2018.1 KFP – public report

Case 1: Osteoporosis in an Older Male Patient

• Medical Heading: Geriatrics, Endocrinology.
• Key Topics: Causes of osteoporosis in males, appropriate investigations, and medication management.
• Candidate Performance: Common errors included gender-specific treatment errors and non-specific causative factors.
• Improvement Areas: Focus on gender-appropriate management strategies and specific risk factors for osteoporosis in males, such as alcohol intake and medication side effects.

Case 2: Vaginal Bleeding in Early Pregnancy

• Medical Heading: Obstetrics.
• Key Topics: Differential diagnoses for early pregnancy bleeding, relevant investigations, dietary advice during pregnancy.
• Candidate Performance: Challenges in focusing on scenario-provided details for differential diagnosis, leading to irrelevant history considerations.
• Improvement Areas: Sharpen focus on clinical scenario details to guide differential diagnoses and investigation choices, and offer specific, evidence-based dietary advice.

Case 3: Diabetic Review and Complication Management

• Medical Heading: Endocrinology, Diabetes Management.
• Key Topics: Identifying diabetic complications, medication complication awareness, non-lifestyle management strategies.
• Candidate Performance: Misinterpretation of the scenario, leading to irrelevant answers or focus on diabetes complications instead of medication impacts.
• Improvement Areas: Enhance interpretation of diabetic management scenarios, specifically regarding medication complications and focused non-lifestyle interventions.

Case 4: Sudden Loss of Vision and Incidental Skin Lesion

• Medical Heading: Ophthalmology, Dermatology.
• Key Topics: Differential diagnoses for sudden vision loss, focused historical inquiry, and skin lesion management.
• Candidate Performance: Misidentifications such as amaurosis fugax as a diagnosis and incorrect management approaches for identified skin lesions.
• Improvement Areas: Develop a precise approach to sudden vision loss diagnosis and lesion management, avoiding misinterpretations of symptoms as diagnoses.

Case 5: Irregular Periods in a Young Female

• Medical Heading: Reproductive Medicine.
• Key Topics: Broad differential diagnosis for irregular menstruation, specific history and investigations, management planning.
• Candidate Performance: Narrow focus on conditions like PCOS without exploring a wider range of diagnoses or specifying targeted investigations.
• Improvement Areas: Broaden differential diagnosis considerations and specify investigation choices and management strategies clearly.

Case 6: Swollen Elbow Diagnosis and Underlying Pathology

• Medical Heading: Rheumatology, Sports Medicine.
• Key Topics: Accurate diagnosis of elbow swelling, understanding of underlying pathology, and appropriate management.
• Candidate Performance: Failure to specify underlying pathology and inappropriate use of abbreviations in management plans.
• Improvement Areas: Clarify understanding of specific conditions leading to elbow swelling and provide explicit management plans without relying on abbreviations.

Case 7: Driving Licence Medical for an Elderly Man

• Medical Heading: Geriatrics, Legal Medicine.
• Key Topics: Fitness to drive assessments, understanding of legal and occupational requirements, management following fitness to drive assessment.
• Candidate Performance: Generic examination responses and lack of specificity in managing fitness to drive outcomes.
• Improvement Areas: Familiarize with ‘fitness to drive’ criteria and develop comprehensive management plans that include legal and ethical considerations post-assessment.

Case 8: Genetics of Huntington’s Disease

• Medical Heading: Genetics.
• Key Topics: Understanding of Huntington’s disease genetics, managing genetic screening requests, antenatal screening options.
• Candidate Performance: Some lacked understanding of genetic testing implications and antenatal screening specifics.
• Improvement Areas: Enhance knowledge on genetic conditions, ethical considerations in genetic testing, and specific antenatal screening methods.

Case 9: Dyspnoea and Palpitations in a Young Female

• Medical Heading: Cardiology, Psychiatry.
• Key Topics: Investigation of dyspnoea and palpitations, differential diagnoses including psychological factors, management strategies.
• Candidate Performance: Overemphasis on asthma management, despite well-controlled asthma, and lack of specificity in management strategies.
• Improvement Areas: Consider a wider range of causes for symptoms, including psychological aspects, and specify detailed management plans.

Case 10: Hot, Tender, Swollen Knee in a Young Girl

• Medical Heading: Pediatrics, Rheumatology.
• Key Topics: Diagnosis of a knee condition in a pediatric patient, immediate and appropriate management, skin condition management.
• Candidate Performance: Misalignment with patient age in management strategies and focus on secondary care rather than initial, urgent care.
• Improvement Areas: Align management strategies with pediatric considerations and provide immediate, appropriate care tailored to primary settings.

