be possible to plea bargain coercion charges down to a dismissal or lesser charge. Common defenses include:
the defendant had no criminal intent;
the defendant was falsely accused; or
there was no coercion
In this article, our Las Vegas Nevada criminal defense attorneys discuss the following coercion topics:
2. Penalties
3. Defenses
4. Sealing criminal records
5. Immigration consequences
6. Related offenses
Coercion can be a misdemeanor or a felony in Nevada depending on whether force was used or threatened.
1. Legal Definition of "Coercion" in Nevada
The Nevada crime of coercion under NRS 207.190 occurs when a person intentionally tries to compel another person do something — or to refrain from doing something — by either:
being violent — or threatening violence — towards the person, his/her family, or property;
depriving the person of a tool, implement, or clothing; or
trying to intimidate the person through threats or force
In short, coercion consists of two elements:
the criminal intent to deprive someone of a right, and
a criminal act depriving someone of that right
Consequently, coercion covers a very broad spectrum of actions where one person bullies another person to make him/her do something — or not do something — that he/she does not legally have to do:1
An extreme example of coercion in Nevada is torturing someone until that person reveals information that the torturer is after: The victim has no legal obligation to tell the torturer anything, but the victim is being forced to with physical violence.
Another example is an ex-boyfriend refusing to give his ex-girlfriend her car keys back, preventing her from being able to drive away from him: The ex-girlfriend has every legal right to drive away, but the ex-boyfriend is stopping her by depriving her of the keys.
An example of "sexually-motivated" coercion is a CEO threatening to demote his administrative assistant unless the assistant sends a naked selfie: The administrative assistant has every legal right to abstain from sending compromising pictures, but the boss is compelling her to by threatening her livelihood.
Note that people accused of coercion may face additional charges as well depending on the facts of the case. For example, if John threatened Joe with a severe beating unless he stole a car for him — and Joe stole the car — then John would face charges for both coercion and the Nevada crime of auto-theft.
1.1. Coercion as a defense
Coercion is unique in that it is both a crime as well as a legal defense: If a coercion victim can show the court that he/she was coerced into engaging in criminal activity, he/she should not be convicted of carrying out that criminal activity.
The only exception is if the victim was coerced into committing the Nevada crime of murder: The law dictates that coercion victims should never kill, even under extreme duress by their coercer. However, coercion is a "mitigating circumstances" that could help a convicted murderer get a lesser sentence.2
2. Penalties for "Coercion" in Nevada
The punishment for the Nevada crime of coercion depends upon whether the defendant used force or the threat of immediate physical force. If there was none, then coercion is just a misdemeanor, carrying a sentence of:
But if the defendant did use or threaten the Nevada crime of battery, then coercion is a category B felony, carrying:
one to six (1 – 6) years in prison, and
Sexually-motivated coercion usually carries harsher penalties.
2.1. Sexually-motivated coercion
Courts may hold a separate hearing after a defendant is convicted of coercion to determine whether the coercion was sexually-motivated. During this hearing, the D.A. has the burden to prove beyond a reasonable doubt that the defendant's motivation was sexual. If the court finds that the coercion was sexually-motivated, the judge will impose a harsher sentence.4
Note that courts may not hold these hearings unless the D.A. gives the defendant notice at least 72 hours before the trial. If the D.A. fails to properly serve the defendant with notice, the final sentence will not reflect whether the coercion was sexually-motivated. Learn more about Nevada sex crimes.
3. Fighting "Coercion" charges in Nevada
There are many possible defense strategies to fight a coercion charge in Nevada. The following are just a few examples that could result in a coercion case getting thrown out or reduced to lesser charges.
Lack of intent: Coercion is an intent crime in Nevada because it requires that the defendant act knowingly and deliberately. If the prosecution cannot show that the defendant intended to deprive the alleged victim of the right to act — or not act — in a certain way, then the charges cannot be sustained. For example, eyewitnesses or recorded text communications may provide evidence of the defendant's lack of criminal intent.
False allegations: It is all too common for people to falsely accuse others of crimes out of jealousy, revenge, or mental illness. If the defense attorney can show that the accuser lied or that insufficient evidence exists to show the defendant committed coercion, then the case should be dismissed.
No assault or battery (in felony coercion cases): If the prosecution cannot prove that the defendant resorted to violence or violent threats to carry out the coercion, then the felony charge should be reduced to a misdemeanor. Or if the defendant used physical violence only in lawful self-defense in Nevada, then the felony charge should be reduced to a misdemeanor as well.
