Gastrointestinal Cases – KFP public report review 2016-2024 topics in exam

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