Case 1: Middle-aged Male with Prolonged Fever and Abnormal Liver Function Tests
Key Medical Subject: Hepatology
Topic Discussed:
- Differential diagnosis of prolonged fever with abnormal liver function tests
- Importance of considering medication history (excessive use of paracetamol)
What Candidates Did Well:
- Recognized the need for differential diagnoses based on liver function test results.
What Candidates Did Poorly:
- Failed to consider the complete clinical history, missing the detail of the patient’s excessive use of paracetamol.
- Provided a list of all possible causes shown by liver function results without contextualizing them within the case.
- Described the results rather than providing a specific diagnosis.
Case 2: Young Adult Male with Shin Lesions, Joint Pains, and Altered Bowel Habits
Key Medical Subject: Rheumatology and Gastroenterology
Topic Discussed:
- Identification of skin lesions and joint pain in conjunction with altered bowel habits
- Appropriate investigations for specific differential diagnoses
What Candidates Did Well:
- Recognized the clinical significance of the combination of symptoms (skin lesions, joint pain, altered bowel habits).
What Candidates Did Poorly:
- Selected irrelevant or routine investigations that did not aid in honing the diagnosis.
- Failed to choose rational, appropriate investigations specific to the clinical presentation.
Case 3: Middle-aged Torres Strait Islander Male with Acute Gout
Key Medical Subject: Rheumatology
Topic Discussed:
- Pharmacological and non-pharmacological management of acute gout
What Candidates Did Well:
- Recognized the need for specific management options for acute gout.
What Candidates Did Poorly:
- Focused too narrowly on NSAIDs without detailing appropriate dosing regimens.
- Provided vague non-pharmacological advice or irrelevant recommendations (e.g., quitting smoking with no history of smoking).
- Failed to specify the content of educational advice or the purpose of referrals to allied health professionals.
Case 4: Middle-aged Female with Basal Cell Carcinomas
Key Medical Subject: Dermatology and Oncology
Topic Discussed:
- Identification and management of basal cell carcinomas
- Recognizing risk factors for developing skin lesions
What Candidates Did Well:
- Identified the need to diagnose and manage skin lesions.
What Candidates Did Poorly:
- Gave nonspecific diagnoses such as ‘skin cancers’ or ‘sun damage’.
- Misinterpreted the risk factors question by describing lesion characteristics instead of patient history.
- Provided inappropriate management options for basal cell carcinomas.
- Discussed long-term skin cancer prevention rather than specific lesion management.
General Advice for Candidates:
- Carefully read and understand the question, ensuring all parts are addressed.
- Contextualize answers within the case provided.
- Provide specific, relevant information rather than general or vague answers.
- Rationally select appropriate investigations and management strategies.
Case 5: Young Couple with Failure to Conceive
Key Medical Subject: Reproductive Medicine
Topic Discussed:
- Relevant history for sub-fertility in the female partner
- Initial appropriate investigations for sub-fertility
- Interpretation of semen analysis
What Candidates Did Well:
- Recognized the need to explore sub-fertility.
What Candidates Did Poorly:
- Provided answers relating to a generic pre-conception consultation rather than a sub-fertility consultation.
- Focused solely on symptoms of polycystic ovarian syndrome, neglecting other potential causes of sub-fertility.
- Selected inappropriate secondary investigations not relevant to the initial presentation.
Case 6: Female Patient with Abnormal Liver Function Tests
Key Medical Subject: Hepatology
Topic Discussed:
- Focused history relevant to cholestatic liver function test results
- Differential diagnosis and secondary investigations for abnormal liver function
What Candidates Did Well:
- Recognized the need to provide a focused history and differential diagnosis.
What Candidates Did Poorly:
- Explored irrelevant aspects of history such as pain, weight loss, or stool changes, which were stated as absent.
- Suggested differential diagnoses that were inconsistent with the asymptomatic presentation.
- Failed to consider pruritus, jaundice, or rash appropriately, as they are common to many causes of abnormal liver function.
