Case 1: Neurology/Cardiology – ‘Funny Turn’
- Topic Discussed: A male patient presents with a non-specific ‘funny turn,’ possibly indicating a transient neurological or cardiovascular event.
- Candidates Did Well On: Identifying the correct diagnosis based on the provided scenario.
- Improvement Areas: Selecting appropriate and immediate investigations was challenging for some. Candidates often chose investigations relevant for later stages rather than focusing on those needed immediately upon presentation.
Case 2: Ophthalmology – Range of Eye Conditions
- Topic Discussed: Diagnosis and management of various ophthalmological conditions, including ‘red eye’ and other common presentations.
- Candidates Did Well On: Recognizing classic descriptions and using clinical photographs to guide diagnoses.
- Improvement Areas: Incorporating all provided information for differential diagnoses was a common challenge. Some candidates failed to match their differentials with the clinical presentations closely.
Case 3: Respiratory Medicine – COPD
- Topic Discussed: A patient presenting with persistent shortness of breath, leading to a diagnosis of Chronic Obstructive Pulmonary Disease (COPD).
- Candidates Did Well On: Tracing through differential diagnoses to initial investigations and treatment initiation.
- Improvement Areas: Avoiding unnecessary focus on cardiac disease or lung neoplasms not supported by the chest X-ray findings. Some candidates also misused or misunderstood medical abbreviations, particularly in medication management.
Case 4: Hematology – Chronic Hematological Condition
- Topic Discussed: New symptoms in a patient with a previously stable chronic hematological condition, requiring further investigation.
- Candidates Did Well On: Identifying additional necessary information for diagnosis.
- Improvement Areas: Recognizing the potential rapid progression of chronic conditions and the importance of specific, targeted answers rather than vague or general responses.
Case 5: Nephrology – 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.
Case 6: Dermatology/Rheumatology – Dermatological and Rheumatological Issues
- Topic Discussed: Management of patients presenting with both dermatological and rheumatological symptoms, including skin lesions and gouty tophi.
- Candidates Did Well On: Identifying lesions through clinical photographs.
- Improvement Areas: Some focused on describing the lesion rather than addressing the management question. There was also confusion over diagnosing and managing gouty tophi.
Case 7: Orthopedics/Geriatrics – Lower Thoracic Pain
- Topic Discussed: Investigation and non-pharmacological management of acute onset lower thoracic midline pain in an elderly patient.
- Candidates Did Well On: Selecting appropriate investigations for the initial presentation.
- Improvement Areas: Many candidates recommended pharmacological treatments instead of focusing on the requested non-pharmacological management strategies.
Case 8: Pediatrics/Immunology – Immunization
- Topic Discussed: Appropriate immunizations for an 18-month-old Aboriginal child, including addressing parental vaccine concerns.
- Candidates Did Well On: Identifying additional and scheduled vaccines for the child.
- Improvement Areas: Some responses did not directly address the parents’ specific concerns, opting for general advice on Aboriginal and Torres Strait Islander health issues.
Case 9: Rheumatology – Symmetrical Joint Pains
- Topic Discussed: Diagnosis and management of new-onset symmetrical significant joint pains in a young female, with initial high inflammatory markers.
- Candidates Did Well On: Offering succinct differential diagnoses.
- Improvement Areas: Some focused on less common conditions instead of the more likely diagnoses. There was also misuse of abbreviations and inappropriate initial management choices.
Case 10: Psychiatry – Underlying Mental Health Issues
- Topic Discussed: A female patient with multiple emergency department attendances, suggesting underlying mental health issues.
- Candidates Did Well On: Analyzing the scenario to develop a differential diagnosis list and identify key risks.
- Improvement Areas: Some candidates focused excessively on organic causes rather than considering the patient’s mental health, and general terms were often used instead of specific management strategies.
Case 11: Gynecology – Mirena IUD Side Effects
- Topic Discussed: Management of side effects related to the Mirena Intrauterine Device (IUD).
- Candidates Did Well On: Approaching initial advice and considering ongoing management strategies.
- Improvement Areas: Candidates needed to be more specific in their management approaches, indicating a lack of familiarity with Mirena IUD’s specific management or broader applications in women’s health. Avoid general terms and ensure knowledge of contemporary treatment.
Case 12: Dermatology – Guttate Psoriasis
- Topic Discussed: Diagnosis and management of guttate psoriasis in a teenager.
- Candidates Did Well On: Correctly identifying guttate psoriasis.
- Improvement Areas: Many leaned towards symptomatic treatments rather than addressing the psoriasis directly. There was an over-reliance on emollients and insufficient focus on specific psoriasis management. Precise usage of topical steroids, including potency, is crucial.
