Chronic Obstructive Pulmonary Disease (COPD)
65-Year-Old Man with Symptoms of Chronic Obstructive Pulmonary Disease (COPD)
- Key Areas:
- Non-pharmacological management advice for COPD
- Identifying additional conditions the patient is at increased risk of
- Specific immunisations appropriate for age and medical condition
- Common Errors:
- Giving generic lifestyle advice irrelevant to the scenario (e.g., alcohol intake, weight management)
- Less-specific answers for immunisations (e.g., ‘influenza immunisation’ rather than age-appropriate immunisation)
Genetic and Chronic Conditions
Cystic Fibrosis Management and Genetic Counseling
- Insight:
- Comprehensive care in cystic fibrosis, including annual investigations and minimizing infection risk, alongside the importance of genetic counseling.
- Strengths:
- Identifying appropriate monitoring investigations and specific non-pharmacological advice.
- Improvements:
- Enhance counseling skills, especially in genetics, to provide patient and family-centered care.
Respiratory Emergencies
Spontaneous Pneumothorax
- Insight:
- Immediate management of spontaneous pneumothorax and considerations regarding air travel.
- Strengths:
- Accurate diagnosis and understanding of the risks associated with flying.
- Improvements:
- Specificity in management plans, avoiding generic responses.
Obstructive Sleep Apnoea (OSA)
- Insight:
- Comprehensive assessment and management of OSA, including driving safety considerations.
- Strengths:
- Broad approach to history taking and non-pharmacological management advice.
- Improvements:
- Focus on the integration of sleep hygiene and lifestyle modifications alongside driving restrictions.
Pneumonia in a Child
- Key Topics Discussed:
- Identifying severity and prescribing appropriate antibiotics.
- Improvements Needed:
- Recognizing the severity of pneumonia and prescribing the most appropriate antibiotics.
Exercise-Induced Asthma
- Key Topics Discussed:
- Confirming diagnosis and managing treatment, including non-pharmacological steps for non-responsive treatment.
- Improvements Needed:
- Aligning management with current guidelines and focusing on non-pharmacological management when medication fails.
Fever and Cough Management
Fever and Cough Management in an Elderly Woman
- Key Topics Discussed:
- Likely diagnoses, initial pharmacological management, immunisation advice.
- Candidate Performance:
- Gaps in immunisation program knowledge.
- Improvement Areas:
- Update on immunisation schedules and management of respiratory infections in the elderly.
Management of Cough and Shortness of Breath
- Key Topics Discussed:
- Diagnosis from CT scan, further investigations, handling information requests from relatives.
- Candidate Performance:
- Insufficient knowledge on pulmonary conditions and medicolegal aspects.
- Improvement Areas:
- Accurate interpretation of pulmonary investigations and ethical management of information requests.
Worsening Shortness of Breath Management
- Key Topics Discussed:
- Differential diagnoses, management actions considering past medical history.
- Candidate Performance:
- Narrow scope in differential diagnoses and management.
- Improvement Areas:
- Broaden differential diagnoses and management plans to encompass comprehensive medical history.
Progressive Shortness of Breath Management
- Key Topics Discussed:
- Interpretation of spirometry findings, initial management strategies, diagnosis, and management of a new rash.
- Candidate Performance:
- Confusion between pharmacological and non-pharmacological management actions.
- Improvement Areas:
- Clearly differentiate between pharmacological and non-pharmacological management strategies, tailoring actions to spirometry results and clinical presentation.
Culturally Sensitive Management
Acute Respiratory Symptoms in an Aboriginal Man
- Key Topics Discussed:
- Diagnosis, management plan considering patient reluctance for hospital transfer.
- Candidate Performance:
- General responses, lacking urgency in management.
- Improvement Areas:
- Tailored management considering patient’s cultural background and clinical urgency.
