RACGP KFP Exam – Exam Reports

General comments:

• Candidates must answer the question in the context of the clinical scenario, using all the information provided. The information will be relevant to consider in response to each question and will impact answers, because it may provide information that could significantly impact investigations or management.
• It is important to ensure that the answers provided are relevant to the key features of the case presentation, including the age, gender, comorbidities and other information provided.
• Provide only the number of answers requested; providing additional answers increases the risk of overcoding.
• Do not provide examples unless requested.
• Be specific in answers. Non-specific answers may not score or could attract fewer marks.
• Ensure that the answers provided are appropriate to, and address the severity and acuity of, illness within the case presentation, as well as the location of the patient encounter.
• Because the cases are all developed in line with current guidelines, it is important that candidates are aware of current clinical guidelines relevant to the provision of primary care at Fellowship level.
• Candidates should access the practice exams provided and use the RACGP assessment resources, such as the exam support online modules accessed via gplearning.
• From 2023.2 onwards there will be no drug doses required within the KFP, although candidates may still be required to provide route of administration or frequency of administration.

James Notes

• The KFP exam is designed to assess whether candidates can apply their knowledge and skills to an individual patient scenario, ensuring all information is considered, and tailoring their investigations and management.
  • Failing to do this when providing answers will significantly reduce the number of marks awarded.
• Answer the question asked – Answer the question asked – Answer the question asked
• It is important that all answers directly address the questions asked within the case.
• If asked for pharacological managment, provide pharmacological management!
  • From 2023.2 onwards there will be no drug doses required within the KFP, although candidates may still be required to provide route of administration or frequency of administration.
  • Deprescribing is considered pharmacological management
  • Dose changes are considered pharacological management
• If asked for non-pharmacological managment, provide non pharmacological management!
• Be specific because generic non specific answers do not score marks ie
  • “lose weight” (no marks) “Assist the patient to lose weight via a structured weight loss plan”
  • “physio referral” (no marks) “Non-urgent referral to physio for graded strengthening exercises”
• Think carefully about whether referral or tranfer is required
  • If referral is required is it urgent?
• In the KFP exam it is important to only provide the number of answers requested, demonstrating rationalisation of responses.
  • Using ‘and’, ‘or’ and ‘/’ within an answer can be signs of overcoding.
  • Each additional answer attracts a 0.25% penalty from the candidate’s overall score.
• In the KFP exam it is important to read investigation questions carefully because answers may be quite different for ‘initial investigations’ versus ‘diagnostic investigations’.
• In KFP questions that focus on the management of musculoskeletal presentations, candidates will often respond with ‘rest, ice, compression and elevation’. These answers are either impractical or incorrect given the context and are not awarded marks. They do not demonstrate to the examiner any understanding of the presentation and, when written on one line, will result in overcoding.
• Several candidates did not complete the final case. Candidates should remember that all cases in the KFP are equally weighted and careful time management is important to ensure the most marks are gained. Do not run out of time! 2 questions per 15 minutes finishes in 3 1/4 hours so aim for that ie 8 questions per hour.
• Cases will often change direction to assess across the domains of general practice so don’t fixate on the initial question if a new question is asked.
• Some candidates provided drug classes rather than specific medication, or provided drug classes and then an example that was often incorrect. In the KFP exam, only provide examples when asked for them. Extra marks are not awarded for examples unless they are asked for.
• DO NOT give patients medication they noted to be allergic to!
• DO NOT look to medication when the ABCs need attention ie Airway, Breathing, Circulation are priority 1, 2 and 3.
• Immunisations are frequently assessed in the KFP exam as a core component of the RACGP Curriculum.
• When considering pharmacological management actions, it is important to consider the appropriateness of adding further medications when cessation of a currently prescribed medication could be a more appropriate strategy.
• Common errors included providing items of history that were already provided within the case presentation, and management actions that did not consider the patient holistically.

Summary of conditions examined

KFP 2016.1

1. Prolonged Cough; Haemoptysis; Recent Emigration
2. Acute Back Pain; Musculoskeletal Injury; Comorbidity Management
3. Suspected Cardiac Failure; Elderly Patient; Pharmacological and Non-Pharmacological Management
4. Abnormal Vaginal Bleeding; Perimenopausal Woman; Investigation Plan
5. Chronic Fatigue; Young Adult; Psychological and Physical Evaluation
6. Polypharmacy Management; Elderly Patient; Medication Review
7. Acute Migraine; Recurrent Headache; Pharmacological and Non-Pharmacological Strategies
8. Child with Persistent Fever; Possible Meningitis; Emergency Management
9. Abdominal Pain and Weight Loss; Possible Malignancy; Diagnostic Approach
10. Acute Abdominal Pain in Pregnancy; Ectopic Pregnancy; Emergency Referral
11. Breast Lump in a Young Woman; Investigation; Referral
12. Acute Ankle Injury; Suspected Fracture; Immediate Management
13. Postnatal Depression; New Mother; Psychological Support
14. Constipation in an Elderly Woman; Medication Side Effects; Management Plan
15. Acute Urinary Retention; Male Patient; Possible Prostate Enlargement
16. Recurrent UTI in a Diabetic Patient; Investigation; Antibiotic Stewardship
17. Suspected DVT; Lower Limb Swelling; Diagnostic Approach
18. Uncontrolled Hypertension; Middle-Aged Patient; Risk Factor Management
19. Skin Rash in a Middle-Aged Woman; Possible Psoriasis; Topical Therapy
20. Chronic Cough and Haemoptysis; Smoker; Lung Cancer Screening
21. Lower Back Pain; Occupational Injury; Rehabilitation Plan
22. Chronic Diarrhoea; Young Adult; Differential Diagnosis
23. Chronic Headache; Neurological Examination; MRI Brain
24. Shoulder Pain and Restricted Movement; Rotator Cuff Tear; Physical Therapy
25. Palpitations in a Middle-Aged Woman; Thyroid Dysfunction; Cardiac Workup
26. Chronic Insomnia; Stress Management; Sleep Hygiene

