1. Management of Specific Conditions
Postnatal Wrist Pain
- Key Areas: Non-pharmacological management of wrist pain and identifying postnatal depression.
- Improvements Needed: Offering specific, practical advice for wrist pain management and addressing the context of postnatal depression.
Symmetrical Swollen Joints
- Key Areas: Diagnosing, managing while awaiting rheumatologist referral, and identifying drug complications.
- Improvements Needed: Providing management that considers patient information and avoiding contraindicated medications.
Back Pain and Stiffness Evaluation
- Key Topics Discussed: History suggesting underlying diagnoses, appropriate investigations, and pharmacological management.
- Candidate Performance: Responses lacked specificity and diagnostic value.
- Improvement Areas: Focus on specific history elements indicative of underlying conditions, and tailor investigation and management plans accordingly.
Acute Foot Swelling in a Torres Strait Islander Man
- Key Topics Discussed: Likely diagnosis, initial management, and non-pharmacological management for foot swelling.
- Candidate Performance: Generalized responses lacking specificity.
- Improvement Areas: Focus on culturally sensitive, specific diagnostic and management strategies for acute foot swelling.
Paget’s Disease
- Key Topics: Identification and investigation of Paget’s disease of bone.
- Candidate Performance: Incorrect selection of diagnostic tests.
- Improvement Areas: Understanding Paget’s disease diagnosis, including appropriate imaging and management strategies.
2. Chronic Pain and Fatigue Management
Long-term Widespread Pain and Fatigue Management
- Key Topics Discussed: Non-pharmacological and pharmacological management, prognosis factors.
- Candidate Performance: Overlooking past medical history in pharmacological management.
- Improvement Areas: Tailor management strategies to individual patient history, focusing on safe and effective pharmacological options.
Fatigue, Weight Gain, and Joint Pains
- Key Topics Discussed: Differential diagnoses, initial investigations, and pharmacological options for weight loss.
- Candidate Performance: Inconsistent differential diagnoses with clinical features.
- Improvement Areas: Use clinical features to guide differential diagnoses and investigation choices.
Fatigue in a Young Female
- Key Topics: Differential diagnosis for fatigue, appropriate investigation selection.
- Candidate Performance: Repetition of case information, unnecessary diagnostics.
- Improvement Areas: Specific history for fatigue causes, judicious use of investigations.
Tiredness, Weight Gain, and Nocturia in a Male Aboriginal Patient
- Key Topics Discussed: Differential diagnoses, investigations, and follow-up for hematuria and proteinuria.
- Candidate Performance: Repeating stem information and providing incongruent differential diagnoses and investigations.
- Improvement Areas: Avoid repetition, ensure differential diagnoses and investigations are relevant to symptoms.
3. Gout and Arthritis Management
Gout Flare Management
- Key Topics: Clinical examination for gout complications and management.
- Candidate Performance: Confusion between examination findings and signs of complications.
- Improvement Areas: Focus on clinical examination specific to gout and its complications, and articulate specific management plans.
Acute Gout Management
- Key Topics: Pharmacological management of acute gout and long-term non-pharmacological strategies.
- 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).
Symmetrical Joint Pains
- Topic Discussed: Diagnosis and management of new-onset symmetrical significant joint pains in a young female, with initial high inflammatory markers.
- Candidates Did Well On: Offering succinct differential diagnoses.
- Improvement Areas: Some focused on less common conditions instead of the more likely diagnoses. Misuse of abbreviations and inappropriate initial management choices.
Polymyalgia Rheumatica
- Specifics: Some candidates focused on treatment complications rather than identifying key symptoms and complications of the disease itself.
- Improvement Areas: Deepen understanding of polymyalgia rheumatica, including its clinical presentation, key complications, and evidence-based treatment strategies with appropriate medication dosages.
4. Dermatological and Rheumatological Overlap
Dermatological and Rheumatological Issues
- Topic Discussed: Management of patients presenting with both dermatological and rheumatological symptoms, including skin lesions and gouty tophi.
- Candidates Did Well On: Identifying lesions through clinical photographs.
- Improvement Areas: Some focused on describing the lesion rather than addressing the management question. There was also confusion over diagnosing and managing gouty tophi.
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.
- 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.
Joint Pains and Skin Lesions
- Medical Heading: Rheumatology and Dermatology.
- Key Topics: Identification of skin lesions, connection to systemic symptoms like joint pains and bowel changes.
- Candidate Performance: Struggled to choose investigations that directly contribute to a focused diagnosis, often opting for generalized batch testing.
- Improvement Areas: Improve selection of targeted investigations based on clinical presentation to avoid unnecessary broad testing, focusing on integrating skin and systemic symptoms for diagnosis.