Metabolic and Gastrointestinal Conditions
1. Metabolic-Associated Fatty Liver Disease (MAFLD)
- 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
2. Gastroesophageal Reflux Disease and H. pylori Infection
- Insight:
- The importance of accurate diagnosis and tailored treatment for gastroesophageal reflux and H. pylori infection
- Strengths:
- Effective identification of initial investigations and combination pharmacotherapy for H. pylori
- Improvements:
- Improve specificity in history-taking and preparation advice for diagnostic tests
3. Coeliac Disease in a Teenager
- Key Areas:
- Diagnosis
- Confirmatory investigations
- Non-pharmacological management
- Improvements Needed:
- Providing specific advice for managing coeliac disease, including dietary modifications
4. Recurrent Abdominal Pain Post-Colon Cancer
- Key Topics Discussed:
- Further history enquiry
- Investigations
- Advising the patient’s son on screening
- Improvements Needed:
- Offering advice in line with current screening guidelines
5. Fluctuating Abdominal Pain Management
- Key Topics Discussed:
- Diagnosis
- Pharmacological management
- Specific dietary advice
- Candidate Performance:
- General dietary advice not addressing specific presentation
- Improvement Areas:
- Specific, evidence-based dietary and pharmacological management tailored to the gastrointestinal condition
6. Acute Abdominal Pain, Diarrhoea, and Fever Management
- Key Topics Discussed:
- Diagnosis
- Investigations
- Lifestyle advice post-recovery
- Candidate Performance:
- Incorrect diagnoses and inappropriate lifestyle advice
- Improvement Areas:
- Accurate diagnostic assessment
- Evidence-based investigation plans
- Lifestyle advice reflective of current guidelines
7. Gastrointestinal Disturbances in School-Aged Children
- Key Topics Discussed:
- Recurrent abdominal pain and nausea
- Differential diagnoses
- Appropriate pharmacological management
- Candidate Performance:
- Recommending non-pharmacological interventions when pharmacological solutions were sought
- Suggesting medications inappropriate for the child’s age
- Improvement Areas:
- Emphasize age-appropriate pharmacological management
- Adhere strictly to the case’s requirements, avoiding the provision of unnecessary non-pharmacological advice
8. Gastrointestinal Symptoms
- Key Topics:
- Differential diagnoses for GI symptoms
- Essential history
- Investigations
- Candidate Performance:
- Repeating information
- Irrelevant past medical history exploration
- Improvement Areas:
- Focused history taking
- Selection of investigations to refine diagnosis
9. 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
10. New-Onset Rectal Discharge Management
- Key Topics Discussed:
- Differential diagnoses for rectal discharge
- Immediate management actions
- Candidate Performance:
- Lack of knowledge on sexually transmitted infections management
- Improvement Areas:
- Enhance understanding of sexually transmitted infections and their management, focusing on specificity
11. Ascites due to Cirrhosis
- Insight:
- Tailoring management to the specifics of cirrhosis complications, emphasizing the balance between pharmacological and non-pharmacological treatments
- Strengths:
- Appropriate selection of investigations to monitor cirrhosis
- Improvements:
- Avoid non-specific advice and focus on cirrhosis-specific management strategies
Liver Conditions
1. Cholestatic Picture on Liver Function Tests
- Key Topics:
- Focused history taking for liver dysfunction
- Differential diagnosis and secondary investigations
- Candidate Performance:
- Some candidates explored unrelated history aspects or failed to tailor differential diagnoses to the provided cholestatic picture
- Improvement Areas:
- Hone in on relevant history and symptoms that directly relate to liver function abnormalities and select investigations that clarify the nature of cholestasis
2. 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
3. Abnormal Liver Function Tests
- Key Topics:
- Liver function test interpretation
- Impact of excessive paracetamol use
- Candidate Performance:
- Missed connecting abnormal liver function tests with excessive paracetamol use, leading to broader, less focused differential diagnoses
- Improvement Areas:
- Emphasize understanding the effects of common medications like paracetamol on liver function and refine differential diagnosis based on detailed patient history and medication use
4. Middle-aged Male with Prolonged Fever and Abnormal Liver Function Tests
- 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
Gastroenterology – Acute Abdominal Pain
1. Acute Abdominal Pain Management in a Rural Emergency Setting
- Key Topics Discussed:
- Initial investigations
- Immediate management
- Fitness to drive evaluation
- Candidate Performance:
- Inadequate management of clinical acuity and fitness to drive assessment
- Improvement Areas:
- Prioritize immediate management actions for acute presentations
- Apply criteria for assessing fitness to drive
2. Acute Abdominal Pain and Follow-Up in an Older Nurse
- Key Topics Discussed:
- Differential diagnoses
- Interpretation of liver function tests
- Management of a skin lesion
- Candidate Performance:
- Difficulty in correctly interpreting patterns of liver function test abnormalities
- Improvement Areas:
- Enhance skills in interpreting common blood tests and tailoring management to specific clinical findings
3. Acute Abdominal Pain Management in a Rural Setting
- Key Topics Discussed:
- Initial investigations
- Immediate management actions for acute abdomen
- Post-surgical care
- Candidate Performance:
- Lack of specificity in management and consideration of rural healthcare challenges
- Improvement Areas:
- Prioritize immediate and specific investigation and management strategies suitable for rural healthcare settings