Case 7: Removed from the Paper
Key Medical Subject: N/A (Case removed due to poor statistical performance)
Case 8: Female Patient with Four-Week History of Cough and Shortness of Breath
Key Medical Subject: Pulmonology
Topic Discussed:
- Interpretation of clinical presentation and chest X-ray
- Differential diagnoses and examination features relevant to the respiratory condition
What Candidates Did Well:
- Recognized the need for differential diagnoses based on history and chest X-ray.
What Candidates Did Poorly:
- Provided answers focusing on history or investigations rather than specific signs on clinical examination.
- Offered non-specific answers and explanations, leading to penalization for extra responses.
Case 9: Elderly Male Retired Miner with Progressive Shortness of Breath
Key Medical Subject: Pulmonology and Occupational Medicine
Topic Discussed:
- Interpretation of spirometry results demonstrating a restrictive pattern
- Differential diagnoses and investigations for respiratory symptoms in a retired miner
What Candidates Did Well:
- Recognized the importance of spirometry in diagnosing respiratory conditions.
What Candidates Did Poorly:
- Failed to identify the restrictive pattern in spirometry results.
- Provided general diagnoses rather than specific disease processes related to the restrictive pattern.
- Listed diagnoses in a manner that led to penalization for over-coding.
General Advice for Candidates:
- Carefully read and understand the question, ensuring all parts are addressed.
- Contextualize answers within the case provided.
- Provide specific, relevant information rather than general or vague answers.
- Rationally select appropriate investigations and management strategies.
- Avoid over-coding by not providing lists or extra responses that are not asked for in the question.
Case 10: Young Adult Male with Acute Anterior Chest Pain and Prodromal Viral Illness
Key Medical Subject: Cardiology
Topic Discussed:
- Interpretation of ECG changes typical of pericarditis
- Pharmacological strategies for smoking cessation in the context of epilepsy
What Candidates Did Well:
- Recognized the ECG changes as indicative of pericarditis.
- Provided specific ECG abnormalities including leads (e.g., ‘ST elevation in leads II, III, and aVF’ or ‘PR depression in leads V1 and V2’).
What Candidates Did Poorly:
- Provided less specific answers such as ‘ST elevation’ or ‘PR depression’ without mentioning the leads.
- Suggested pharmacological strategies for smoking cessation without considering the patient’s history of epilepsy, leading to the recommendation of medications that may increase seizure risk.
- Grouped similar answers (e.g., two nicotine replacement strategies) instead of providing diverse options.
Case 11: Female Patient with Progressive Reduction in Mood and Mental Wellbeing
Key Medical Subject: Psychiatry
Topic Discussed:
- Additional medication to improve mental state considering current medication (tramadol)
- Suicide risk assessment
What Candidates Did Well:
- Identified appropriate medication options considering the patient’s current medication.
- Conducted a thorough suicide risk assessment.
What Candidates Did Poorly:
- Suggested medications that could interact negatively with tramadol.
- Provided only the drug name without the specific dosing regimen.
- Included elements in the suicide risk assessment that were not specific to assessing suicidal risk or repeated information already provided in the case.
Case 12: Older Male with History of Prostate Cancer and Low Thoracic Back Pain
Key Medical Subject: Oncology and Pain Management
Topic Discussed:
- Differential diagnoses for low thoracic back pain in the context of a history of prostate cancer
- Pain management options
- Planning for future care and advanced care planning
What Candidates Did Well:
- Identified the need for differential diagnoses considering the patient’s cancer history.
- Recognized the importance of advanced care planning and appointing a medical power of attorney.
What Candidates Did Poorly:
- Provided a list of different opiates or NSAIDs without considering a range of management options from different drug classes.
- Failed to group pain management strategies effectively.
General Advice for Candidates:
- Carefully read and understand the question, ensuring all parts are addressed.
- Contextualize answers within the case provided.
- Provide specific, relevant information rather than general or vague answers.
- Rationally select appropriate investigations and management strategies.
- Avoid over-coding by not providing lists or extra responses that are not asked for in the question.
