2016.1 KFP – public report

Case 1: Respiratory Medicine – Prolonged Cough and Haemoptysis

• Medical Heading: Infectious diseases, potentially tuberculosis given the patient’s recent emigration from Papua New Guinea.
• Candidates Did Well On: 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.

Case 2: Musculoskeletal Medicine – Acute Back Pain

• Medical Heading: Orthopedics or musculoskeletal medicine, with considerations for comorbid conditions.
• Candidates Did Well On: Identifying likely differential diagnoses but sometimes failed to narrow these down appropriately.
• Improvement Areas: Avoiding broad or irrelevant differential diagnoses and focusing on next steps after investigations that are directly relevant to managing a simple musculoskeletal injury.

Case 3: Cardiology – Suspected Cardiac Failure

• Medical Heading: Cardiology, focusing on heart failure management.
• Candidates Did Well On: Offering medication changes for heart failure management.
• Improvement Areas: Ensuring answers are specific and evidence-based, avoiding general management strategies not directly related to heart failure.

Case 4: Neurology – Unilateral Severe Facial Pain

• Medical Heading: Neurology, specifically assessing and managing trigeminal neuralgia.
• Candidates Did Well On: Diagnosing based on classic presentation but struggled with further assessment specifics.
• Improvement Areas: Providing focused management strategies beyond investigations, specifically targeting the facial pain with appropriate treatments.

Case 5: Dermatology – Lesion Management

• Medical Heading: Dermatology, focusing on lesion diagnosis and management.
• Candidates Did Well On: Safe management of one lesion requiring excision and biopsy, and recognizing benign nature of the second lesion.
• Improvement Areas: Avoiding incorrect focus on patient’s history of melanoma for both lesions and concentrating on specific diagnoses and management for presented lesions.

Case 6: Sports Medicine – Hamstring Injury and Erythema Nodosum

• Medical Heading: Sports medicine and dermatology.
• Candidates Did Well On: Being concise and specific in diagnosing the hamstring injury and identifying erythema nodosum.
• Improvement Areas: Avoiding multiple diagnoses when only one is asked for and focusing on the most likely causes for erythema nodosum in the clinical scenario.

Case 7: Urology – Swollen Scrotum

• Medical Heading: Urology, with a focus on differential diagnosis and assessment of a swollen scrotum.
• Candidates Did Well On: Identifying likely diagnoses but struggled with appropriate examination detail.
• Improvement Areas: Providing focused and concise examination details relevant to diagnosing the cause of scrotal swelling.

Case 8: Endocrinology – Gestational Diabetes

• Medical Heading: Obstetrics and endocrinology, managing diabetes in pregnancy.
• Candidates Did Well On: Focusing on specific diabetes management in pregnancy and addressing Vitamin D deficiency according to guidelines.
• Improvement Areas: Ensuring management strategies are specifically tailored to gestational diabetes and not general diabetes management.

Case 9: Infectious Disease – Sexually Transmitted Infection

• Medical Heading: Infectious disease, focusing on STI management in an indigenous teenager.
• Candidates Did Well On: Identifying need for specific investigation and correct antibiotic treatment.
• Improvement Areas: Considering cultural aspects and providing focused follow-up and advice specific to STI management.

Case 10: Psychiatry – Mental Health and Suicide Risk

• Medical Heading: Psychiatry, assessing suicide risk and developing a safety plan.
• Candidates Did Well On: Identifying risk factors and appropriate safety plan management.
• Improvement Areas: Avoiding lists of answers, broad, non-specific responses, or providing information already given in the scenario.

Case 11: Ophthalmology – Red Watery Eye

• Medical Heading: Ophthalmology, focusing on differential diagnoses and examination of a unilateral red eye in a child.
• Candidates Did Well On: Identifying age-appropriate causes of a red eye.
• Improvement Areas: Focusing on specific examination relevant to the eye and avoiding over-generalization or irrelevant examination details.

Case 12: Geriatric Medicine – Pain Management and Polypharmacy

• Medical Heading: Geriatrics, addressing pain management and polypharmacy in an elderly nursing home resident.
• Candidates Did Well On: Applying knowledge to the case specifics and comorbidities.
• Improvement Areas: Focusing on reducing polypharmacy according to evidence-based guidelines and specific analgesia options for palliative care.

Case 13: Pediatrics – Persistent Cough in a Child

• Medical Heading: Pediatrics, focusing on the management of a suspected inhaled foreign body.
• Candidates Did Well On: Identifying a possible inhaled foreign body as the cause.
• Improvement Areas: Specifying the urgency of referral and the appropriate investigations in the context of a foreign body inhalation.

