Febrile Illness and General Management
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
2. 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
3. 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
4. Fever and Dry Cough Management in a Child
- Key Topics Discussed:
- Diagnosis, immediate non-pharmacological, and pharmacological management
- Candidate Performance:
- Lack of knowledge on managing acute conditions in children
- Improvement Areas:
- Specific management strategies for pediatric respiratory conditions, including acute and supportive care
Musculoskeletal and Orthopedic Conditions
1. Slipped Upper Femoral Epiphysis
- Insight:
- The importance of timely diagnosis and management to prevent complications in pediatric orthopedic conditions
- Strengths:
- Recognizing the need for immediate management and referral
- Improvements:
- Avoiding non-specific or inappropriate management strategies that could harm the patient
2. Hip Pain in a Child Refusing to Walk
- Key Topics Discussed:
- Likely diagnosis, further investigations, pharmacological management
- Candidate Performance:
- Adult-oriented diagnoses, lack of pediatric focus
- Improvement Areas:
- Pediatric-focused diagnostic and management strategies for hip pain
Respiratory and Infectious Diseases
1. Simple Upper Respiratory Tract Infection and a Significant Cause in an 18-Month-Old Child
- Key Areas:
- Determining significant underlying causes for respiratory symptoms in a pediatric patient
- Recognizing signs and symptoms that warrant further investigation
- Managing patient and family inquiries about unrelated medical concerns during a consultation
- Common Errors:
- Providing non-specific or irrelevant answers to the history-taking question
- Failing to focus on serious underlying causes of respiratory symptoms
- Not adequately addressing the shift in consultation focus when asked about the husband’s test results
2. Fever and Cough Management in an Aboriginal Infant
- Key Topics Discussed:
- Differential diagnoses, risk factor identification, management actions
- Candidate Performance:
- Failure to recognize high-risk presentations and relevant risk factors
- Improvement Areas:
- Apply knowledge of high-risk factors and evidence-based guidelines to manage serious conditions in Aboriginal health context
3. Acute Respiratory Distress in an Infant
- Key Topics Discussed:
- Identification of physical examination features warranting hospital admission, post-discharge management, and handling unexplained bruising
- Candidate Performance:
- Lack of specificity in physical examination details
- Improvement Areas:
- Focus on specific, relevant physical examination findings indicative of respiratory distress and appropriate management of potential child abuse signs
4. Acute Respiratory Symptoms in a Child
- Key Topics Discussed:
- Immediate management for coughing and shortness of breath, identification of signs requiring hospital admission, and management during transfer
- Candidate Performance:
- Lack of immediate action knowledge for an acutely unwell child
- Improvement Areas:
- Emergency management skills for acute respiratory distress and criteria for hospital admission
Developmental and Behavioral Issues
1. Pediatric Bedwetting in the Context of Parental Separation
- Key Topics Discussed:
- History relevant to underlying diagnosis, non-pharmacological management, handling medical record requests by a non-present parent
- Candidate Performance:
- Repetitive history taking, lack of knowledge on medical record legislation
- Improvement Areas:
- Focus on holistic, non-pharmacological management strategies for bedwetting, and understand medicolegal aspects of patient care, including confidentiality and record release
2. Fever and Jerking in an Infant
- Key Topics Discussed:
- Underlying cause identification, advice on symptom recurrence, immunization advice
- Candidate Performance:
- Gaps in knowledge on immunization program
- Improvement Areas:
- Updated knowledge on immunization schedules and management of acute pediatric conditions
Dermatological and Gastrointestinal Conditions
1. Vaginal Itch and Rash in a Child
- Key Topics Discussed:
- Differential diagnoses, pharmacological and non-pharmacological management
- Candidate Performance:
- Lack of specificity in diagnoses and inappropriate management strategies
- Improvement Areas:
- Specific diagnostic approaches and relevant management strategies for pediatric dermatological conditions
2. Persistent Cough and Fevers in a Child
- Key Topics Discussed:
- Identification of causative pathogens, public health management actions, and management of persistent symptoms
- Candidate Performance:
- Lack of knowledge regarding common pathogens and failed to focus on public health issues in their management plans
- Improvement Areas:
- Enhance understanding of pathogens common in pediatric cases and emphasize public health approaches in management strategies
Developmental Delays and Immunization
1. Developmental Delays in Infants
- Key Topics Discussed:
- Identifying signs of developmental delay, considering differential diagnoses, recommending further investigations, and providing immunization advice according to the National Immunization Program Schedule
- Candidate Performance:
- Often lacked specificity in their answers, failed to read the case stem fully, and missed considering all key features
- Improvement Areas:
- Enhance attention to detail, specifically tailoring answers to the provided case information, and ensure a comprehensive approach to differential diagnoses and investigation plans
2. Routine Childhood Immunizations and Vaccine Opposition
- Key Topics Discussed:
- Identifying contraindications to vaccination, handling vaccine opposition, and managing a facial rash
- Candidate Performance:
- Lack of knowledge on contraindications and legal aspects of vaccination
- Improvement Areas:
- Enhance understanding of vaccination contraindications and legal frameworks regarding parental opposition
Infectious Diseases and Orthopedics
1. Recurrent Fevers in an Aboriginal Child
- Key Topics Discussed:
- Differential diagnosis for recurrent fevers, consent issues
- Candidate Performance:
- Inappropriate diagnostic focus, misunderstanding of consent process
- Improvement Areas:
- Tailored diagnostics for recurrent fever, appropriate consent procedures
2. Hip Pain in a Child
- Key Topics Discussed:
- Differential diagnoses and management of pediatric hip pain
- Candidate Performance:
- Generalized diagnoses and misunderstanding specific causes
- Improvement Areas:
- Develop specific diagnoses and tailored management strategies for pediatric orthopedic issues