Sometimes innocent and legal acts can be misconstrued as coercion.
Another defense is to argue that what transpired did not rise to the level of coercion. Coercion is such a vague offense, and perhaps law enforcement simply misinterpreted the defendant's legal actions.
4. Sealing a "Coercion" case in Nevada
Misdemeanor coercion convictions can be sealed one (1) year after the case ends. Felony coercion convictions may be sealed five (5) years after the case ends. That is one reason why people charged with felony coercion are encouraged to hire counsel to try to get the charges reduced to a misdemeanor (if not dismissed).5
Note that coercion cases that get dismissed can be sealed right away.6 However, the record seal process itself takes several weeks. Learn more about sealing criminal records in Nevada.
5. Deportation from a "Coercion" case in Nevada
Coercion may be considered an aggravated felony or a crime involving moral turpitude.7 Therefore, non-citizens convicted of it may face deportation from the U.S.
Any immigrant charged with a crime in Nevada should retain experienced legal counsel to attempt to get his/her charges reduced to non-deportable crimes or dismissed. Visit our page on the criminal defense of aliens in Nevada to learn more.
6.1. Extortion (NRS 205.320)
Coercion is a separate crime from extortion, which is where the extorter is trying to get something of value.
The Nevada crime of extortion (a.k.a. blackmail) comprises situations where someone threatens someone else in order to procure something of value such as money or property. Extortion is a category B felony, typically carrying restitution payments as well as:
one to ten (1 – 10) years in prison, and/or
up to $10,000 in fines
6.2. Bribery (NRS 197; NRS 207)
Nevada bribery crimes occur when a person offers another person something of value in order to persuade him/her to do something for the briber in return. The penalties turn on the context, such as as if the bribery involved public officials, trial witnesses, or judicial officers. In many cases, bribery is a category C felony in Nevada, carrying restitution payments as well as:
one to five (1 – 5) years in prison, and
possibly up to $10,000 in fines
6.3. Harassment (NRS 200.571)
The Nevada crime of harassment is knowingly threatening someone else with harm so that the person reasonably fears that the threat will be carried out. A first offense that involves no cyber-harassment or fear of bodily harm is a misdemeanor, carrying:
Otherwise, harassment is a felony.
6.4. Dissuading a witness (NRS 199.230)
The Nevada crime of dissuading a witness occurs when a person tries to intimidate a witness from testifying in a case. If the defendant uses no physical force (or threats of immediate physical force), dissuading is a gross misdemeanor that carries:
up to 364 days in jail, and/or
Otherwise, dissuading is a category D felony in Nevada, carrying:
one to four (1 – 4) years in prison, and
possibly up to $5,000 in fines
Call our Las Vegas criminal defense attorneys for a FREE consultation today.
Call a Nevada criminal defense attorney…
If you have been arrested or have further questions, call our Las Vegas criminal defense lawyers to set up a free meeting on how we may be able to get your charges lessened or thrown out. We can usually achieve a favorable resolution through negotiation alone. But if necessary, we are prepared to take your case all the way to trial in pursuit of a not guilty verdict.
NRS 207.190
NRS 207.193 Coercion: Hearing to determine whether sexually motivated
Santana v. State, 122 Nev. 1458, 148 P.3d 741, 1462-1463 (2006)("[I]in determining whether a defendant has made an immediate threat of physical force under NRS 207.190, the inquiry must focus on the viewpoint of a reasonable person. Depending on that viewpoint, an immediate threat of physical force may exist even where the defendant is not presently able to carry out the threat. We add that while the jury can and should consider the testimony of victims, the jury remains responsible for determining whether the threat was immediate, future, or incapable of being performed."
NRS 179.245
See INA 212(a)(2)(a)(i) and 8 U.S. Code § 1101
Nevada Revised Statutes Blog Posts:
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What remedies do people have in Las Vegas when neighbors play music too loud?
Las Vegas residents whose neighbors play their music too loud can take various non-legal, criminal, or civil courses of action, discussed below. In any event, residents should compile evidence of the noisy music, such as: video and audio recordings of the music playing; contact information of other neighbors willing to testify as witnesses to the ...
What to Expect When You're Given Field Sobriety Tests in North Las Vegas, Nevada
If you are pulled over in North Las Vegas, Nevada and the officer suspects that you may be intoxicated, you will likely be asked to take a series of physical tests as the officer evaluates your condition. Field sobriety tests (FSTs), as they are known, are entirely subjective in that the determination as to whether you ...