Case 14: Obstetrics – Breastfeeding Issues and Mastitis

• Medical Heading: Obstetrics, focusing on breastfeeding challenges and early signs of mastitis.
• Candidates Did Well On: Providing initial breastfeeding support and identifying mastitis.
• Improvement Areas: Being concise in management strategies without over-justification or listing multiple treatment options.

Case 15: Adolescent Medicine – Menstrual Pattern Change

• Medical Heading: Adolescent medicine, with a focus on differential diagnosis of menstrual changes and eating disorders.
• Candidates Did Well On: Identifying key diagnoses and relevant investigations.
• Improvement Areas: Focusing on specific management strategies that are directly relevant to the diagnosis of an eating disorder, avoiding broad or unrelated treatment options.

Case 16: Addiction Medicine – Migraine and Drug Seeking

• Medical Heading: Addiction medicine and neurology, assessing and managing migraine in the context of potential drug-seeking behavior.
• Candidates Did Well On: Demonstrating a safe approach to drug-seeking behaviors.
• Improvement Areas: Being concise and avoiding lists or justifications in management responses, and prescribing inappropriate medications like pethidine.

Case 17: Geriatric Medicine – Delirium and Falls

• Medical Heading: Geriatrics, focusing on the management of delirium and fall prevention.
• Candidates Did Well On: Identifying possible causes for acute confusion and behavior change.
• Improvement Areas: Demonstrating a holistic approach to falls risk management, avoiding overemphasis on single aspects like fracture minimization.

Case 18: Infectious Disease – Lymphadenopathy in a Traveler

• Medical Heading: Infectious diseases, focusing on differential diagnosis of lymphadenopathy in a returning traveler.
• Candidates Did Well On: Focusing on concise differential diagnoses relevant to the travel history.
• Improvement Areas: Identifying appropriate investigations and the most important management step of excision/biopsy of the affected node.

Case 19: Respiratory Medicine – Bronchiectasis

• Medical Heading: Respiratory medicine, focusing on the diagnosis and management of bronchiectasis.
• Candidates Did Well On: Identifying bronchiectasis and its predisposing conditions.
• Improvement Areas: Focusing on specific management strategies for maintaining optimal lung function, including mucous clearance and appropriate medication.

Case 20: Emergency Medicine – Facial Trauma

• Medical Heading: Emergency medicine, assessing and managing facial trauma.
• Candidates Did Well On: Identifying important examination aspects to exclude serious pathology.
• Improvement Areas: Providing a specific diagnosis and targeted management steps for facial trauma, avoiding broad or generic answers.

Case 21: Emergency Medicine – Snake Bite

• Medical Heading: Emergency medicine, focusing on first aid and management of a snake bite.
• Candidates Did Well On: Identifying pressure immobilization as essential first aid.
• Improvement Areas: Specifying immediate and appropriate onsite management upon medical assessment, including monitoring for signs of envenomation.

Case 22: Respiratory Medicine – Pneumonia

• Medical Heading: Respiratory medicine, managing pneumonia or severe viral infection symptoms.
• Candidates Did Well On: Identifying infective processes based on clinical findings and chest x-ray.
• Improvement Areas: Focusing on the single most important management action, emphasizing the urgency of hospital transfer for assessment and treatment.

Case 23: Dermatology – Dermatomycosis and Breast Swelling

• Medical Heading: Dermatology and adolescent medicine, focusing on fungal infections and normal pubertal changes.
• Candidates Did Well On: Identifying fungal infection management and normal pubertal breast changes.
• Improvement Areas: Avoiding over-investigation for normal pubertal changes and focusing on education and reassurance for normal body changes.

Case 24: Gastroenterology – Gastro-Esophageal Reflux Progression

• Medical Heading: Gastroenterology, managing symptoms of gastro-esophageal reflux and identifying further diagnoses.
• Candidates Did Well On: Identifying the condition and considering a range of possible conditions.
• Improvement Areas: Avoiding focus on acute events when chronic symptoms are presented, ensuring a comprehensive consideration of the patient’s symptoms.

Case 25: Cardiology – Atrial Fibrillation

• Medical Heading: Cardiology, focusing on the diagnosis and management of atrial fibrillation.
• Candidates Did Well On: Identifying atrial fibrillation from an ECG and relevant investigations.
• Improvement Areas: Focusing on specific investigations to determine the cause of atrial fibrillation and principles of managing atrial fibrillation including rate, rhythm, and embolic risk.

Case 26: Palliative Care – Advanced Glioblastoma

• Medical Heading: Palliative care, managing an advanced glioblastoma patient in a home environment.
• Candidates Did Well On: Acknowledging the cultural setting and ensuring holistic care.
• Improvement Areas: Focusing on all aspects of patient care, including physical, social, spiritual, and legal aspects, and demonstrating appropriate end-of-life planning.