Harefuah
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The State of Israel Physicians' Law of 1987 requires all immigrant physicians to pass a state licensing examination in order to practice medicine. The examination is prepared by the Board of Examination for the Medical License, appointed according to the Ministry of Health regulations of 1987. It consists of 220 written multiple choice questions in internal medicine, surgery, pediatrics, psychiatry and obstetrics and gynecology. ⋯ Of these, 1,968 (65.9%) were licensed. Factors affecting success rate were: age (mean 34 years), with the highest success rate at ages 31-35; length of medical experience, with the best results in those with 11-15 years of experience (mean 12); and country of origin, which is crucial. The success rate in immigrants from Western countries was 79.2%, from South America 72.3% and from Russia and Eastern European countries about 60%.
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3 children with the clinical picture of bacterial meningitis are described. Lumbar puncture was not done on admission due to increased intracranial pressure, cardiopulmonary shock, or petechial rash with suspected coagulopathy. ⋯ We maintain that in fulminating cases lumbar puncture might prove fatal, and should therefore be deferred until the child's condition improves. However, if bacterial meningitis is suspected and lumbar puncture is delayed, intravenous antibiotics should be given immediately after blood is drawn for culture.