KFP 2016.2

1. Prolonged Fever; Abnormal Liver Function Tests; Differential Diagnosis
2. Shin Lesions; Joint Pain; Altered Bowel Habits; Investigation Plan
3. Dysmenorrhoea; Heavy Menstrual Bleeding; Initial Investigations
4. Child with Recurrent Wheezing; Asthma Management; Inhaler Technique
5. Persistent Lymphadenopathy; HIV Risk Assessment; Lymphoma Screening
6. Young Adult with Sudden Onset Chest Pain; Pulmonary Embolism; Initial Investigations
7. Fatigue and Weight Gain in a Middle-Aged Woman; Hypothyroidism; Medication Adjustment
8. Child with Fever and Rash; Measles; Public Health Notification
9. Older Adult with Acute Confusion; UTI; Delirium Management
10. Painless Jaundice; Obstructive Causes; Imaging Modalities
11. Sudden Vision Loss; Retinal Detachment; Ophthalmology Referral
12. Post-operative Wound Infection; Surgical Site Management; Antibiotic Therapy
13. Chest Pain in a Young Athlete; Hypertrophic Cardiomyopathy; Cardiological Assessment
14. Newborn with Failure to Thrive; Congenital Heart Defect; Echocardiography
15. Chronic Cough in a Smoker; COPD Exacerbation; Spirometry
16. Unilateral Leg Swelling; Cellulitis; Antibiotic Choice
17. Abdominal Pain in the Elderly; Aortic Aneurysm; Emergency Imaging
18. Painful Genital Ulcers; STI Screening; Sexual Health Education
19. Recurrent Epistaxis; Hypertension Control; ENT Referral
20. Young Woman with Amenorrhoea; PCOS; Hormonal Therapy
21. Infant with Poor Feeding; Congenital Conditions; Genetic Counselling
22. Weight Loss in an Elderly Male; GI Malignancy; Colonoscopy
23. Skin Lesion on Back; Melanoma Risk; Excision Biopsy
24. Lower Limb Weakness; Multiple Sclerosis; Neurology Referral
25. Hypertension in Pregnancy; Preeclampsia; Urgent Management
26. Preconception Counselling; Genetic Carrier Screening; Lifestyle Modifications

KFP 2017.1

1. Cognitive Decline; Memory Impairment; Dementia Workup
2. Post-Lumbar Puncture Headache; Recurrent Headaches; Management Strategies
3. Severe Acne in Teenager; Dermatological Treatment; Psychosocial Impact
4. New Diagnosis of Diabetes; Glycaemic Control; Lifestyle Advice
5. Elderly Man with Dyspnoea; Heart Failure; Diuretic Management
6. Child with Noisy Breathing; Stridor; Airway Management
7. Woman with Breast Lump; Triple Assessment; Oncology Referral
8. Fever and Cough in a Smoker; Pneumonia; Antibiotic Choice
9. Young Woman with Palpitations; Hyperthyroidism; Beta-Blocker Use
10. Adult Male with Epigastric Pain; Peptic Ulcer; H. Pylori Eradication
11. Adolescent with Weight Loss; Eating Disorder; Multidisciplinary Approach
12. Acute Knee Pain; Meniscal Tear; Imaging and Rehabilitation
13. Chronic Lower Limb Ulcer; Venous Insufficiency; Compression Therapy
14. Recurrent Sinusitis; Allergy Management; Surgical Referral
15. Adult with Syncope; Cardiac and Neurological Evaluation; Driving Restrictions
16. Paediatric Abdominal Pain; Appendicitis; Surgical Referral
17. Young Adult with Depression; SSRI Initiation; Monitoring Side Effects
18. Female with Hair Loss; Iron Deficiency Anaemia; Endocrine Review
19. Elderly Patient with Falls; Polypharmacy; Home Safety Assessment
20. Newborn with Jaundice; Hyperbilirubinemia; Phototherapy
21. Female with Dysuria; UTI; Pregnancy Considerations
22. Middle-Aged Man with Tinnitus; Hearing Loss; Audiology Referral
23. Patient with Constipation; Laxative Options; Colorectal Cancer Screening
24. Man with Reduced Vision; Diabetic Retinopathy; Ophthalmology Referral
25. Middle-Aged Woman with Chest Pain; Angina; Statin Therapy
26. Man with Chronic Low Back Pain; Multidisciplinary Management; Opioid Risk Assessment

KFP 2017.2

1. Persistent Cough; Occupational Asthma; Inhaler Technique
2. Elderly Woman with Hip Pain; Osteoporosis; Bone Density Testing
3. Young Adult with Dizziness; BPPV; Epley Manoeuvre
4. Woman with Recurrent UTIs; Postmenopausal; Hormone Replacement Therapy
5. Child with Behavioural Issues; ADHD; Parental Support
6. Elderly Male with Weight Loss; Prostate Cancer; PSA Testing
7. Teenager with Menstrual Irregularity; PCOS; Lifestyle Modification
8. Young Woman with Rash and Fever; Meningococcal Septicaemia; Prophylaxis for Contacts
9. Man with Erectile Dysfunction; Cardiovascular Risk; Phosphodiesterase Inhibitors
10. Female with Bloating and Abdominal Pain; IBS; Dietary Management
11. Newborn with Cyanosis; Congenital Heart Disease; Urgent Echocardiography
12. Woman with Shoulder Pain; Rotator Cuff Injury; Rehabilitation Exercises
13. Man with Fatigue; Sleep Apnoea; CPAP Therapy
14. Child with Limp; Transient Synovitis; NSAID Use
15. Adult with High BMI; Bariatric Surgery Referral; Pre-operative Assessment
16. Elderly Patient with Bruising; Anticoagulation Management; INR Monitoring
17. Man with Loin Pain; Renal Colic; Analgesia Choice
18. Adolescent with Head Injury; Concussion Management; Return to Play Guidelines
19. Female with Postcoital Bleeding; Cervical Cancer Screening; Colposcopy Referral
20. Man with Peripheral Neuropathy; Diabetes; Optimizing Glycaemic Control
21. Woman with Dyspareunia; Vulvodynia; Pelvic Floor Physiotherapy
22. Young Man with Sudden Vision Loss; Retinal Detachment; Emergency Ophthalmology Referral
23. Elderly Male with Memory Loss; Alzheimer’s Disease; Carer Support
24. Man with Chronic Cough; GERD; PPI Therapy
25. Woman with Unilateral Hearing Loss; Acoustic Neuroma; MRI Brain
26. Patient with Fibromyalgia; Multimodal Therapy; CBT

