2016.2 KFP – public report

Case 1: Neurology/Cardiology – ‘Funny Turn’

• Topic Discussed: A male patient presents with a non-specific ‘funny turn,’ possibly indicating a transient neurological or cardiovascular event.
• Candidates Did Well On: Identifying the correct diagnosis based on the provided scenario.
• Improvement Areas: Selecting appropriate and immediate investigations was challenging for some. Candidates often chose investigations relevant for later stages rather than focusing on those needed immediately upon presentation.

Case 2: Ophthalmology – Range of Eye Conditions

• Topic Discussed: Diagnosis and management of various ophthalmological conditions, including ‘red eye’ and other common presentations.
• Candidates Did Well On: Recognizing classic descriptions and using clinical photographs to guide diagnoses.
• Improvement Areas: Incorporating all provided information for differential diagnoses was a common challenge. Some candidates failed to match their differentials with the clinical presentations closely.

Case 3: Respiratory Medicine – COPD

• Topic Discussed: A patient presenting with persistent shortness of breath, leading to a diagnosis of Chronic Obstructive Pulmonary Disease (COPD).
• Candidates Did Well On: Tracing through differential diagnoses to initial investigations and treatment initiation.
• Improvement Areas: Avoiding unnecessary focus on cardiac disease or lung neoplasms not supported by the chest X-ray findings. Some candidates also misused or misunderstood medical abbreviations, particularly in medication management.

Case 4: Hematology – Chronic Hematological Condition

• Topic Discussed: New symptoms in a patient with a previously stable chronic hematological condition, requiring further investigation.
• Candidates Did Well On: Identifying additional necessary information for diagnosis.
• Improvement Areas: Recognizing the potential rapid progression of chronic conditions and the importance of specific, targeted answers rather than vague or general responses.

Case 5: Nephrology – Moderate Renal Disease

• Topic Discussed: Management of moderate renal disease resulting from previously undiagnosed hypertension.
• Candidates Did Well On: Rational choice of investigations for diagnosing common conditions like hypertension and its renal effects.
• Improvement Areas: Many candidates chose investigations that would not directly assist in diagnosing the underlying pathology or managing the patient’s renal disease effectively.

Case 6: Dermatology/Rheumatology – Dermatological and Rheumatological Issues

• Topic Discussed: Management of patients presenting with both dermatological and rheumatological symptoms, including skin lesions and gouty tophi.
• Candidates Did Well On: Identifying lesions through clinical photographs.
• Improvement Areas: Some focused on describing the lesion rather than addressing the management question. There was also confusion over diagnosing and managing gouty tophi.

Case 7: Orthopedics/Geriatrics – Lower Thoracic Pain

• Topic Discussed: Investigation and non-pharmacological management of acute onset lower thoracic midline pain in an elderly patient.
• Candidates Did Well On: Selecting appropriate investigations for the initial presentation.
• Improvement Areas: Many candidates recommended pharmacological treatments instead of focusing on the requested non-pharmacological management strategies.

Case 8: Pediatrics/Immunology – Immunization

• Topic Discussed: Appropriate immunizations for an 18-month-old Aboriginal child, including addressing parental vaccine concerns.
• Candidates Did Well On: Identifying additional and scheduled vaccines for the child.
• Improvement Areas: Some responses did not directly address the parents’ specific concerns, opting for general advice on Aboriginal and Torres Strait Islander health issues.

Case 9: Rheumatology – Symmetrical Joint Pains

• Topic Discussed: Diagnosis and management of new-onset symmetrical significant joint pains in a young female, with initial high inflammatory markers.
• Candidates Did Well On: Offering succinct differential diagnoses.
• Improvement Areas: Some focused on less common conditions instead of the more likely diagnoses. There was also misuse of abbreviations and inappropriate initial management choices.

Case 10: Psychiatry – Underlying Mental Health Issues

• Topic Discussed: A female patient with multiple emergency department attendances, suggesting underlying mental health issues.
• Candidates Did Well On: Analyzing the scenario to develop a differential diagnosis list and identify key risks.
• Improvement Areas: Some candidates focused excessively on organic causes rather than considering the patient’s mental health, and general terms were often used instead of specific management strategies.

Case 11: Gynecology – Mirena IUD Side Effects

• Topic Discussed: Management of side effects related to the Mirena Intrauterine Device (IUD).
• Candidates Did Well On: Approaching initial advice and considering ongoing management strategies.
• Improvement Areas: Candidates needed to be more specific in their management approaches, indicating a lack of familiarity with Mirena IUD’s specific management or broader applications in women’s health. Avoid general terms and ensure knowledge of contemporary treatment.

Case 12: Dermatology – Guttate Psoriasis

• Topic Discussed: Diagnosis and management of guttate psoriasis in a teenager.
• Candidates Did Well On: Correctly identifying guttate psoriasis.
• Improvement Areas: Many leaned towards symptomatic treatments rather than addressing the psoriasis directly. There was an over-reliance on emollients and insufficient focus on specific psoriasis management. Precise usage of topical steroids, including potency, is crucial.