Nevada Gun Laws in Car – What You Need to Know
Firearms are largely permitted in vehicles in Nevada, but CCW permits are still required for concealed carry, and long guns may not be loaded. Guns are also prohibited in the parking lots of public school grounds and federal properties such as post offices. Can I open carry in a car? Nevada is traditionally an open ...
LAS VEGAS DEFENSE GROUP
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We Can Help You Fight Back
Being accused of a crime, or arrested, does not necessarily mean you will be convicted. Our Las Vegas criminal defense lawyers have helped many people avoid conviction, avoid jail, and keep their records clean.
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text:
CHILDREN'S RIGHTS COUNCIL AGREES WITH POPE— LAWYERS SHOULD STAY OUT OF DIVORCE
For further information, contact Meghann Ellis, legislative assistant, at 202-547-6227
Washington, D.C. – Pope John Paul II on Monday urged lawyers and judges not to take part in divorce cases, decrying divorce as a "festering wound" that has devastated society. The Pontiff urged lawyers to instead devote their efforts to reconciling couples.
The Children's Rights Council would like to meet the Pontiff halfway. "We know we can't and shouldn't abolish divorce in America, but we have long urged that lawyers stay out of the divorce process," said David L. Levy a lawyer and president of the Children's Rights Council. "Instead, mediators, parent educators and advocates for co-parenting should take over," said Levy.
"This will lead to some parents reconciling and foster cooperation between parents," said Levy.
"For those parents who do not reconcile, it will make divorce a lot easier on the children. And those children will grow up to respect marriage more, because their parents divorced in a responsible, caring way –without divorce battle-oriented lawyers," said Levy.
For more information on the Children's Rights council, a national child-advocacy organization, see www.gocrc.com


I have had chronic health problems since I was 12. They are on going and even now getting worse.
Four out of my seven children are autistic ….
Since a child I have been through many traumatising events.
For about five years I battled with sucidal thoughts, even now I'm suffering through night terrors and wake up screaming.
Some of my children have been extremely sick.
Most of my days are busy with organising different therapies for the children and support, making appointments and attending them if possible or organising for them to take place in the home as well as my own medical appointments. Juggling the fact that between our kids we have three different schools plus a preschool and a family day centre they attend. As well as after school activities like dancing and music.
We try to attend church as regular as possible and to continue to practise our faith… Though with seven children, four who struggle socially and with myself struggling to make it out side the house it is extremely difficult to say the least.
I guess …. See no matter how hopeless the situation is or how our life seems it's because faith can bring hope. Against all odds or against all hope I'm still here. As crazy as it may seem a mother with seven children four on the spectrum and myself extremely sick in and out of hospital we strive to do Gods will, not our own and He continues to bless us in so many ways.
He always provides for us and comforts me in my darkest hours.
I suffer from chronic pain which is unbearable at times and I cry because it's taking a lot out of me. But I have been offering it up for people I know or the souls in purgatory for people I hear who are dying or who have lost or struggle with their faith, when I do this I am happy- in pain but happy and at peace and slowly the pain stops.
I have learnt I can suffer with joy and happiness because to not suffer is rejecting my cross and rejecting Jesus.
A true Christian takes up their cross like Jesus did and than takes on the sufferings and offers them up for eternal life of all souls.
It's about living your life for the other and not for yourself.
Against everything that has happened in my life and that is happening now.
Against any hopeless situation , I am still here.
Because God has rescued me.
God continues to rescue me over and over again, no matter how many times I fall or fail Him, He still manages to pick me up at the right moment. Every. Single. Time.


text:
Rong Jiang biography
Author Biography | Books by this Author | Readalikes
Rong Jiang
Jiang Rong is the pen name of Lu Jiamin (in Chinese, the family name comes first). To protect himself from what he describes as "the least liberal country in the world", he wrote Wolf Totem under a pen-name and carefully hid his real identity. It was not until he won the Man Asia prize in 2007, three years after the book was first published, that anyone outside a small circle of friends knew what Jiang looked like. Before the Man Booker prize he had given interviews but never allowed his photograph to be taken. Some critics have dismissed this as a marketing gimmick but for Jiang it was a matter of survival. Speaking after the Man Asia prize was announced he says:
"When the book came out three years ago, it was controversial. Critics called me a liberal, a traitor, a fascist. They said the book was anti-communist, that it should be banned by the propaganda department because it has evil political aims, that it stands for liberalism and capitalism. That is why I thought it was wise to hide my identity at the time. But now things have changed. We have economic freedom, social freedom, literary freedom, internet freedom, even press freedom has improved quickly. The conditions for freedom in China have improved."
