Renal Function and Chronic Kidney Disease
1. 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 prioritizing relevant investigations
- Misinterpreting investigation questions, not distinguishing between initial, additional, or diagnostic tests
2. Chronic Kidney Disease
- Key Areas:
- Monitoring and managing deteriorating renal function
- Adjusting medications to minimize renal impairment
3. Moderate Renal Disease
- Topic Discussed:
- Management of moderate renal disease resulting from previously undiagnosed hypertension
- Candidates Did Well On:
- Rational choice of investigations for diagnosing common conditions like hypertension and its renal effects
- Improvement Areas:
- Many candidates chose investigations that would not directly assist in diagnosing the underlying pathology or managing the patient’s renal disease effectively
4. Renal Disease and Anemia
- Specifics:
- Confusion about the type of anemia and its management
- Some candidates suggesting irrelevant tests or failing to distinguish between immediate and long-term management strategies
- Improvement Areas:
- Clarify the management of anemia in the context of renal disease
- Focus on treatments that address the underlying cause and are suitable for the patient’s overall health status
5. Microscopic Hematuria
- Topic Discussed:
- Investigation of microscopic hematuria discovered during a routine medical exam
- Candidates Did Well On:
- Outlining relevant investigations based on patient history
- Improvement Areas:
- Selecting age and gender-appropriate investigations
- Avoiding unnecessary tests like PSA in young men or cystoscopy as initial steps
Nephrology – Acute and Pregnancy-Related Conditions
1. Pyelonephritis in Pregnancy
- Insight:
- Recognizing the seriousness of pyelonephritis in pregnancy and the necessity for immediate management, including hospital transfer
- Strengths:
- Identifying appropriate pharmacological management and the need for transfer to a tertiary center
- Improvements:
- Improve severity assessment skills to avoid underestimating the patient’s condition
2. Acute Limb Swelling and Abnormal Urinalysis in an Aboriginal Man
- Key Topics Discussed:
- Likely diagnosis based on swelling and urinalysis
- Appropriate investigations
- Non-pharmacological management for an itchy rash
- Candidate Performance:
- Insufficient knowledge on differential diagnosis
- Inappropriate pharmacological focus for a non-pharmacological management question
- Improvement Areas:
- Accurate diagnosis and tailored investigation choices
- Emphasis on non-pharmacological management strategies
Nephrology – Lithium and Renal Dysfunction
1. Lithium Management in Renal Dysfunction
- Key Topics:
- Management of lithium treatment in a patient with deteriorating renal function
- Candidate Performance:
- Inadequate management of renal dysfunction and hypertension in a patient on lithium
- Improvement Areas:
- Monitoring and adjusting lithium therapy in patients with renal changes
- Managing comorbid conditions
General and Integrative Management
1. Progressive Fatigue and Muscle Weakness
- Medical Heading: Neurology
- Key Topics:
- Identifying symptoms indicative of neurological conditions
- Initial neurological investigation selection
- Management of a suspicious skin lesion
- Candidate Performance:
- Good identification of symptoms suggestive of myasthenia gravis
- Some confusion over specific neurological investigations needed
- Management strategies for the skin lesion sometimes missed the mark
- Improvement Areas:
- Enhance knowledge on neurological investigation specifics for conditions like myasthenia gravis
- Clarify dermatological management principles for common skin conditions