KFP 2018.1

1. Fever in an Immunocompromised Patient; Neutropenic Sepsis; Empirical Antibiotics
2. Female with Chronic Pelvic Pain; Endometriosis; Hormonal Therapy
3. Young Child with Febrile Seizures; Education for Parents; Safety Measures
4. Elderly Male with Weight Loss and Dysphagia; Oesophageal Cancer; Endoscopic Biopsy
5. Female with Urinary Incontinence; Stress Incontinence; Pelvic Floor Exercises
6. Man with Itchy Skin; Scabies; Treatment Plan
7. Patient with Panic Attacks; Cognitive Behavioural Therapy; Pharmacological Options
8. Woman with Chronic Fatigue; Iron Deficiency; Iron Supplementation
9. Young Adult with Sports Injury; ACL Tear; Surgical Referral
10. Child with Recurrent Ear Infections; Tympanostomy Tube Indication; ENT Referral
11. Patient with Red Eye; Conjunctivitis; Antibiotic Eye Drops
12. Middle-Aged Man with Dyspepsia; H. pylori Testing; PPI Use
13. Elderly Woman with Depression; Antidepressant Initiation; Follow-up Plan
14. Child with Poor Weight Gain; Coeliac Disease; Gluten-Free Diet
15. Male with Low Libido; Testosterone Deficiency; Hormone Replacement
16. Patient with Chronic Pain; Opioid Reduction Strategy; Alternative Therapies
17. Woman with Hair Thinning; Androgenetic Alopecia; Dermatological Referral
18. Man with Diarrhoea; Inflammatory Bowel Disease; Colonoscopy Referral
19. Patient with Hypertension; Secondary Causes; Ambulatory Monitoring
20. Adult with Shoulder Instability; Physiotherapy; Surgical Consultation
21. Female with Nausea and Vomiting in Pregnancy; Hyperemesis Gravidarum; Hydration Strategies
22. Elderly Male with Postural Hypotension; Medication Review; Hydration Advice
23. Woman with Vaginal Discharge; Bacterial Vaginosis; Metronidazole Therapy
24. Child with Rash; Atopic Dermatitis; Emollient Use
25. Young Man with Persistent Headache; Migraine; Prophylactic Treatment
26. Adult with Facial Palsy; Bell’s Palsy; Steroid Use

KFP 2018.2

1. Man with Lower Urinary Tract Symptoms; BPH; Alpha-Blocker Therapy
2. Adolescent with Acne; Topical Retinoids; Dermatology Referral
3. Female with Breastfeeding Difficulties; Mastitis; Lactation Consultant
4. Elderly Patient with Polypharmacy; Deprescribing Strategy; Review of Medications
5. Woman with Painful Periods; Endometriosis; NSAID Use
6. Middle-Aged Man with Chest Pain; Angina; Referral for Stress Testing
7. Child with Behavioural Concerns; Autism Spectrum Disorder; Multidisciplinary Support
8. Young Female with Amenorrhoea; PCOS; Weight Management
9. Male with Chronic Obstructive Pulmonary Disease; Inhaler Use; Smoking Cessation
10. Child with Ankle Injury; Growth Plate Fracture; Orthopaedic Referral
11. Female with Recurrent UTI; Post-Coital Prophylaxis; Lifestyle Modifications
12. Male with Palpitations; Atrial Fibrillation; Anticoagulation Therapy
13. Elderly Male with Night Sweats; Tuberculosis Screening; Public Health Notification
14. Woman with Infertility; Ovulation Induction; Reproductive Endocrinology Referral
15. Adolescent with Weight Loss; Anorexia Nervosa; Psychological Therapy
16. Male with Red Eye; Acute Angle-Closure Glaucoma; Emergency Management
17. Woman with Vaginal Itching; Candidiasis; Antifungal Creams
18. Child with Constipation; Faecal Impaction; Laxative Use
19. Young Woman with Hair Loss; Telogen Effluvium; Reassurance and Monitoring
20. Adult with Eczema; Topical Steroids; Dermatology Advice
21. Elderly Female with Shoulder Pain; Frozen Shoulder; Corticosteroid Injection
22. Male with Dysuria; Prostatitis; Antibiotic Therapy
23. Patient with Tinnitus; Audiometry; ENT Referral
24. Woman with Nipple Discharge; Galactorrhoea; Endocrine Workup
25. Young Female with Menorrhagia; Fibroid Uterus; Surgical Options
26. Adult with Sleep Apnoea; CPAP Compliance; Follow-up Sleep Study

KFP 2019.1

1. Chest Pain in a Young Athlete; Myocarditis; Echocardiography
2. Child with Wheeze; Asthma Exacerbation; Inhaler Management
3. Man with Dizziness; Vestibular Neuritis; Antivertigo Medications
4. Woman with Vaginal Bleeding; Ectopic Pregnancy; Emergency Referral
5. Elderly Male with Visual Changes; Cataracts; Ophthalmology Referral
6. Patient with Dyspepsia; NSAID Use; Gastroprotection
7. Adolescent with Social Anxiety; CBT; SSRI Consideration
8. Female with Fever and Back Pain; Pyelonephritis; IV Antibiotics
9. Young Woman with Heavy Menstrual Bleeding; Iron Deficiency Anaemia; Hormonal Therapy
10. Male with Shoulder Pain; Bursitis; Corticosteroid Injection
11. Child with Vomiting and Diarrhoea; Gastroenteritis; Hydration Management
12. Elderly Woman with Hypertension; Resistant Hypertension; Secondary Causes
13. Patient with Foot Ulcer; Diabetic Neuropathy; Wound Care
14. Young Male with Chest Tightness; Panic Disorder; Psychosocial Support
15. Woman with Fatigue; Coeliac Disease; Gluten-Free Diet
16. Child with Ear Pain; Otitis Media; Antibiotic Guidelines
17. Male with Nocturia; BPH; Watchful Waiting
18. Female with Abdominal Pain; Endometriosis; Laparoscopy
19. Adult with Chronic Cough; GERD; Proton Pump Inhibitor
20. Elderly Patient with Falls; Balance Exercises; Home Safety Assessment
21. Young Woman with Urinary Frequency; UTI; Antibiotic Stewardship
22. Middle-Aged Man with Dyspnoea; COPD; Inhaled Corticosteroid
23. Adolescent with Acne; Oral Contraceptive Pills; Dermatology Referral
24. Female with Dyspepsia; H. Pylori Eradication; Lifestyle Advice
25. Patient with Neuropathy; Diabetes Control; Foot Care Education
26. Adult with Insomnia; Cognitive Behavioral Therapy for Insomnia (CBT-I); Sleep Hygiene