Chronic and Acute Respiratory Conditions
Elderly Female with Respiratory Symptoms Management
- Key Topics Discussed:
- Likely diagnosis, appropriate investigations, and non-pharmacological management strategies.
- Candidate Performance:
- Inappropriate pharmacological management for a non-pharmacological question.
- Improvement Areas:
- Develop non-pharmacological management strategies relevant to the clinical presentation.
Management of Cough with Purulent Discharge and Hemoptysis
- Key Topics Discussed:
- Differential diagnoses based on chest X-ray findings and initial investigations for suspected serious condition.
- Candidate Performance:
- Failure to address serious underlying conditions.
- Improvement Areas:
- Recognize and manage potential serious conditions based on clinical and radiographic findings.
Chronic Cough Management and Acute Visual Deterioration in an Elderly Woman
- Key Topics Discussed:
- Management based on spirometry findings, hospital admission criteria, and management of acute visual loss.
- Candidate Performance:
- Poor interpretation of spirometry results and inadequate management plans.
- Improvement Areas:
- Enhance understanding of spirometry interpretation, recognize indications for hospital admission, and manage acute visual changes effectively.
Diagnostic Skills
Spirometry and Chest X-ray Interpretation
- Key Topics Discussed:
- Differential diagnosis based on spirometry and chest X-ray findings.
- Candidate Performance:
- Common errors included misinterpretation of diagnostic tests and incorrect medication examples.
- Improvement Areas:
- Accurate interpretation of diagnostic tests and specific medication choices tailored to the patient’s condition.
Infectious Diseases and Public Health
Hemoptysis and Possible Tuberculosis
- Key Topics Discussed:
- Diagnosis of TB, management including public health measures.
- Candidate Performance:
- Non-specific responses, inadequate investigation selection.
- Improvement Areas:
- Specific investigations for TB, immediate management with infection control.
Persistent Cough Post-Infection
- Medical Heading:
- Respiratory Medicine.
- Key Topics Discussed:
- Differential diagnosis for persistent productive cough, initial investigations to identify underlying cause.
- Candidate Performance:
- Some candidates failed to integrate the patient’s history with symptomatology, leading to unfocused differential diagnoses.
- Improvement Areas:
- Sharpen the ability to link persistent cough symptoms with relevant patient history for focused differential diagnoses. Choose initial investigations that directly contribute to identifying the underlying respiratory condition.
Acute and Chronic Conditions
Middle-Aged Female with Cough, Shortness of Breath, and Exercise Intolerance
- Key Topics Discussed:
- Identification of consolidation on chest X-ray, risk factors for diagnosis, factors indicating severity of presentation.
- Candidate Performance:
- Recognized the need to identify consolidation on the chest X-ray.
- Improvement Areas:
- Repeated information in the scenario or made assumptions about exposure to illnesses. Provided symptoms instead of examination findings.
Prolonged Cough and Haemoptysis
- Medical Heading:
- Infectious diseases, potentially tuberculosis given the patient’s recent emigration from Papua New Guinea.
- Candidate Performance:
- Providing differential diagnoses but needed to focus on the most likely causes considering the patient’s background.
- Improvement Areas:
- Refining the list of differential diagnoses to those most likely in the context of the patient’s history and selecting initial investigations that directly assist in diagnosis.
Respiratory and Cardiac Conditions
Older Male with Acute Shortness of Breath and Previous Chest Pain
- Key Topics Discussed:
- Differential diagnoses and initial investigations for acute shortness of breath, immediate management of acute chest pain in a general practice environment.
- Candidate Performance:
- Recognized the need to identify differential diagnoses for acute shortness of breath. Provided some appropriate initial investigations.
- Improvement Areas:
- Provided a generic list of all possible causes of shortness of breath without focusing on the provided history. Selected ongoing outpatient investigations rather than immediate investigations. Lacked awareness of current guidelines for the management of acute chest pain. Provided non-specific answers and failed to give appropriate drug regimens.