Rheumatology
Case 4: 52-Year-Old Woman with Foot and Heel Pain
- Key Areas:
- Diagnosing Morton’s neuroma and Achilles tendinopathy
- Management of Morton’s neuroma
- Non-pharmacological management of Achilles tendinopathy
- Common Errors:
- Misdiagnosing Achilles tendinopathy as plantar fasciitis or calcaneal apophysitis
- Providing insufficient detail about reasons for referrals
- Duplicating answers by giving similar responses in different ways
- Non-specific answers that do not demonstrate understanding of appropriate clinical care
Case 8: 55-Year-Old Woman with Frozen Shoulder
- Key Areas:
- Diagnosing frozen shoulder
- Confirmatory examination findings
- Initial management of frozen shoulder
- Common Errors:
- General overview statements such as ‘rest’ or ‘avoid lifting’ instead of specific patient education
- Lack of specific physiotherapy referrals or procedural interventions
Case 11: 53-Year-Old Man with Gout
- Key Areas:
- Factors contributing to gout development
- Appropriate diagnostic investigation
- Long-term pharmacological management
- Common Errors:
- Overcoding by providing more responses than requested
- Use of words or symbols that led to extra responses
Gynecology and Endocrinology
Case 12: 21-Year-Old Female Elite Athlete with Menstrual Issues
- Key Areas:
- Pharmacological management of menstrual difficulties
- Identifying adverse effects of anabolic steroid use
- Immediate investigation for significant family cardiac history (electrocardiogram)
- Common Errors:
- Inappropriate treatments such as ‘Implanon’ or ‘Kyleena intrauterine device’
- Listing adverse effects of corticosteroids instead of anabolic steroids
- Prioritizing irrelevant screenings over necessary cardiac investigation
Pediatrics
Case 1: 2½-Month-Old Aboriginal Infant with Non-Specific Febrile Illness
- Key Areas:
- Differential diagnoses for febrile illness in infants
- Appropriate initial investigations
- Preventative health assessment for Aboriginal and Torres Strait Islander children
- Addressing greater health disadvantages and common adolescent health issues
- Common Errors:
- Incorrect diagnoses such as bronchiolitis, otitis media, or acute rheumatic fever
- Extensive irrelevant family history or unrelated symptom questions for the adolescent sister
Case 13: 7-Year-Old Boy with Abdominal Pain and Constipation
- Key Areas:
- Additional history to indicate a serious underlying cause of symptoms
- Non-pharmacological management of constipation
- Common Errors:
- Providing history features already given in the clinical stem
- Vague management answers such as ‘educate’ or ‘reassure’
- Failure to provide specific non-pharmacological strategies for managing constipation
Case 6: 5-Year-Old Girl with Respiratory Symptoms in a Rural Setting
- Key Areas:
- Identifying history features necessitating face-to-face review
- Examination findings necessitating transfer to hospital
- Medico-legal and ethical issues related to providing medical records
- Common Errors:
- Not taking the patient’s age into account
- Providing answers appropriate for infants rather than a 5-year-old child
- Providing similar answers on different lines, missing the opportunity to demonstrate breadth of knowledge
- Incorrectly refusing to provide medical records to the child’s father
Gynecology and Immunology
Case 16: 22-Year-Old Woman with Solid Organ Transplantation Requesting Cervical Cancer Screening
- Key Areas:
- Explanation of rationale behind the changes to the cervical screening program in 2017
- Identifying factors in the patient’s history supporting cervical screening and self-collected samples
- Understanding the importance of immunosuppression, early sexual debut, and patient preferences
- Common Errors:
- Describing the current screening program instead of the rationale for changes
- Incorrectly stating that cervical screening is not required post-HPV vaccination
- Misidentifying factors in history relevant for self-collected samples (e.g., personal history of STIs, family history of cervical cancer)
Case Evolution:
- Partner’s Scenario:
- A transgender man aged 31 years requiring an internal vaginal examination
- Identifying specific approaches to reduce discomfort during the examination
- Common Errors:
- Failing to consider the unique aspects of genital examinations for transgender male patients, providing generic advice instead.