Case 13: Dermatology – Pigmented Lesion Assessment

• Topic Discussed: Evaluation and management of a changing pigmented lesion, emphasizing the importance of frameworks like ABCDE or Glasgow for assessment.
• Candidates Did Well On: Using frameworks to assess pigmented lesions.
• Improvement Areas: Failing to mention biopsy or histopathology with excision led to missed scores. Essential to ensure histology of any excised lesion for medico-legal reasons.

Case 14: Urology – Microscopic Hematuria

• Topic Discussed: Investigation of microscopic hematuria discovered during a routine medical exam.
• Candidates Did Well On: Outlining relevant investigations based on patient history.
• Improvement Areas: Selecting age and gender-appropriate investigations, avoiding unnecessary tests like PSA in young men or cystoscopy as initial steps.

Case 15: Endocrinology – Tender Goitre

• Topic Discussed: Differential diagnoses and management of an acutely tender goitre.
• Candidates Did Well On: Identifying immediate management priorities.
• Improvement Areas: Selection of specific tests that help differentiate causes of an acutely tender goitre, focusing on managing pain and tenderness effectively.

Case 16: Infectious Diseases – Atypical Pneumonia

• Topic Discussed: Diagnosis of atypical pneumonia in a pet shop worker, likely zoonotic in origin.
• Candidates Did Well On: Narrowing down the most likely diagnosis based on occupational exposure.
• Improvement Areas: Providing focused, specific answers. Avoid expanding on multiple unrelated aspects of history together.

Case 17: Emergency Medicine/Pediatrics – Acute Epiglottitis

• Topic Discussed: Diagnosis and immediate management of acute epiglottitis in a child at a remote hospital.
• Candidates Did Well On: Identifying a life-threatening condition.
• Improvement Areas: Considering the remote location in management plans, ensuring that treatment options are realistic for the setting.

Case 18: Geriatrics/Psychiatry – Behavioral Changes in Elderly

• Topic Discussed: Possible causes and management of sudden behavioral changes in an elderly care facility resident.
• Candidates Did Well On: Choosing initial investigations wisely.
• Improvement Areas: Providing specific management strategies, including reviewing and adjusting medications based on the provided list.

Case 19: Surgery – Penetrating Finger Injury

• Topic Discussed: Immediate management and potential complications of a penetrating injury to the distal phalanx.
• Candidates Did Well On: Identifying steps for immediate management.
• Improvement Areas: Specifying analgesia type and considering a broad range of complications, not just infections.

Case 20: Hematology – Macrocytic Anemia

• Topic Discussed: Investigation and management of macrocytic anemia with low B12 levels, indicating potential pernicious anemia.
• Candidates Did Well On: Identifying possible underlying causes based on history.
• Improvement Areas: Progressing with investigations to confirm pernicious anemia, recognizing outdated tests like the Schilling test, and avoiding inappropriate initial investigations.

Case 21: Cardiology/Emergency Medicine – Leaking Aortic Aneurysm

• Topic Discussed: Identification and management of a leaking aortic aneurysm, differentiating it from a ruptured aneurysm.
• Candidates Did Well On: Careful reading of the scenario to identify the correct diagnosis.
• Improvement Areas: Specifying the urgency and details of the transfer to a higher level of care.

Case 22: Pediatrics/Surgery – Inguinal Swelling in Infant

• Topic Discussed: Diagnosis and management of inguinal swelling in a six-week-old baby, emphasizing the need for timely intervention.
• Candidates Did Well On: Identifying the need for an appropriate and timely referral.
• Improvement Areas: Recognizing the urgency of the situation and the specific needs of pediatric patients regarding hernias.

Case 23: Psychiatry – Aggressive Behavior in Group Home Resident

• Topic Discussed: Underlying causes and management of increased aggressive behavior.
• Candidates Did Well On: Adopting a holistic approach in managing the patient.
• Improvement Areas: Avoiding a broad list of potential infections or medications without specific evidence from the scenario.

Case 24: Gastroenterology – Abdominal Pain and Weight Loss

• Topic Discussed: Investigation of increasing abdominal pain and weight loss, and managing abnormal results.
• Candidates Did Well On: Identifying important differential diagnoses.
• Improvement Areas: Ensuring follow-up on abnormal results, emphasizing the duty of care.

Case 25: Emergency Medicine/Gynecology – Lower Abdominal Pain

• Topic Discussed: Differential diagnosis of right-sided lower abdominal pain in a female patient, with an emphasis on excluding ectopic pregnancy.
• Candidates Did Well On: Considering ectopic pregnancy as a differential.
• Improvement Areas: Including pregnancy tests in the initial investigation list to exclude pregnancy-related conditions.

Case 26: Psychiatry – Bipolar Depression in Older Patient

• Topic Discussed: Management of bipolar depression, focusing on a holistic approach including medication monitoring and support for the patient and family.
• Candidates Did Well On: Considering a comprehensive management plan that addresses medication, education, and support.
• Improvement Areas: Ensuring specific, targeted education and support strategies rather than generic mentions of education or review.