- Consider patient history and specific case details when recommending treatments to avoid contraindications.
Case 13: Older Male with Acute Shortness of Breath and Previous Chest Pain
Key Medical Subject: Cardiology and Pulmonology
Topic Discussed:
- Differential diagnoses and initial investigations for acute shortness of breath
- Immediate management of acute chest pain in a general practice environment
What Candidates Did Well:
- Recognized the need to identify differential diagnoses for acute shortness of breath.
- Provided some appropriate initial investigations.
What Candidates Did Poorly:
- Provided a generic list of all possible causes of shortness of breath without focusing on the provided history.
- Selected ongoing outpatient investigations rather than immediate investigations.
- Lacked awareness of current guidelines for the management of acute chest pain.
- Provided non-specific answers and failed to give appropriate drug regimens.
Case 14: Female with Raised Systolic and Diastolic Blood Pressure
Key Medical Subject: Hypertension
Topic Discussed:
- Possible causes of raised blood pressure
- Confirmation of isolated reading versus uncontrolled blood pressure
- Pharmacological strategies for uncontrolled hypertension
What Candidates Did Well:
- Identified the need to explore possible causes of uncontrolled hypertension.
What Candidates Did Poorly:
- Provided pharmacological causes instead of lifestyle factors when asked.
- Grouped answers, leading to over-coding penalties.
- Gave non-specific pharmacological management answers without specific drug names or dosages.
Case 15: Child with Upper-Respiratory Symptoms and Suspected Epiglottitis
Key Medical Subject: Pediatrics and Emergency Medicine
Topic Discussed:
- Differential diagnoses for serious illness in a child
- Immediate management of a child with suspected epiglottitis
What Candidates Did Well:
- Identified epiglottitis as a possible differential diagnosis.
- Avoided dangerous examination practices that could distress the child and risk the airway.
What Candidates Did Poorly:
- Provided lists of causative organisms instead of specific diagnoses.
- Suggested emergency-department-focused answers rather than those suitable for general practice.
- Failed to recognize the urgency of the situation and provide immediate management steps.
Case 16: Female Returning from Southeast Asia with Cough, Back Pain, and Fever
Key Medical Subject: Infectious Disease and Travel Medicine
Topic Discussed:
- Differential diagnoses for post-travel illness
- Relevant history to assess symptoms
What Candidates Did Well:
- Recognized the need to consider travel-related illnesses in the differential diagnoses.
What Candidates Did Poorly:
- Failed to provide appropriate differential diagnoses based on the pattern of presentation.
- Asked about irrelevant history aspects not indicated by the scenario.
- Explored past medical history unnecessarily when none was indicated.
Case 17: Asymptomatic Neck Swelling Thought to be a Thyroid Nodule
Key Medical Subject: Endocrinology
Topic Discussed:
- History elements suggesting possible thyroid malignancy
- Initial investigations for thyroid nodule
What Candidates Did Well:
- Identified elements of the history relevant to thyroid malignancy.
What Candidates Did Poorly:
- Provided later-stage investigations rather than initial ones.
- Failed to understand the time sequence of investigations.
Case 18: Female with Secondary Amenorrhea
Key Medical Subject: Gynecology
Topic Discussed:
- Differential diagnoses for secondary amenorrhea
- Initial investigations based on the scenario
What Candidates Did Well:
- Recognized the need for differential diagnoses and initial investigations.
What Candidates Did Poorly:
- Provided similar answers over multiple lines, leading to over-coding penalties.
- Gave broad answers that were not specific diagnoses.
Case 19: Vulnerable Adult with Intellectual Disability and Recent Behavioral Changes
Key Medical Subject: Psychiatry and General Practice
Topic Discussed:
- Sources to corroborate history
- Differential diagnoses for recent behavioral changes
- Initial investigations
What Candidates Did Well:
- Identified the need for corroborating history from multiple sources.
What Candidates Did Poorly:
- Assumed the presence of mental health issues without patient engagement.