Hepatology
Case 3: 60-Year-Old Woman with Metabolic-Associated Fatty Liver Disease
- Key Areas:
- Identifying metabolic-associated fatty liver disease (MAFLD)
- Appropriate subsequent investigations for MAFLD
- Non-pharmacological management advice for MAFLD
- Common Errors:
- Providing non-specific management advice like ‘healthy diet’ instead of specific dietary or activity recommendations for weight loss
Nephrology
Case 17: 58-Year-Old Man with Impaired Renal Function
- Key Areas:
- Identifying causative factors contributing to impaired renal function (type 2 diabetes, NSAIDs, comorbidities, medications)
- Arranging appropriate investigations to confirm renal impairment and microalbuminuria
- Adjusting medications based on renal function findings
- Common Errors:
- Selecting unnecessary repeat tests instead of prioritising relevant investigations
- Misinterpreting investigation questions, not distinguishing between initial, additional, or diagnostic tests
ENT and Respiratory Medicine
Case 18: 47-Year-Old Man with Chronic Rhinosinusitis
- Key Areas:
- Initial pharmacological management, including cessation of nasal decongestants
- Selecting appropriate investigations if symptoms persist
- Considering smoking cessation management, factoring in monoamine oxidase inhibitor use
- Common Errors:
- Prescribing bupropion for smoking cessation despite contraindications with monoamine oxidase inhibitors
- Failing to consider medication interactions and contraindications
Endocrinology
Case 19: 16-Year-Old Girl with Symptoms of Turner Syndrome
- Key Areas:
- Interpreting clinical information (parental height, growth chart) to make a diagnosis of Turner syndrome
- Arranging appropriate initial investigations, particularly the karyotype
- Providing advice on confidentiality in adolescent consultations, considering Gillick competence
- Common Errors:
- Describing the condition without a specific diagnosis (e.g., ‘delayed puberty’, ‘primary amenorrhoea’)
- Overlooking the importance of a karyotype in initial investigations
- Providing answers unrelated to confidentiality or incorrectly assessing Gillick competence
Cardiology
Case 10: 69-Year-Old Aboriginal Woman Post-Myocardial Infarction
- Key Areas:
- Identifying barriers to medication compliance
- Strategies to assist medication adherence
- Common Errors:
- Making assumptions about the patient based on ethnicity (socioeconomic status, education level, substance use)
- Failing to demonstrate cultural safety in answers
Case 15: 47-Year-Old Man Requesting General Check-Up with Cardiovascular Risks
- Key Areas:
- Identifying additional factors increasing cardiovascular disease risk
- Providing specific lifestyle advice to reduce cardiovascular risk
- Commencing pharmacological management for cardiovascular risk reduction
- Common Errors:
- Providing physical symptoms instead of risk factors (e.g., ‘palpitations’, ‘chest pain’)
- Repeating information already given in the patient history
- Non-specific lifestyle advice (e.g., ‘lose weight’ instead of specific targets)
- Incorrect examples of medications (e.g., ‘ACE-inhibitor, for example candesartan’)
Case 20: 69-Year-Old Man with Poorly Controlled Hypertension
- Key Areas:
- Initial investigations and pharmacological management for poorly controlled hypertension
- Immediate management of hypertensive urgency, including appropriate medication and patient monitoring
- Common Errors:
- Not reading the patient’s medication history correctly
- Providing non-pharmacological answers that did not address the question
- Diagnostic errors, giving non-specific advice, and not following current clinical guidelines
Geriatrics
Case 14: 84-Year-Old Man in Aged Care with Asymptomatic Bacteriuria and Subsequent UTI
- Key Areas:
- Identifying asymptomatic bacteriuria and appropriate management in aged care
- Educating nursing staff on management of non-specific urinary symptoms
- Pharmacological management of a urinary tract infection (UTI)
- Management of a subconjunctival haemorrhage
- Common Errors:
- Advising regular urine testing, which is inappropriate in aged care
- Not administering simple analgesia or prematurely ceasing sodium–glucose cotransporter 2 inhibitors for UTI
- Incorrect management of subconjunctival haemorrhage
Case 21: 86-Year-Old Woman in Aged Care with Hypoglycaemia and Long-Term Cognitive Impairment
- Key Areas:
- Identifying hypoglycaemia secondary to sulfonylurea use and urgent management
- Appropriate initial investigation of long-term cognitive impairment
- Common Errors:
- Not recognizing hypoglycaemia as the most likely diagnosis
- Providing vague answers without effective medical management
