2020.1 KFP – public report

Case 1: Pediatrics/Neurology

• Subject Area: Developmental delays in infants.
• Key Topics Discussed: The case involved identifying signs of developmental delay, considering differential diagnoses, recommending further investigations, and providing immunization advice according to the National Immunisation Program Schedule.
• Candidate Performance: Candidates often lacked specificity in their answers, failed to read the case stem fully, and missed considering all key features.
• Improvement Areas: Candidates need to enhance their attention to detail, specifically tailoring their answers to the provided case information and ensuring a comprehensive approach to differential diagnoses and investigation plans.

Case 2: Pediatrics/Gastroenterology

• Subject Area: Gastrointestinal disturbances in school-aged children.
• Key Topics Discussed: The focus was on recurrent abdominal pain and nausea, with an evolution to include a breast lump, requiring differential diagnoses, and appropriate pharmacological management.
• Candidate Performance: Common mistakes included recommending non-pharmacological interventions when pharmacological solutions were sought and suggesting medications inappropriate for the child’s age.
• Improvement Areas: Emphasize age-appropriate pharmacological management and adhere strictly to the case’s requirements, avoiding the provision of unnecessary non-pharmacological advice.

Case 3: Dermatology

• Subject Area: Exacerbation of a chronic dermatological condition.
• Key Topics Discussed: Consideration of exacerbating factors for a long-standing rash, with a focus on topical pharmacological management and appropriate diagnostic investigations.
• Candidate Performance: Errors included suggesting oral medications for a scenario emphasizing topical treatment and mentioning irrelevant exacerbating factors.
• Improvement Areas: Candidates should focus more on relevant topical treatments and closely align their management suggestions with the case specifics.

Case 4: Surgery/Dermatology

• Subject Area: Management of an incidental skin lesion.
• Key Topics Discussed: Initial management actions, considerations for informed consent, and pre-operative medication optimization.
• Candidate Performance: Common errors were repeating information provided in the stem and providing more answers than requested, leading to penalties.
• Improvement Areas: Improve precision in responses, adhere to the instructions regarding the number of answers, and focus on the relevance of provided information.

Case 5: Pediatrics/Infectious Diseases

• Subject Area: 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: Candidates showed a 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.

Case 6: Psychiatry

• Subject Area: Psychiatric presentation in a young adult.
• Key Topics Discussed: Identification of specific aspects of history indicative of psychiatric conditions, differential diagnoses, and appropriate post-admission investigations.
• Candidate Performance: Errors included providing differential diagnoses instead of focusing on history aspects and suggesting diagnoses not aligned with patient demographics.
• Improvement Areas: Focus on gathering a comprehensive history relevant to psychiatric assessments and ensure differential diagnoses are demographically appropriate.

Case 7: Rheumatology/Orthopedics

• Subject Area: Acute and recurrent knee pain.
• Key Topics Discussed: Differential diagnosis based on investigation results, pharmacological management of recurrent knee pain.
• Candidate Performance: Errors included overcoding by listing multiple management options within the same line and lack of specificity in pharmacological management.
• Improvement Areas: Prioritize specificity in management plans, avoid redundancy in pharmacological options.

Case 8: Neurology

• Subject Area: Chronic headaches in a young adult female.
• Key Topics Discussed: Differential diagnoses for chronic headaches, pharmacological management, and later presentation of a rash.
• Candidate Performance: Provision of generic diagnoses like “daily headaches” without specificity.
• Improvement Areas: Provide specific, case-relevant differential diagnoses and management plans.

Case 9: Urology/Geriatrics

• Subject Area: Urinary incontinence in an older female.
• Key Topics Discussed: Differential diagnoses, examination findings, and non-pharmacological management options.
• Candidate Performance: Lack of specificity in differential diagnoses and providing more answers than required.
• Improvement Areas: Focus on providing concise, specific answers and adhering to the requirements of the question.

Case 10: Gynecology

• Subject Area: Cervical screening and post-coital bleeding.
• Key Topics Discussed: Investigations for post-coital bleeding and emergency contraception options.
• Candidate Performance: Many failed to address the need for emergency contraception, offering inappropriate contraceptive options instead.
• Improvement Areas: Address all aspects of the case presentation, including emergency contraception when indicated.

Case 11: Endocrinology

• Subject Area: Symptoms suggestive of an endocrine disorder in an older female.
• Key Topics Discussed: Differential diagnosis, investigation arrangement, and management of ineffective treatment.
• Candidate Performance: Providing factors not relevant to the case presentation.
• Improvement Areas: Ensure relevance and specificity in considering factors affecting treatment efficacy.

Case 12: Dermatology

• Subject Area: Facial rash in a 34-year-old female.
• Key Topics Discussed: Specific history aspects, differential diagnosis, and management strategies.
• Candidate Performance: Repetitive answers and not directly addressing the case presentation.
• Improvement Areas: Provide unique, case-specific answers and focus on direct case management.

Case 13: General Medicine/Indigenous Health

• Subject Area: Tiredness, weight gain, and nocturia in a male Aboriginal patient.
• Key Topics Discussed: Differential diagnoses, investigations, and follow-up for haematuria and proteinuria.
• Candidate Performance: Repeating stem information and providing incongruent differential diagnoses and investigations.
• Improvement Areas: Avoid repetition, ensure differential diagnoses and investigations are relevant to symptoms.