KFP 2019.2

1. Man with Lower Back Pain; Red Flags; Imaging Requirements
2. Child with Sore Throat; Streptococcal Pharyngitis; Penicillin Therapy
3. Elderly Male with Constipation; Laxatives; Colorectal Cancer Screening
4. Female with Vaginal Itching; Candida; Antifungal Management
5. Patient with Dizziness; BPPV; Epley Manoeuvre
6. Middle-Aged Man with Weight Loss; GI Malignancy; Endoscopic Investigation
7. Young Female with Amenorrhoea; Polycystic Ovarian Syndrome; Lifestyle Modification
8. Adolescent with Learning Difficulties; ADHD; Medication Management
9. Elderly Woman with Ankle Swelling; Heart Failure; Diuretic Titration
10. Man with Erectile Dysfunction; Cardiovascular Risk Assessment; PDE5 Inhibitors
11. Child with Recurrent Cough; Asthma Management; Action Plan
12. Woman with Pelvic Pain; Pelvic Inflammatory Disease; Antibiotic Therapy
13. Male with Fatigue; Anaemia; Iron Deficiency Workup
14. Young Adult with Chest Pain; Anxiety Management; Reassurance
15. Female with Fever and Abdominal Pain; Appendicitis; Surgical Referral
16. Male with Groin Swelling; Inguinal Hernia; Surgical Consultation
17. Female with Lower Urinary Tract Symptoms; Interstitial Cystitis; Bladder Training
18. Adult with Abnormal Liver Function Tests; Non-Alcoholic Fatty Liver Disease; Lifestyle Modification
19. Adolescent with Obesity; Healthy Lifestyle Advice; Family Support
20. Patient with Chronic Pain; Opioid Dependency; Tapering Strategy
21. Elderly Patient with Unsteady Gait; Parkinson’s Disease; Neurology Referral
22. Male with Wheezing; COPD Exacerbation; Steroid Therapy
23. Child with Earache; Otitis Media; Observation versus Antibiotics
24. Middle-Aged Man with Skin Rash; Psoriasis; Topical Therapy
25. Young Woman with Joint Pain; Rheumatoid Arthritis; DMARD Therapy
26. Female with Hair Loss; Alopecia Areata; Intralesional Steroid Injection

KFP 2020.1

1. Woman with Nausea in Early Pregnancy; Hyperemesis Gravidarum; IV Rehydration
2. Male with Neck Pain; Cervical Radiculopathy; Physiotherapy Referral
3. Child with Abdominal Pain; Constipation; Fibre Supplementation
4. Elderly Male with Hip Pain; Osteoarthritis; Pain Management Options
5. Female with Headache; Migraine; Triptan Use
6. Patient with Chronic Fatigue; Sleep Apnoea; CPAP Initiation
7. Middle-Aged Man with Recurrent Sinusitis; Nasal Polyps; Surgical Referral
8. Female with Heavy Periods; Uterine Fibroids; Surgical Options
9. Adolescent with Acne; Benzoyl Peroxide Use; Follow-up Plan
10. Man with Back Pain; Disc Herniation; Neurological Assessment
11. Elderly Patient with Falls; Vitamin D Deficiency; Supplementation
12. Young Woman with Breast Pain; Fibroadenoma; Ultrasound
13. Male with Foot Pain; Plantar Fasciitis; Orthotic Support
14. Patient with Difficulty Swallowing; Oesophageal Stricture; Endoscopic Dilation
15. Female with Itchy Scalp; Psoriasis; Topical Steroids
16. Man with Shoulder Instability; Labral Tear; Orthopaedic Referral
17. Patient with Joint Pain; Osteoarthritis; Exercise Therapy
18. Child with Cough; Pertussis; Notification and Prophylaxis
19. Woman with Palpitations; Anxiety Disorder; Holter Monitoring
20. Male with Dysuria; Prostatitis; Urine Culture
21. Female with Dyspareunia; Pelvic Floor Dysfunction; Physiotherapy
22. Man with Chronic Rhinosinusitis; Intranasal Corticosteroids; ENT Review
23. Adolescent with Abdominal Pain; Mesenteric Adenitis; Symptomatic Management
24. Elderly Female with Urinary Incontinence; Pelvic Floor Exercises; Continence Services
25. Young Adult with Hair Loss; Androgenic Alopecia; Topical Minoxidil
26. Middle-Aged Woman with Dizziness; Meniere’s Disease; Betahistine Therapy

KFP 2020.2

1. Elderly Man with Memory Loss; Dementia; Cognitive Testing
2. Woman with Frequent Nosebleeds; Von Willebrand Disease; Haematology Referral
3. Young Adult with Chest Pain; Pericarditis; NSAID Use
4. Male with Leg Swelling; DVT; Anticoagulation Therapy
5. Female with Recurrent Cystitis; Post-Coital Prophylaxis; Urology Referral
6. Child with Noisy Breathing; Croup; Steroid Therapy
7. Man with Fatigue; Sleep Study; Management of Sleep Apnoea
8. Woman with Chronic Cough; GERD; Lifestyle Modifications
9. Male with BPH Symptoms; Tamsulosin; Monitoring Plan
10. Female with Depression; SSRI Use; Counselling
11. Young Woman with Infertility; PCOS; Ovulation Induction
12. Male with Elbow Pain; Lateral Epicondylitis; Physiotherapy
13. Female with Pelvic Pain; Endometriosis; Laparoscopic Surgery
14. Adolescent with Abnormal Vaginal Bleeding; Bleeding Disorder; Haematology Referral
15. Woman with Breast Discharge; Duct Ectasia; Ultrasound
16. Child with Developmental Delay; Autism Spectrum Disorder; Early Intervention
17. Elderly Patient with Pruritus; Chronic Kidney Disease; Emollient Use
18. Man with Prostatitis; Antibiotics; Pain Management
19. Female with Lower Limb Swelling; Lymphoedema; Compression Stockings
20. Adolescent with Weight Loss; Hyperthyroidism; Endocrinology Referral
21. Male with Intermittent Claudication; Peripheral Artery Disease; Smoking Cessation
22. Patient with Wheezing; Asthma Management; Spacer Technique
23. Woman with Scalp Itching; Lice; Permethrin Treatment
24. Man with Chronic Pain; Gabapentin Use; Monitoring Plan
25. Elderly Female with Hip Fracture; Osteoporosis; Bone Density Measurement
26. Young Adult with Rash; Dermatitis Herpetiformis; Coeliac Disease Screening

KFP 2021.1

1. Woman with Fever and Rash; Dengue Fever; Public Health Reporting
2. Male with Blurred Vision; Diabetic Retinopathy; Ophthalmology Review
3. Young Woman with Dysmenorrhoea; Endometriosis; Hormonal Treatment
4. Elderly Man with Dyspnoea; Heart Failure; Diuretic Optimization
5. Child with Swollen Joints; Juvenile Idiopathic Arthritis; Rheumatology Referral
6. Female with Abdominal Pain; Gallstones; Cholecystectomy Consideration
7. Patient with Weight Gain; Hypothyroidism; Levothyroxine Adjustment
8. Adolescent with Low Back Pain; Spondylolysis; Rest and Physiotherapy
9. Man with Leg Weakness; Spinal Stenosis; Surgical Referral
10. Woman with Postmenopausal Bleeding; Endometrial Hyperplasia; Biopsy
11. Female with Joint Pain; Osteoarthritis; Topical NSAIDs
12. Male with Chronic Fatigue; Infectious Mononucleosis; Symptomatic Management
13. Child with Recurrent Wheeze; Asthma; Peak Flow Monitoring
14. Elderly Patient with Tremor; Parkinson’s Disease; Medication Review
15. Male with Unilateral Hearing Loss; Acoustic Neuroma; MRI Referral
16. Woman with Pelvic Pain; Ovarian Cyst; Ultrasound Assessment
17. Young Female with Ankle Injury; Ligament Tear; Rehabilitation
18. Male with Recurrent Abdominal Pain; Irritable Bowel Syndrome; Dietary Advice
19. Woman with Sudden Visual Loss; Temporal Arteritis; High-Dose Steroids
20. Man with Scrotal Swelling; Varicocele; Surgical Evaluation
21. Elderly Female with Difficulty Swallowing; Achalasia; Gastroenterology Referral
22. Young Man with Chest Tightness; Hyperventilation; Rebreathing Techniques
23. Patient with Psoriasis; Topical Vitamin D Analogues; Phototherapy
24. Female with Infertility; Polycystic Ovary Syndrome; Clomiphene Citrate
25. Elderly Man with Gait Disturbance; Normal Pressure Hydrocephalus; Neurosurgical Review
26. Woman with Vaginal Discharge; Trichomoniasis; Metronidazole Therapy

