2017.1 KFP – public report

Case 1: Geriatrics and Audiology – Elderly Male with Multiple Symptoms

• Specifics: Candidates missed the directive to identify conditions other than hearing loss and struggled with interpreting the audiogram accurately.
• Improvement Areas: Enhance understanding of audiogram interpretation and ensure responses directly address the question asked, focusing on conditions beyond the obvious hearing loss.

Case 2: Orthopedics and Pediatrics – Forearm Fracture in a Child

• Specifics: The severity of the fracture, requiring urgent orthopedic referral, was often underestimated, and the need for adequate analgesia and neurovascular assessments was overlooked.
• Improvement Areas: Improve fracture management knowledge, especially identifying signs of neurovascular compromise, and ensure comprehensive pain management strategies are included.

Case 3: Dermatology – Allergic Contact Dermatitis

• Specifics: Misdiagnoses were common, with candidates suggesting infective causes instead of recognizing an irritant/allergic cause based on scenario cues.
• Improvement Areas: Sharpen diagnostic skills to distinguish between contact dermatitis and other skin conditions, and provide detailed treatment plans including steroid potency and application frequency.

Case 4: Neurology/Psychiatry – Lewy Body Dementia

• Specifics: Focus was often too narrow, centering on Parkinson’s-like symptoms without considering the broader symptom spectrum necessary for a Lewy body dementia diagnosis.
• Improvement Areas: Broaden knowledge of Lewy body dementia’s symptomatology and refine management strategies to include both pharmacological interventions and practical non-pharmacological support.

Case 5: General Practice – Non-healing Wound in an Older Aboriginal Patient

• Specifics: Initial management sometimes included inappropriate choices, like compressive dressings without vascular assessment, and the importance of Doppler ultrasound was not universally recognized.
• Improvement Areas: Prioritize vascular assessments in wound management and articulate specific investigation requests, including detailed justification for each test.

Case 6: Neurology – Post-lumbar Puncture Headache

• Specifics: Difficulty in distinguishing the initial post-procedure complication from a subsequent, unrelated headache presentation indicating new pathology.
• Improvement Areas: Enhance clinical reasoning to consider new diagnoses in patients with previous significant health episodes presenting with similar symptoms.

Case 7: Hepatology – Abnormal Liver Function

• Specifics: Broad, unfocused differential diagnoses that did not consider the specific liver function test patterns or the scenario’s details.
• Improvement Areas: Focus on relevant, scenario-specific liver pathologies and tailor investigation choices to those most likely to elucidate the disease’s nature and progression.

Case 8: Respiratory Medicine – Cavitating Lesion

• Specifics: Challenges included focusing too narrowly on describing X-ray findings without providing differential diagnoses and missing cultural and contextual factors in patient management.
• Improvement Areas: Develop skills in interpreting radiological findings within clinical context and include culturally appropriate management strategies.

Case 9: Hematology – Upper-limb Venous Thromboembolism

• Specifics: Failure to specify the investigation site and to adapt initial management to the patient’s medication history, especially concerning anticoagulation.
• Improvement Areas: Specify investigations clearly and adjust management plans based on comprehensive patient history, including medication use and risk factors.

Case 10: Dermatology – Severe Rosacea

• Specifics: A tendency to focus on pharmacological treatments without incorporating holistic management approaches or considering the condition’s impact on the patient’s quality of life.
• Improvement Areas: Emphasize a balanced approach that includes both pharmacological and non-pharmacological treatments, and consider patient education on trigger avoidance.

Case 11: Psychiatry – Postnatal Depression

• Specifics: Inappropriate medication suggestions for a breastfeeding mother and broad, non-specific management strategies that fail to offer concrete support or treatment paths.
• Improvement Areas: Recommend safe pharmacological options for breastfeeding mothers and detail specific, actionable steps for managing postnatal depression, including support systems and therapy options.

Case 12: Nephrology – Renal Disease and Anemia

• Specifics: Confusion about the type of anemia and its management, with some candidates suggesting irrelevant tests or failing to distinguish between immediate and long-term management strategies.
• Improvement Areas: Clarify the management of anemia in the context of renal disease, focusing on treatments that address the underlying cause and are suitable for the patient’s overall health status.

Case 13: Pediatrics – Child Obesity

• Specifics: The challenge was accurately assessing the child’s degree of obesity using pediatric growth or BMI charts and providing targeted lifestyle advice without immediately resorting to unnecessary investigations.
• Improvement Areas: Enhance skills in using pediatric growth charts to assess obesity accurately and focus on providing specific lifestyle advice tailored to the child’s needs. Avoid premature investigations that aren’t supported by the clinical scenario.