Case 14: Gynecology/Dermatology

• Subject Area: Skin lesion and vulval lump in a young female.
• Key Topics Discussed: Differential diagnoses and informed consent for a vaginal examination.
• Candidate Performance: Lack of knowledge on differential diagnoses and overlooking patient rights in informed consent.
• Improvement Areas: Improve knowledge on differential diagnoses and emphasize patient consent and rights.

Case 15: Internal Medicine

• Subject Area: Deranged magnesium levels in an older female.
• Key Topics Discussed: Contributing factors, management strategies, and further investigations.
• Candidate Performance: Contributing factors provided were incongruent to the case.
• Improvement Areas: Ensure contributing factors and management strategies are relevant to the specific case context.

Case 16: Gynecology/Endocrinology

• Subject Area: Menopausal symptoms and breast cancer risk.
• Key Topics Discussed: Investigations, pharmacological management of menopausal symptoms, addressing concerns about breast cancer.
• Candidate Performance: Lack of knowledge on managing menopausal symptoms and addressing familial cancer concerns.
• Improvement Areas: Increase knowledge on menopause management and incorporate patient history and concerns into management plans.

Case 17: Dermatology/Obstetrics

• Subject Area: Ear lesion and concerns about fetal abnormalities.
• Key Topics Discussed: Differential diagnoses for ear lesion, management actions, and antenatal advice for fetal abnormalities.
• Candidate Performance: Answers incongruent to case presentations and misunderstanding of antenatal screening/diagnostic tests.
• Improvement Areas: Tailor answers to case specifics and understand the role and interpretation of antenatal tests.

Case 18: Pediatrics/Rheumatology

• Subject Area: Acute knee pain and fever in an Aboriginal child.
• Key Topics Discussed: Differential diagnoses, initial investigations, and immediate management.
• Candidate Performance: Inappropriate management actions for the urgency of clinical presentation.
• Improvement Areas: Recognize and address the acuity and urgency of clinical presentations in management plans.

Case 19: Pediatrics/Gastroenterology

• Subject Area: Acute and persistent gastrointestinal symptoms in a child with Down syndrome.
• Key Topics Discussed: Differential diagnoses, public health management, and investigations for ongoing symptoms.
• Candidate Performance: Management actions did not focus on public health implications.
• Improvement Areas: Emphasize public health considerations and appropriate investigations for persistent symptoms.

Case 20: Pediatrics/Orthopedics

• Subject Area: Hip pain in a child and management of parental complaints.
• Key Topics Discussed: Differential diagnoses, initial management, and addressing parental concerns over delayed diagnosis.
• Candidate Performance: Inappropriate initial management and lack of knowledge on handling complaints.
• Improvement Areas: Provide appropriate early management and develop strategies for addressing and resolving complaints.

Case 21: Ophthalmology/Geriatrics

• Subject Area: Worsening vision in an older male.
• Key Topics Discussed: Differential diagnoses, interim management before specialist assessment, and considerations for driving fitness.
• Candidate Performance: Lack of knowledge in differential diagnosis and assessing fitness to drive.
• Improvement Areas: Improve understanding of ophthalmologic conditions and legal/medical standards for driving assessments.

Case 22: Gastroenterology

• Subject Area: Acute abdominal pain and follow-up in an older nurse.
• Key Topics Discussed: Differential diagnoses, interpretation of liver function tests, and management of a skin lesion.
• Candidate Performance: Difficulty in correctly interpreting patterns of liver function test abnormalities.
• Improvement Areas: Enhance skills in interpreting common blood tests and tailoring management to specific clinical findings.

Case 23: Dermatology

• Subject Area: Facial rash in an adolescent female.
• Key Topics Discussed: Non-pharmacological and pharmacological management, monitoring for medication adverse effects, and pre-conception advice.
• Candidate Performance: Lack of specificity in answers and inappropriate responses to key features of the case.
• Improvement Areas: Provide specific management options, closely monitor for adverse effects, and tailor advice to patient’s life stages.

Case 24: Orthopedics/Sports Medicine

• Subject Area: Chronic shoulder pain post-injury in a snowboarder.
• Key Topics Discussed: Differential diagnoses, patient requests for MRI and strong painkillers.
• Candidate Performance: Incorrect differential diagnoses, failure to address patient requests appropriately, and prescribing unsuitable medications.
• Improvement Areas: Correct identification of differential diagnoses, appropriate response to diagnostic and treatment requests.

Case 25: Psychiatry/Addiction Medicine

• Subject Area: Acute alcohol intoxication and cessation in a young adult male.
• Key Topics Discussed: Examination findings, initial investigations, and pharmacological management for alcohol cessation.
• Candidate Performance: Use of generic descriptors in examination findings.
• Improvement Areas: Provide specific examination findings and tailor pharmacological management to support alcohol cessation.

Case 26: Obstetrics/Indigenous Health

• Subject Area: Unexpected pregnancy and pediatric concern in a young Aboriginal woman.
• Key Topics Discussed: Investigations and advice for unexpected pregnancy, assessment of a child with inward eye movements.
• Candidate Performance: Incorrect advice regarding pregnancy and lack of specificity in examination findings.
• Improvement Areas: Provide accurate, culturally sensitive advice for pregnancy and detailed examination findings for pediatric concerns