KFP 2021.2

1. Elderly Patient with Sudden Weakness; Stroke; Thrombolysis Criteria
2. Young Woman with Pelvic Pain; PID; Antibiotic Therapy
3. Man with Chronic Insomnia; Cognitive Behavioural Therapy; Melatonin Use
4. Child with Recurrent Ear Infections; Hearing Loss; ENT Referral
5. Female with Chest Pain; Angina; Cardiac Catheterisation
6. Male with Epigastric Pain; Acute Pancreatitis; Fasting and IV Fluids
7. Woman with Recurrent Miscarriages; Thrombophilia Screen; Referral to Specialist
8. Adolescent with Acne; Isotretinoin; Dermatology Referral
9. Patient with Chronic Pain; Mindfulness-Based Stress Reduction; Referral to Pain Clinic
10. Male with Hyperlipidaemia; Statin Therapy; Lifestyle Modification
11. Woman with Severe Menorrhagia; Endometrial Ablation; Follow-up Plan
12. Elderly Female with Syncope; Aortic Stenosis; Echocardiography
13. Male with DVT; Anticoagulation Therapy; Duration of Treatment
14. Child with Obesity; Dietary Counselling; Physical Activity Promotion
15. Female with Breast Lump; Mammography; Biopsy Referral
16. Elderly Man with Confusion; UTI; Delirium Prevention
17. Young Adult with Diarrhoea; Coeliac Disease; Gluten-Free Diet
18. Female with Chronic Migraine; Botox Injections; Neurology Referral
19. Man with Erectile Dysfunction; Cardiovascular Risk Assessment; PDE5 Inhibitors
20. Child with Constipation; Behavioural Therapy; Bowel Routine
21. Elderly Female with Knee Pain; Osteoarthritis; Intra-articular Steroid Injection
22. Male with Post-Operative Wound Infection; Debridement; Antibiotic Therapy
23. Woman with Tinnitus; Noise Reduction Strategies; ENT Referral
24. Female with Recurrent UTI; Cranberry Extract; Prophylactic Antibiotics
25. Male with Persistent Cough; Bronchiectasis; Chest Physiotherapy
26. Patient with Fatigue; Chronic Fatigue Syndrome; Multidisciplinary Approach

KFP 2022.1

1. Elderly Man with Fainting; Arrhythmia; Holter Monitoring
2. Woman with Vaginal Discharge; Bacterial Vaginosis; Metronidazole Use
3. Young Male with Chest Pain; Pneumothorax; Needle Decompression
4. Child with Abdominal Pain; Appendicitis; Surgical Referral
5. Female with Rash; Lupus Erythematosus; Immunosuppressive Therapy
6. Male with Foot Pain; Gout; Allopurinol Management
7. Woman with Depression; CBT; SSRI Consideration
8. Man with Fatigue; Sleep Apnoea; Referral for Sleep Study
9. Female with Breast Pain; Mastitis; Antibiotic Therapy
10. Adolescent with Heavy Periods; Iron Deficiency; Haematology Review
11. Young Woman with Palpitations; Atrial Fibrillation; Rate Control
12. Child with Short Stature; Growth Hormone Deficiency; Endocrinology Referral
13. Female with Lower Back Pain; Lumbar Spondylosis; Physiotherapy
14. Male with Polyuria; Diabetes Mellitus; Glycaemic Control
15. Patient with Facial Rash; Rosacea; Topical Therapy
16. Woman with Hair Loss; Alopecia Areata; Dermatology Referral
17. Man with Constipation; Fibre Supplementation; Laxative Use
18. Elderly Female with Confusion; Delirium; Underlying Causes
19. Young Adult with Headache; Migraine; Lifestyle Modifications
20. Male with Nocturia; BPH; Alpha-Blocker Therapy
21. Woman with Dysphagia; Achalasia; Balloon Dilation
22. Patient with Chest Pain; Gastro-Oesophageal Reflux; Proton Pump Inhibitor
23. Child with Recurrent Abdominal Pain; Functional Dyspepsia; Dietary Advice
24. Male with Shoulder Pain; Rotator Cuff Tendonitis; Rehabilitation Exercises
25. Female with Scalp Itching; Psoriasis; Topical Calcipotriol
26. Woman with Infertility; Tubal Blockage; IVF Referral

KFP 2022.2

1. Patient with Fatigue; Hypothyroidism; Thyroid Function Test
2. Woman with Fever and Abdominal Pain; Pelvic Inflammatory Disease; Antibiotic Therapy
3. Male with Dizziness; Vestibular Neuritis; Antivertigo Drugs
4. Child with Wheezing; Asthma; Inhaled Corticosteroids
5. Elderly Man with Memory Problems; Dementia; Cognitive Testing
6. Female with Vaginal Itching; Thrush; Antifungal Cream
7. Patient with Chest Pain; Angina; Statin Therapy
8. Adolescent with Acne; Retinoid Cream; Hormonal Therapy
9. Male with Chronic Obstructive Pulmonary Disease; Smoking Cessation; Pulmonary Rehabilitation
10. Child with Sore Throat; Tonsillitis; Penicillin Treatment
11. Young Woman with Irregular Periods; PCOS; Weight Management
12. Female with Joint Pain; Rheumatoid Arthritis; DMARD Therapy
13. Male with Fatigue; Iron Deficiency Anaemia; Iron Supplements
14. Woman with Headache; Migraine; Preventive Medication
15. Patient with Depression; Psychological Therapy; Antidepressant Medication
16. Man with Weight Loss; Cancer Screening; Endoscopic Investigation
17. Female with Hip Pain; Osteoarthritis; Analgesia
18. Child with Abdominal Pain; Appendicitis; Surgical Intervention
19. Young Woman with Rash; Psoriasis; Topical Therapy
20. Elderly Male with Difficulty Urinating; Prostate Enlargement; Alpha Blocker Therapy
21. Male with Night Sweats; Lymphoma; Biopsy
22. Female with Chronic Fatigue; Sleep Study; Sleep Apnoea Treatment
23. Woman with Postmenopausal Bleeding; Endometrial Cancer; Gynaecological Referral
24. Adolescent with Recurrent Cystitis; Urine Culture; Antibiotic Stewardship
25. Child with Fever and Rash; Meningitis; Emergency Management
26. Patient with Palpitations; Hyperthyroidism; Beta Blocker Therapy