Case 11: Chronic Hepatitis C in a Middle-aged Female

• Medical Heading: Hepatology.
• Key Topics: Barriers to care in chronic hepatitis C, initial assessment for GP-based treatment, understanding of hepatitis C management.
• Candidate Performance: Selection of non-essential investigations prior to treatment initiation and well-addressed management strategies.
• Improvement Areas: Focus on essential investigations for hepatitis C treatment initiation and overcome barriers to care with targeted strategies.

Case 12: Anaphylactic Shock in a Rural Setting

• Medical Heading: Emergency Medicine.
• Key Topics: Diagnosis and management of anaphylactic shock, especially in remote or rural settings, emergency medication dosages.
• Candidate Performance: Misinterpretation of setting and urgency, incorrect emergency medication management.
• Improvement Areas: Strengthen emergency response strategies, including medication dosages and adjustments for remote settings.

Case 13: Bronchiolitis in a Three-month-old Baby

• Medical Heading: Pediatrics.
• Key Topics: Diagnosis of bronchiolitis, identification of causative organisms, risk factors for severe disease, management of a common self-limiting facial rash.
• Candidate Performance: Confusion over causative organisms and risk assessment, well-managed identification of facial rash.
• Improvement Areas: Improve understanding of bronchiolitis causative factors, risk assessment for severity, and non-intervention management for common pediatric conditions.

Case 14: Cardiology – Acute Breathlessness Post-Viral Infection

• Medical Heading: Cardiology.
• Key Topics: History elements for breathlessness diagnosis, cardiovascular examination interpretation, acute management of suspected cardiac condition.
• Candidate Performance: Candidates often missed broader history elements, focusing on specific conditions like pulmonary embolism without a wide differential scope. Misinterpretation of cardiovascular findings was common, leading to missed or incorrect diagnoses.
• Improvement Areas: Enhance skills in comprehensive history taking for breathlessness, improve interpretation of cardiovascular signs, and focus on acute, evidence-based management strategies for suspected cardiac conditions.

Case 15: Geriatrics – Deep Venous Thrombosis in an Elderly Resident

• Medical Heading: Geriatrics, Vascular Medicine.
• Key Topics: Examination for DVT confirmation, initial investigations, and urgent management considerations in an elderly patient with complex medical history.
• Candidate Performance: Some candidates failed to focus on specific examination and investigation for DVT, offering generalized management plans. Urgent referral for anticoagulation management was often overlooked.
• Improvement Areas: Prioritize urgent and specific management for suspected DVT, considering patient history. Tailor investigation requests explicitly and recognize the need for immediate specialist input in complex cases.

Case 16: Emergency Medicine – Older Female with Collapse

• Medical Heading: Emergency Medicine, Geriatrics.
• Key Topics: Differential diagnosis for collapse in an older patient, initial investigations relevant to past medical history and medication use.
• Candidate Performance: Difficulty in correlating the patient’s medical history and current symptoms to form a focused differential diagnosis. Some candidates chose broad or irrelevant initial investigations.
• Improvement Areas: Develop a more targeted approach to differential diagnosis in older patients presenting with collapse, ensuring initial investigations are directly relevant to the most likely underlying causes.

Case 17: Pediatrics – Immunisation in a Child with Allergies

• Medical Heading: Pediatrics, Immunology.
• Key Topics: Contraindications to immunisation, managing parental concerns and legal aspects regarding consent for vaccination.
• Candidate Performance: Struggles with identifying actual contraindications versus parental concerns. Some candidates proposed vaccination without addressing legal consent issues or the father’s opposition.
• Improvement Areas: Improve understanding of vaccine contraindications, especially in context of allergies. Enhance strategies for managing divided parental consent and incorporate legal guidelines into practice.

Case 18: Respiratory Medicine – Persistent Cough Post-Infection

• Medical Heading: Respiratory Medicine.
• Key Topics: Differential diagnosis for persistent productive cough, initial investigations to identify underlying cause.
• Candidate Performance: Some candidates failed to integrate the patient’s history with symptomatology, leading to unfocused differential diagnoses. Initial investigation choices sometimes lacked relevance to the most probable diagnoses.
• Improvement Areas: Sharpen the ability to link persistent cough symptoms with relevant patient history for focused differential diagnoses. Choose initial investigations that directly contribute to identifying the underlying respiratory condition.