Case 13: Dermatology – Pigmented Lesion Assessment
- Topic Discussed: Evaluation and management of a changing pigmented lesion, emphasizing the importance of frameworks like ABCDE or Glasgow for assessment.
- Candidates Did Well On: Using frameworks to assess pigmented lesions.
- Improvement Areas: Failing to mention biopsy or histopathology with excision led to missed scores. Essential to ensure histology of any excised lesion for medico-legal reasons.
Case 14: Urology – 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.
Case 15: Endocrinology – Tender Goitre
- Topic Discussed: Differential diagnoses and management of an acutely tender goitre.
- Candidates Did Well On: Identifying immediate management priorities.
- Improvement Areas: Selection of specific tests that help differentiate causes of an acutely tender goitre, focusing on managing pain and tenderness effectively.
Case 16: Infectious Diseases – Atypical Pneumonia
- Topic Discussed: Diagnosis of atypical pneumonia in a pet shop worker, likely zoonotic in origin.
- Candidates Did Well On: Narrowing down the most likely diagnosis based on occupational exposure.
- Improvement Areas: Providing focused, specific answers. Avoid expanding on multiple unrelated aspects of history together.
Case 17: Emergency Medicine/Pediatrics – Acute Epiglottitis
- Topic Discussed: Diagnosis and immediate management of acute epiglottitis in a child at a remote hospital.
- Candidates Did Well On: Identifying a life-threatening condition.
- Improvement Areas: Considering the remote location in management plans, ensuring that treatment options are realistic for the setting.
Case 18: Geriatrics/Psychiatry – Behavioral Changes in Elderly
- Topic Discussed: Possible causes and management of sudden behavioral changes in an elderly care facility resident.
- Candidates Did Well On: Choosing initial investigations wisely.
- Improvement Areas: Providing specific management strategies, including reviewing and adjusting medications based on the provided list.
Case 19: Surgery – Penetrating Finger Injury
- Topic Discussed: Immediate management and potential complications of a penetrating injury to the distal phalanx.
- Candidates Did Well On: Identifying steps for immediate management.
- Improvement Areas: Specifying analgesia type and considering a broad range of complications, not just infections.
Case 20: Hematology – Macrocytic Anemia
- Topic Discussed: Investigation and management of macrocytic anemia with low B12 levels, indicating potential pernicious anemia.
- Candidates Did Well On: Identifying possible underlying causes based on history.
- Improvement Areas: Progressing with investigations to confirm pernicious anemia, recognizing outdated tests like the Schilling test, and avoiding inappropriate initial investigations.
Case 21: Cardiology/Emergency Medicine – Leaking Aortic Aneurysm
- Topic Discussed: Identification and management of a leaking aortic aneurysm, differentiating it from a ruptured aneurysm.
- Candidates Did Well On: Careful reading of the scenario to identify the correct diagnosis.
- Improvement Areas: Specifying the urgency and details of the transfer to a higher level of care.
Case 22: Pediatrics/Surgery – Inguinal Swelling in Infant
- Topic Discussed: Diagnosis and management of inguinal swelling in a six-week-old baby, emphasizing the need for timely intervention.
- Candidates Did Well On: Identifying the need for an appropriate and timely referral.
- Improvement Areas: Recognizing the urgency of the situation and the specific needs of pediatric patients regarding hernias.
Case 23: Psychiatry – Aggressive Behavior in Group Home Resident
- Topic Discussed: Underlying causes and management of increased aggressive behavior.
- Candidates Did Well On: Adopting a holistic approach in managing the patient.
- Improvement Areas: Avoiding a broad list of potential infections or medications without specific evidence from the scenario.
Case 24: Gastroenterology – Abdominal Pain and Weight Loss
- Topic Discussed: Investigation of increasing abdominal pain and weight loss, and managing abnormal results.
- Candidates Did Well On: Identifying important differential diagnoses.
- Improvement Areas: Ensuring follow-up on abnormal results, emphasizing the duty of care.
Case 25: Emergency Medicine/Gynecology – Lower Abdominal Pain
- Topic Discussed: Differential diagnosis of right-sided lower abdominal pain in a female patient, with an emphasis on excluding ectopic pregnancy.
- Candidates Did Well On: Considering ectopic pregnancy as a differential.
- Improvement Areas: Including pregnancy tests in the initial investigation list to exclude pregnancy-related conditions.
Case 26: Psychiatry – Bipolar Depression in Older Patient
- Topic Discussed: Management of bipolar depression, focusing on a holistic approach including medication monitoring and support for the patient and family.
- Candidates Did Well On: Considering a comprehensive management plan that addresses medication, education, and support.
- Improvement Areas: Ensuring specific, targeted education and support strategies rather than generic mentions of education or review.
Related