KFP 2023.1

1. Elderly Female with Hip Fracture; Osteoporosis; Rehabilitation
2. Male with Visual Loss; Macular Degeneration; Intravitreal Injections
3. Young Woman with Heavy Periods; Anaemia; Iron Supplementation
4. Adolescent with Abdominal Pain; Appendicitis; Surgical Referral
5. Female with Chest Pain; Ischaemic Heart Disease; Lifestyle Advice
6. Male with Epistaxis; Hypertension; Medication Adjustment
7. Patient with Persistent Cough; Lung Cancer Screening; Low-Dose CT
8. Child with Fever and Seizures; Febrile Convulsion; Parental Education
9. Female with Fatigue; Hypothyroidism; Levothyroxine Adjustment
10. Man with Erectile Dysfunction; Cardiovascular Risk Factors; PDE5 Inhibitors
11. Elderly Woman with Recurrent UTIs; Post-Menopausal; Vaginal Oestrogen
12. Young Male with Palpitations; Supraventricular Tachycardia; Ablation Therapy
13. Woman with Knee Pain; Osteoarthritis; Exercise Therapy
14. Patient with Migraine; Preventive Therapy; Lifestyle Modification
15. Child with Wheeze; Asthma Management; Inhaler Technique
16. Male with Low Back Pain; Sciatica; Physiotherapy
17. Female with Postmenopausal Bleeding; Uterine Cancer; Gynaecological Referral
18. Adolescent with Anxiety; Cognitive Behavioural Therapy; SSRI Use
19. Patient with Hyperlipidaemia; Statin Therapy; Regular Monitoring
20. Elderly Male with Confusion; Delirium; Underlying Causes
21. Woman with Breast Lump; Triple Assessment; Surgical Referral
22. Man with Recurrent Epigastric Pain; GERD; Endoscopy
23. Patient with Joint Pain; Osteoarthritis; Analgesic Ladder
24. Young Female with Rash; Eczema; Emollient Therapy
25. Male with Hypertension; ACE Inhibitors; Monitoring Electrolytes
26. Woman with Dyspareunia; Vaginal Atrophy; Hormone Therapy

KFP 2023.2

1. Female with Fever and Rash; Rubella; Public Health Notification
2. Male with Dizziness; Vertigo; Vestibular Rehabilitation
3. Child with Persistent Vomiting; Pyloric Stenosis; Surgical Referral
4. Elderly Female with Chest Pain; Aortic Stenosis; Cardiological Review
5. Man with Lower Urinary Tract Symptoms; BPH; Urology Referral
6. Young Woman with Amenorrhoea; Hypothalamic Dysfunction; Lifestyle Advice
7. Patient with Wheeze; COPD Exacerbation; Antibiotic Use
8. Female with Breast Lump; Malignancy Screening; Core Biopsy
9. Elderly Male with Painful Urination; Prostatitis; Fluoroquinolone Therapy
10. Child with Fever and Rash; Kawasaki Disease; IV Immunoglobulin
11. Young Woman with Palpitations; Anxiety; Beta Blocker Therapy
12. Male with Diarrhoea; Infectious Causes; Stool Culture
13. Patient with Hypertension; Lifestyle Advice; Medication Adherence
14. Woman with Heavy Menstrual Bleeding; Fibroids; Uterine Artery Embolization
15. Adolescent with Acne; Isotretinoin; Dermatology Referral
16. Man with Chronic Cough; TB Screening; Sputum Culture
17. Female with Urinary Frequency; Interstitial Cystitis; Bladder Training
18. Elderly Patient with Balance Issues; Vestibular Disorder; Physical Therapy
19. Woman with Fatigue; Anaemia; Iron Studies
20. Man with Shoulder Pain; Adhesive Capsulitis; Physiotherapy
21. Child with Constipation; Dietary Advice; Laxative Therapy
22. Woman with Scalp Itching; Seborrheic Dermatitis; Ketoconazole Shampoo
23. Female with Recurrent Miscarriages; Thrombophilia Testing; Specialist Referral
24. Young Adult with Headache; Cluster Headache; Prophylactic Therapy
25. Man with Erectile Dysfunction; Testosterone Deficiency; Hormonal Therapy
26. Elderly Female with Weight Loss; GI Malignancy; Colonoscopy

KFP 2024.1

1. Aboriginal Paediatrics; Febrile Illness; Preventative Health Assessment
2. Woman with Cyclical Symptoms; Endometriosis; Opioid Management
3. Patient with Metabolic-Associated Fatty Liver Disease; Diagnostic Investigations; Lifestyle Advice
4. Male with Sudden Onset Chest Pain; Aortic Dissection; Emergency Management
5. Child with Swollen Joints; Juvenile Idiopathic Arthritis; Multidisciplinary Care
6. Elderly Woman with Weight Loss; GI Malignancy; Diagnostic Imaging
7. Female with Hair Loss; Androgenetic Alopecia; Dermatological Referral
8. Young Adult with Rash; Contact Dermatitis; Topical Steroids
9. Man with Chronic Cough; GERD; Lifestyle Modifications
10. Woman with Palpitations; Atrial Fibrillation; Anticoagulation Management
11. Elderly Male with Falls; Balance Assessment; Physiotherapy Referral
12. Child with Behavioural Problems; ADHD; Medication Review
13. Woman with Abdominal Pain; Ectopic Pregnancy; Surgical Intervention
14. Man with Erectile Dysfunction; Cardiovascular Risk Factors; PDE5 Inhibitors
15. Adolescent with Obesity; Healthy Lifestyle Promotion; Multidisciplinary Support
16. Female with Painful Periods; Dysmenorrhoea; NSAID Therapy
17. Patient with Low Back Pain; Mechanical Back Pain; Exercise Program
18. Woman with Persistent Vaginal Discharge; STI Screening; Empirical Therapy
19. Man with Swollen Legs; Heart Failure; Diuretic Adjustment
20. Young Woman with Amenorrhoea; PCOS; Lifestyle Modification
21. Elderly Male with Memory Loss; Alzheimer’s Disease; Cholinesterase Inhibitors
22. Male with Wheeze; Asthma Action Plan; Peak Flow Monitoring
23. Female with Chest Pain; Angina; Stress Test
24. Child with Cough; Pertussis; Notification and Management
25. Man with Rash; Psoriasis; Immunosuppressive Therapy
26. Woman with Recurrent UTIs; Post-Coital Prophylaxis; Urology Referral

Exam Report Commentary

KFP 2016.1

Case 1

This case focuses on a patient presenting with a prolonged cough and an episode of haemoptysis who had recently emigrated from Papua New Guinea. The case explores the potential differential diagnoses and subsequent initial investigations.