Case 14: Rheumatology – Polymyalgia Rheumatica

• Specifics: Some candidates focused on treatment complications rather than identifying key symptoms and complications of the disease itself. There was confusion over the initial investigations and appropriate starting doses for medication.
• Improvement Areas: Deepen understanding of polymyalgia rheumatica, including its clinical presentation, key complications, and evidence-based treatment strategies with appropriate medication dosages.

Case 15: Cardiology – Suspected Cardiac Failure

• Specifics: Candidates struggled to prioritize the most important components of initial management and to differentiate between similar answers, such as asking about orthopnoea in different ways.
• Improvement Areas: Focus on critical aspects of initial management relevant to cardiac failure, ensuring answers are distinct and directly address the question’s requirements.

Case 16: Emergency Medicine – Severe Abdominal Pain in a Diabetic Patient

• Specifics: A common error was not recognizing the urgency of the patient’s presentation and focusing on long-term management of alcohol use instead of addressing immediate acute care needs.
• Improvement Areas: Improve triage skills to recognize acute emergencies and provide specific, immediate management steps that address both the acute presentation and underlying chronic conditions.

Case 17: Endocrinology – Weight Loss, Amenorrhea, and Diarrhea

• Specifics: While broad ranges of differential diagnoses were provided, some candidates focused too narrowly on similar conditions or unlikely initial differentials.
• Improvement Areas: Broaden clinical reasoning to consider a wide range of plausible diagnoses and focus on those most likely given the patient’s symptoms and history.

Case 18: Dermatology – Tinea Cruris and Herpes Zoster

• Specifics: Identifying the rash was generally done well, but understanding the underlying conditions predisposing to tinea cruris and distinguishing between herpes zoster and genital herpes treatments were challenging.
• Improvement Areas: Deepen knowledge on conditions predisposing to dermatological issues and ensure treatment plans are specific to the diagnosed condition, including appropriate antiviral regimens for herpes zoster.

Case 19: General Practice – Fatigue in a Teenager

• Specifics: Over-investigation of fatigue without a rational approach aligned with contemporary guidelines was a common issue. Focusing on mental health despite the question’s different directive was also noted.
• Improvement Areas: Apply a rational, guideline-based approach to investigating non-specific symptoms like fatigue and ensure history taking is focused on uncovering the most relevant clinical information.

Case 20: Orthopedics/Pediatrics – Acute Limp in a Child

• Specifics: Candidates sometimes provided broad differential diagnoses without considering the acute presentation’s specific details. Managing molluscum contagiosum appropriately was also a challenge.
• Improvement Areas: Tailor differential diagnoses to the clinical scenario’s specifics and provide evidence-based management for incidental findings, like molluscum contagiosum, that match the case context.

Case 21: Gynecology – Contraindications for the Combined Oral Contraceptive

• Specifics: Some responses lacked specificity, such as failing to define precise contraindications for the combined oral contraceptive pill.
• Improvement Areas: Provide detailed and specific contraindications based on clinical guidelines and ensure counseling for alternative contraceptive methods includes comprehensive and actionable advice.

Case 22: Respiratory Medicine – Poorly Controlled Asthma

• Specifics: Mismanagement of medication in line with stepwise asthma guidelines and providing pediatric doses for an adult patient were noted issues.
• Improvement Areas: Align asthma management with current guidelines, ensuring medication choices and doses are appropriate for an adult patient’s age and severity of asthma.

Case 23: Cardiology – Atrial Fibrillation

• Specifics: Identifying atrial fibrillation from an ECG and assessing future stroke risk was generally well done, but some candidates could improve on providing a more comprehensive history for stroke risk assessment.
• Improvement Areas: Enhance understanding of stroke risk factors in atrial fibrillation beyond the provided scenario, applying guideline-based assessments more comprehensively.

Case 24: Psychiatry – Bipolar Disorder Management

• Specifics: While the diagnosis of a manic episode was identified, some candidates focused solely on medication strategies without considering broader management approaches.
• Improvement Areas: Include both pharmacological and non-pharmacological strategies in managing bipolar disorder, focusing on safety, support networks, and long-term management plans.

Case 25: Infectious Diseases – Acute Pertussis Infection

• Specifics: Specifying the exact test for pertussis confirmation was a challenge, and some candidates provided generic answers for management that lacked specificity.
• Improvement Areas: Specify detailed investigation requests and provide a comprehensive management plan for pertussis, including prophylactic treatment for close contacts and specific advice on exclusion periods.

Case 26: Oncology – Breast Lump Management

• Specifics: The need for a translator was often overlooked, and some candidates incorrectly prioritized palliative care over curative treatments based on the patient’s age.
• Improvement Areas: Recognize the importance of using professional translators in patient consultations and accurately assess the need for curative versus palliative care, ensuring decisions are patient-centered and informed.