Lu Jiamin (family name = Lu) was born in Jiangsu in 1946. His biggest influence was his mother. In the 1920s and 30s, she had been an underground member of the communist party in Shanghai. After Mao took power in 1949, she moved into education, working for the women's federation and running the Jiangsu provincial nursery school.
Speaking to the British newspaper The Guardian, Lu says, "I have a liberal character by nature. It comes from my mother. She liked to travel and we moved house a lot - Shanghai, Wuxi, Nanjing and Beijing. She was exposed to western culture through the films she loved to watch and books she liked to read. We loved to read western novels." Among them were Jane Eyre and Wuthering Heights."
His happy childhood came to an end in 1957 when his mother died from cancer and war injuries at 39 years of age and Mao launched a bloody anti-rightist purge of those who criticized him. The years that followed were rife with doubts, suspicions and hardships. The family moved to Beijing in 1957 where Lu entered a middle school attached to the Central Academy of Fine Arts (which he entered in 1966). In 1964, he wrote a poster criticizing the latest political campaign. It was the first of four times in his life that he was to be condemned as "counter-revolutionary".
During the early months of the Cultural Revolution his father, a disabled veteran who had fought against the Japanese, was denounced as a "black gang capitalist-roader" and was beaten so badly he nearly died. Jiang fought back, joining the student Red Guard and rose to become deputy head of the revolutionary core group in his college. When asked whether he felt torn after what happened to his father he says: "Yes, there was a confusion in my mind. But I thought things would improve ... There was a conflict within me between Mao's theories and western liberal theories."
In 1966-67, he was in a Red Guard gang that ransacked homes in Beijing, confiscating and burning any books deemed counter-revolutionary. While publicly following the mob, Lu squirreled away many of the novels, adding them to a secret collection he had bought and kept in two large trunks.
After a year, the Cultural Revolution collapsed into factions and Mao sent the students into the countryside to learn from the masses. 21-year-old Lu was one of the first to volunteer to be sent to Inner Mongolia's East Ujimchin Banner in 1967, where he lived and labored with the native nomads until the age of thirty-three. He took with him two cases filled with Chinese translations of Western literary classics, and spent eleven years immersed in personal studies of Mongolian history, culture, and tradition. In particular, he developed a fascination for the mythologies surrounding the wolves of the grasslands, spending much of his leisure time learning the stories and raising an orphaned wolf cub.
In 1978 he returned to Beijing, continuing his education at the Chinese Academy of Social Sciences one year later. The period between 1978 and his retirement from academia in 2006 is murky. Lu is reluctant to give details about topics that are still politically sensitive but he has confirmed reports that he was jailed for more than three years, narrowly missing the death penalty; that he founded the "Beijing Spring" reform publication during the protests in 1978; and that he spent 18 months in prison following the Tiananmen Square protests in 1989.
Wolf Totem is a fictional account of life in the 1970s that draws on Lu's personal experience of the grasslands of China's border region. He spent six years researching and writing the book. Today, the book has sold more than 2 million official copies in China with an estimated 10 times that amount in pirated copies. Apparently, the only book to have sold more copies is Mao's "Little Red Book."
Books by this author
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Books by Rong Jiang at BookBrowse
All the books below are recommended as readalikes for Rong Jiang but some maybe more relevant to you than others depending on which books by the author you have read and enjoyed. So look for the suggested read-alikes by title linked on the right.
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Helen Benedict
Helen Benedict, a professor at Columbia University, writes frequently about justice, women, soldiers, and war. She is the author of seven novels, including Sand Queen, a Publishers Weekly "Best Contemporary War Novel." A ... (more)
If you enjoyed:
Wolf Totem
Wolf Season
by Helen Benedict
Mischa Berlinski
Fieldwork is Mischa's first novel, it won him a $50,000 Whiting Award in 2008. Peacekeeping: A Novel was published in 2016.
Mischa Berlinski was born in New York in 1973. He studied classics at the University of California... (more)
by Mischa Berlinski
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by Lea Ypi
"Nothing short of a masterpiece."
(starred review)
At times, our own light goes out, and is rekindled by a spark from another person.


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