Candidates gave a range of differential diagnoses but what was important was to focus on the key information in the scenario and provide the most likely answers. Whilst there may be many causes of a prolonged cough and haemoptysis the list of most likely differential diagnoses becomes much narrower in the context of a 21 year old male patient recently arrived from overseas. This is the ‘Key Feature Problem paper’ and not a straightforward short answer paper. The answers to this and all the questions need to be focussed in the context of both the clinical scenario and the question, which in this case was the differential diagnoses’ and not a list of all causes of haemoptysis.

Likewise the initial investigations need to assist in clarifying the diagnosis and form part of a rational management approach rather than second line investigations or those investigations that will not assist in assessing the differential diagnoses

Case 2

This case revolves around a 62yr old woman with acute onset of back pain after moving some books from a car. The case focuses on the ability to assess and manage a simple musculoskeletal injury whilst taking into consideration comorbidities of asthma and hypertension.

There were a broad range of answers provided by candidates, highlighting again the need for candidates to look at the most likely differential diagnoses. Not just listing all causes of back pain or providing answers relevant to the broad clinical context. Listing causes of back pain in a male patient such as metastatic prostate cancer would obviously not have scored. It is important exam technique to ensure you read the scenario, and identify the key information about the patient, such as age and gender.

In managing the condition the question asked about the next steps after investigations. In the KFP paper candidates are requested to provide a specific number of answers, in this case there was a request for four answers. If candidates provide extra responses above this then there is a penalty for each answer above the four answers. Answers are meant to be short, and one answer per line. No request was made to explain, expand or justify the management steps given. In doing any of these, candidates risk being penalised for extra responses. It is good exam technique to review the answers and if you have used phrases/words such as, ‘for example’, ‘because’ or ‘and’ or even need to use commas then the answer is most likely to contain extra responses and therefore attract penalties. (For further discussion on extra responses please refer to the RACGP Examinations Guide ^[1])

Case 3

This case presents an elderly female patient recently arrived in a retirement village and a new patient to the practice. The patient has suspected cardiac failure and the questions look at the assessment and management of the patient, both pharmacological and non —pharmacological.

In the KFP paper it is important to remember that giving answers that are in the case or question will not gain marks. For example, when being asked for history to establish the diagnosis, responding with their age or foot swelling (since these were in the case scenario) will not gain marks.

Candidates were asked to offer changes to her medication to better manage her heart failure. Many candidates offered changes to her management unrelated to her heart failure or offered management strategies not evidence-based given her age and condition. It is important to focus on the question and ensure answers match the information being asked for and are specific.

Case 4

In this case we find a 32 year old male with unilateral severe facial pain. Candidates are asked for a single diagnosis, given the classic presentation, and the subsequent assessment and management of this presentation.

Whilst a significant proportion of the candidates gave the diagnosis they could not identify further aspects of the assessment, either history or examination to clarify their diagnosis. Many candidates offered answers to assess any form of pain and so were not specific and did not gain marks.

In the management section candidates were asked to provide answers other than investigations. Despite this, there were many candidates who offered investigations, which whilst appropriate did not answer the question. This is a common error in the KFP: Providing answers not relevant to a focussed question such as, ‘other than investigations how would you manage this patient’s facial pain?’ Many answers were nonspecific such as ‘analgesia’ or ‘educate’. Broad general answers will not gain marks, it is important to be specific: which analgesia/medication, educate about what? A good answer also focussed on all aspects of management and not simply listing all possible medications.

Case 5

This was a dermatology case with a patient presenting with two lesions, both requiring diagnosis and specific management.

Historically, dermatology questions are not answered well. In this case many candidates incorrectly focussed on the patient’s history that involved a previous successful melanoma removal several years before and responded to both lesions as variants of melanoma and their management centred on referrals and so did not score marks

The questions asked for specific diagnoses and management of two classic lesions that are spot diagnoses. Good responses obviously centred on safe management, one requiring excision and biopsy/histopathology, and marks were gained for appropriate margins to the excision. The second lesion was benign and needed appropriate, specific advice on its benign nature and appropriate follow up/monitoring

There are many excellent online resources to assist candidates in reviewing the common dermatological presentations in Australian general practice and therefore what may be part of the KFP cases.

Case 6

This case presented a 29 year old female with a classic hamstring injury and the predisposing factors increasing the risk of this injury. The final part to the case presented an incidental finding on the patients shins and required candidates to consider the possible causes of the lesions in this patient.

Good answers were concise and specific, despite asking for a single ‘most likely’ diagnosis, some candidates provided two diagnoses, often with conflicting answers and many used ‘od between their answers. As discussed previously this will attract penalties and highlights the need to review answers to ensure the correct number of responses is given.

The final part of this case required candidates to correctly identify a classic presentation/appearance of erythema nodosum and then offer the most likely causes of this in the given clinical scenario; again not just a list of all causes but targeted to the patient in this case. The question did not ask for the diagnosis but required candidates to assess the photograph and history and then concisely list the most likely causes.

Case 7

This case centred on the differential diagnosis, assessment and management of a 34 year old with a 4 week history of a swollen scrotum. The case also described an episode of successfully treated syphilis over a decade before.

Whilst candidates were able to identify the most likely diagnoses, in describing appropriate examination findings many candidates gave a continuous list of examination stages. These stages were across the lines with multiple non-focussed answers with some giving 50% more answers than required and included history questions. A good response was focussed and concise and examination centred.

Case 8

In this case we see a 21 year old patient being diagnosed with gestational diabetes in the early stages of her pregnancy. The cases required subsequent management of the diabetes in the context of being pregnant as well as vitamin D deficiency identified at the same time.

In this question good answers were those that focussed on specific management for diabetes within pregnancy and not diabetes in general or general advice in pregnancy (such as smoking alcohol or dietary changes unrelated to diabetes). Regarding the Vitamin D deficiency, offering treatment in line with the appropriate published Australian guidelines gained more marks. Again being concise as well as focussed on what is required in the case of such deficiency during pregnancy.

Case 9

This case required the investigation, treatment and subsequent holistic management of a sexually transmitted infection in a 16 year old indigenous girl.