Case 19: Neurology – Progressive Fatigue and Muscle Weakness

• Medical Heading: Neurology.
• Key Topics: Identifying symptoms indicative of neurological conditions, initial neurological investigation selection, management of a suspicious skin lesion.
• Candidate Performance: Good identification of symptoms suggestive of myasthenia gravis but some confusion over specific neurological investigations needed. Management strategies for the skin lesion sometimes missed the mark.
• Improvement Areas: Enhance knowledge on neurological investigation specifics for conditions like myasthenia gravis. Clarify dermatological management principles for common skin conditions.

Case 20: Oncology – Elevated CA 125 in Post-Menopausal Woman

• Medical Heading: Oncology, Gynecology.
• Key Topics: Risk factor assessment for elevated CA 125, focused history and examination, managing elevated tumor markers in a nonscreening context.
• Candidate Performance: Overreliance on CA 125 for cancer screening without considering other potential causes. Some candidates missed key risk factors in history and examination.
• Improvement Areas: Educate on appropriate use of tumor markers and broaden differential diagnoses for elevated CA 125. Improve communication about the limitations of such markers in cancer screening.

Case 21: Endocrinology – Adrenal Insufficiency Presentation

• Medical Heading: Endocrinology.
• Key Topics: Diagnosis of adrenal insufficiency, interpreting related symptoms and test results, acute shock management.
• Candidate Performance: Some candidates overlooked adrenal insufficiency signs, focusing on less likely diagnoses or failing to propose specific acute management steps for adrenal crisis.
• Improvement Areas: Improve recognition of adrenal insufficiency signs and symptoms. Develop urgent management strategies for adrenal crisis, including emergency steroid administration.

Case 22: Neurology – Facial Palsy Management

• Medical Heading: Neurology.
• Key Topics: Differential diagnosis for facial palsy, focused history for neurological symptoms, specific pharmacological and non-pharmacological management.
• Candidate Performance: Missteps in pharmacological management specifics and non-targeted non-pharmacological advice. Some lacked specificity in steroid dosing or comprehensive care strategies.
• Improvement Areas: Precise pharmacological treatment regimens for neurological conditions and tailored non-pharmacological management plans that reflect patient-specific needs.

Case 23: Dermatology – Acute Desquamation Presentation

• Medical Heading: Dermatology, Emergency Medicine.
• Key Topics: Diagnosis of acute skin reactions, urgent supportive treatment, and differential considerations.
• Candidate Performance: Well-identified diagnosis but some confusion over immediate management priorities and specific supportive care steps.
• Improvement Areas: Focus on emergency management of severe dermatological reactions, emphasizing rapid supportive care and specific treatment modalities.

Case 24: Ophthalmology – Raised Intra-Ocular Pressures

• Medical Heading: Ophthalmology.
• Key Topics: Risk factors for glaucoma, appropriate management options, interpretation of skin lesions.
• Candidate Performance: Some candidates offered general risk factors without specificity or proposed inappropriate management steps for diagnosed conditions.
• Improvement Areas: Detailed risk factor assessment for glaucoma and precise management strategies, both pharmacological and surgical, as appropriate.

Case 25: Gynecology – Dysmenorrhea and Menorrhagia Management

• Medical Heading: Gynecology.
• Key Topics: Investigation strategy for abnormal menstruation, management of cervical screening results, contraindications for specific contraceptives.
• Candidate Performance: This case contained a ‘killer question’: given the patient’s age and smoking status, there was an absolute contraindication to using the combined oral contraceptive pill. If candidates chose this as one of their answers, their answer scored zero. This is appropriate given the serious complication of using this medication to manage this patient.
• Improvement Areas: Recognize contraindications for contraceptive use, especially in smokers, and apply current guidelines to manage abnormal cervical screening results effectively.

Contraindications to the OCP¹

Case 26: Respiratory Medicine – Severe Cough in a Young Male

• Medical Heading: Respiratory Medicine.
• Key Topics: Differential diagnosis for severe cough, interpretation of chest X-ray, selection of appropriate investigations.
• Candidate Performance: Some challenges in linking clinical presentation to specific respiratory conditions and selecting targeted investigations based on normal chest X-ray findings.
• Improvement Areas: Strengthen interpretation of chest X-ray results in the context of clinical symptoms. Select investigations that directly aim to uncover the underlying cause of respiratory symptoms.