- Recommending investigations that had already been performed or were not indicated by current guidelines
Gastroenterology
Case 22: 36-Year-Old Woman with Symptoms Suggestive of Irritable Bowel Syndrome (IBS)
- Key Areas:
- Diagnosing irritable bowel syndrome
- Initial investigations for IBS
- Pharmacological management when conservative measures fail
- Common Errors:
- Selecting less relevant investigations for a patient with several years of symptoms
- Providing answers that did not address the specific patient scenario
Gynecology
Case 2: 31-Year-Old Woman with Symptoms Indicative of Endometriosis
- Key Areas:
- Relevant history for diagnosing endometriosis
- Appropriate initial investigations for endometriosis
- Non-pharmacological actions for opioid therapy management
- Common Errors:
- Misinterpreting clinical information, focusing on other diagnoses like STIs
- Asking history already provided or irrelevant questions
- Listing lifestyle changes instead of non-pharmacological decision-making processes for opioid prescribing
Urology and Ophthalmology
Case 23: 70-Year-Old Woman with Painless Macroscopic Haematuria
- Key Areas:
- Differential diagnoses based on smoking history, occupational chemical exposure, and urine microscopy/culture results
- Appropriate investigations for haematuria
- Management of chalazion
- Common Errors:
- Providing unrelated diagnoses (e.g., ‘renal abscess’, ‘ovarian cancer’) or non-specific answers
- Misinterpreting the question by giving the diagnosis of chalazion rather than management strategies
Dermatology
Case 7: 41-Year-Old Man with Melanoma
- Key Areas:
- Surgical management of melanoma, specifying appropriate margin width
- Patient education about ongoing care and skin cancer prevention
- End-of-life care for metastatic disease
- Common Errors:
- Non-specific description of local excision without specifying margin width
- Inappropriate intervals for skin examination checks
- Overemphasis on sun protection at the expense of other skin cancer education
- Overcoding by providing more answers than requested in end-of-life care
Case 9: 48-Year-Old Man with Scalp Itch and Hair Loss
- Key Areas:
- Differential diagnoses for scalp itch and hair loss
- Initial pharmacological management of scalp psoriasis
- Non-pharmacological management advice
- Common Errors:
- Not recognizing appropriate formulation of topical therapy for the scalp (lotion or shampoo instead of cream)
- Lack of awareness of best practice guidelines
Pulmonology
Case 24: 65-Year-Old Man with Symptoms of Chronic Obstructive Pulmonary Disease (COPD)
- Key Areas:
- Non-pharmacological management advice for COPD
- Identifying additional conditions the patient is at increased risk of
- Specific immunisations appropriate for age and medical condition
- Common Errors:
- Giving generic lifestyle advice irrelevant to the scenario (e.g., alcohol intake, weight management)
- Less-specific answers for immunisations (e.g., ‘influenza immunisation’ rather than age-appropriate immunisation)
Neurology
Case 25: 23-Year-Old Woman with Migraine with Aura Considering Pregnancy
- Key Areas:
- Additional symptoms indicating a serious underlying cause of headache
- Prophylactic medication for migraine suitable for pregnancy
- Long-term effective contraception considering migraine with aura
- Common Errors:
- Asking for symptoms already provided, examination findings, or irrelevant history
- Giving acute migraine treatment rather than prophylaxis or unsuitable medications for pregnancy
- Not recognizing that migraine with aura contraindicates combined hormonal contraception
Psychiatry and Dermatology
Case 26: 19-Year-Old Man with Social Anxiety Disorder
- Key Areas:
- Psychological management strategies specific to social anxiety disorder
- Understanding NDIS eligibility requirements
- Medication for performance anxiety (e.g., propranolol)
- Pharmacological treatment of plantar wart
- Common Errors:
- Providing therapies not indicated for social anxiety or non-specific answers (e.g., ‘refer to psychologist’)
- Confusing NDIS with Centrelink disability support eligibility
- Choosing non-pharmacological treatments for plantar wart
Case 5: 48-Year-Old Man with Depression
- Key Areas:
- Additional history to clarify depression diagnosis
- Identifying first-line medication for depression
- Managing acute suicidal ideation in an emergency services worker
- Common Errors:
- Not including anhedonia and suicidal ideation in the history
- Providing similar variations on answers rather than a broad range
- Recommending involuntary treatment when the patient was willing to receive treatment voluntarily
- Referring for outpatient treatment rather than urgent psychiatric review