- Asked about medication side effects or interactions despite being told the patient was on no medications.
- Provided diagnoses and solutions for problems not listed in the scenario.
Case 20: Older Female with Acute Onset of Upper-Back Pain and Osteoporosis
Key Medical Subject: Orthopedics and Geriatrics
Topic Discussed:
- Diagnosis of osteoporosis from lateral spinal X-ray
- Initial investigations for osteoporosis
- Non-pharmacological management strategies
What Candidates Did Well:
- Identified osteoporosis and appropriate initial investigations.
What Candidates Did Poorly:
- Provided pharmacological advice or non-specific advice instead of non-pharmacological strategies.
Case 21: Middle-Aged Female with Cough, Shortness of Breath, and Exercise Intolerance
Key Medical Subject: Pulmonology
Topic Discussed:
- Identification of consolidation on chest X-ray
- Risk factors for diagnosis
- Factors indicating severity of presentation
What Candidates Did Well:
- Recognized the need to identify consolidation on the chest X-ray.
What Candidates Did Poorly:
- Repeated information in the scenario or made assumptions about exposure to illnesses.
- Provided symptoms instead of examination findings.
Case 22: End-of-Life Care for Female Aboriginal Patient with High-Grade Glioblastoma
Key Medical Subject: Palliative Care and Cultural Competence
Topic Discussed:
- Key issues in end-of-life care considering cultural, social, and medical needs
What Candidates Did Well:
- Recognized the importance of addressing cultural, social, and medical needs.
What Candidates Did Poorly:
- Repeated information already given in the scenario.
- Focused on issues in the hospital environment rather than the home environment.
Case 23: Male with Gastrointestinal Symptoms and Helicobacter pylori Infection
Key Medical Subject: Gastroenterology
Topic Discussed:
- Differential diagnoses for gastrointestinal symptoms
- Management of Helicobacter pylori infection
What Candidates Did Well:
- Provided appropriate differential diagnoses for gastrointestinal symptoms.
What Candidates Did Poorly:
- Gave non-specific management answers for Helicobacter pylori infection.
- Failed to provide specific pharmacological strategies and address lifestyle issues.
Case 24: Older Male with Light-Headedness, Near-Syncope, and Reduced Exercise Tolerance
Key Medical Subject: Cardiology and Oncology
Topic Discussed:
- Differential diagnoses considering red flag symptoms
- Initial investigations for the patient’s symptoms
What Candidates Did Well:
- Recognized the need for differential diagnoses and initial investigations.
What Candidates Did Poorly:
- Failed to identify red flag symptoms.
- Provided only cardiovascular causes without considering other possibilities.
Case 25: Male with Generalized Pruritus and Later Development of Night Sweats and Lymphadenopathy
Key Medical Subject: Hematology and Dermatology
Topic Discussed:
- Differential diagnoses for generalized pruritus
- Appropriate investigations for pruritus and lymphadenopathy
What Candidates Did Well:
- Provided some appropriate differential diagnoses and investigations.
What Candidates Did Poorly:
- Suggested dermatological causes that would have shown signs on examination.
- Provided further diagnoses instead of specific investigations.
Case 26: Adolescent Male with Collapse, Loss of Consciousness, and Muscle Jerking
Key Medical Subject: Neurology and General Practice
Topic Discussed:
- Differential diagnoses for fits, faints, or dizzy spells
- Key features in history to establish a diagnosis
What Candidates Did Well:
- Considered a range of possible causes for the presentation.
What Candidates Did Poorly:
- Focused solely on different forms of epilepsy without considering other possibilities.
- Gave a narrow neurological history rather than appreciating the range of possible causes.
General Advice for Candidates:
- Carefully read and understand the question, ensuring all parts are addressed.
- Contextualize answers within the case provided.
- Provide specific, relevant information rather than general or vague answers.
- Rationally select appropriate investigations and management strategies.
- Avoid over-coding by not providing lists or extra responses that are not asked for in the question.
- Consider patient history and specific case details when recommending treatments to avoid contraindications.