Good answers in this question identified the need for specific investigation and not simply listing all possible investigation or using broad terms such as ‘PCR’, ‘swabs’, ‘smear’ etc. The treatment required the correct antibiotics as well as the dose/duration. When considering the management of this presentation the assessment of the risks to the patient and assessment of her safety given her sexual activity and infection as well as the appropriate follow up and advice.

Candidates were required to identify issues specific to her cultural background as well as advice relevant to all patients with this clinical presentation. Many candidates did not correctly identify these issues and so missed marks.

Case 10

This case focussed on the presentation of a 16 year old boy who is brought by his mother because she is concerned about his mental health. The scenario requires the appropriate assessment of suicide risk and the subsequent development of a suicide safety plan management of the situation presented.

This case was answered well with candidates identifying the risk factors in the given scenario and the appropriate management including the safety plan. The main issues in this case were the number of extra responses, with candidates giving lists of answers; trying to justify their answers with examples, giving broad non-specific answers or providing answers that were already in the case/scenario. The risk in providing examples is that you may get an example wrong and you may introduce more answers. This is a key feature paper and as such it is important to give the key answers which are focussed and critical to this case.

Case 11

In this case an 8 year old girl presents with a red watery eye and centres on the most likely differential diagnoses, subsequent key examination features and the assessment of a further unrelated eye problem in the same child at a further consult.

Good answers were relevant to the age of the child and not simply (as discussed previously) a knowledge dump of all causes of a unilateral red eye in a young child. Likewise the examination component was focussed on the examination of the eye, so listing vital signs, examination of joints or skin did not score. Many candidates provided up to 50% more responses than asked for because they either listed lots of examination issues or justified their answers with examples and further examination or explanation of their answers. It is important to remember that the examiners marking the questions are all practicing GPs and so no explanation of answers or expanding of answers is required but medical language appropriate to communication with a clinical colleague is appropriate

The final part require the correct identification of a classic presentation of an eye-lid namely a chalazion/meibomian cyst

Case 12

This case requires the management and identification of appropriate medications for poor pain control in an 81 year old female new resident of a nursing home along with the management of her polypharmacy. The case then progresses to the need to identify the appropriate drugs and symptom control for her palliative care.

Good answers in this case demonstrated applied knowledge to the case and co-morbidities and not a list of all possible analgesia options independent of the patient’s presentation and the appropriate steps in reducing her polypharmacy in line with evidence-base and appropriate guidelines. Those not scoring well were generally in the final section by not reading the question and focussing on the palliative stage of treatment and the cessation of oral medication and the change to a syringe driver.

In all RACGP assessments it is important to ensure you have read the question thoroughly, at

least twice, to understand what is being asked. Furthermore it is important to identify the context in which the question is being asked before providing answers. Try to imagine the patient in front of you in general practice, rather than thinking about a textbook answer for a condition

Case 13

This case requires the assessment, investigation and management of a 2 year old boy presenting with a persistent cough that has progressed from a dry to a moist cough despite antibiotic treatment. The history describes features suggestive of an inhaled foreign body.

Good answers involved the identification of a possible inhaled foreign body and the subsequent appropriate investigation and management. This is a commonly missed diagnosis. In this case the most common error was not giving an appropriate timeline on the referral. It is important to demonstrate insight into the urgency of referrals where appropriate and furthermore identifying who the patient is being referred to. A simple answer of ‘refer’ would not score marks. This is a key feature exam and as such requires demonstration of insight into the critical nature of the presentation.

Case 14

In this case a 23 year old mother is presenting with her two week old baby concerned that she has poor milk supply and the baby is not growing. The case provides information to assess whether her concerns are correct and to offer the appropriate advice and management at this point and in a follow up appointment when the mother presents with symptoms and findings suggestive of early mastitis.

The case was answered well with candidates giving appropriate advice in the initial presentation but in the management section many candidates gave extra responses by justifying their answers or providing the rationale. Candidates also erroneously provided lists of treatments, sometimes also providing alternatives on the same line. It is important to remember that in the exam there is one line provided for each answer requested so there should only be one answer per line. In this part good answers included both continuing breastfeeding and the correct antibiotic along with evidence-based symptomatic management.

It is important for candidates to assess their current day to day practice and identify presentations or clinical areas they do not commonly see and ensure they review these areas as they prepare for the exam

Case 15

This case centred on the presentation of a 14 year old girl with her mother who is concerned that her daughter’s menstrual pattern has changed. A differential diagnosis along with subsequent investigations is required and then the ongoing management of the patient in the light of normal results.

Good answers in this case required giving the right number of most important diagnoses to consider and not providing lists with examples or clarification. Candidates identified the most important investigations to assess the differential diagnoses. The management of the presentation, in light of normal results, and the information in the scenario pointed to the most likely diagnosis of an eating disorder. Those candidates not scoring well focussed on non-specific answers such as referral, contraceptive advice, and using screening tools for unrelated issues or giving answers that covered the same conceptual areas

Case 16

This case presents a new patient presenting with a migraine and letter from a previous GP stating that she requires pethidine for these migraines. The case focuses on the initial assessment of the patient and subsequent appropriate management.

A good answer in this case required candidates to demonstrate a safe and systematic as well as

a professional approach to patients presenting with drug seeking behaviours. This included the appropriate contact with her previous GP and agencies monitoring ‘doctor shopping’ as well as assessment of the presenting symptoms.

Candidates again provided lists of management options with justifications and were not concise at all and so were penalised with extra codes. If the candidates gave pethidine then they scored zero for that part of the case, not the whole case but for that part of the case as this is definitely not appropriate management.

Case 17

In this case a 78 year old female patient recently admitted to an aged care facility presents with an acute change in her behaviour and symptoms suggestive of delirium. The case requires the differential diagnosis of this presentation and appropriate investigations. The case also focuses on subsequent management of falls once the acute symptoms have settled.

In this case many candidates provided multiple answers including answers detailed in the case and question, there were many examples of providing lists with different answers and examples. Candidates are reminded to be concise, give one answer per line and not expand answers. Good answers looked at the range of possible causes for acute confusion/behaviour change rather than creating a list of one area such as different infections or types of intracranial pathology.

A good answer regarding management of this patient’s falls risk demonstrated a holistic approach and understanding of the potential causes of falls in the elderly as well as providing concise responses. Some candidates looked at fracture minimization or treating osteoporosis and not at the reduction in falls, again it is important to read what the question is requiring.

Case 18

The case centred on the differential diagnosis, investigation and management of a 20 year old patient returning from a visit to family in Eastern Europe. While away he was unwell, was treated for tonsillitis and now presents with an isolated submandibular lymph node.

Good answers focussed on a concise list of most likely diagnoses in this returning traveller. Poor answers included providing lists of all possible causes for isolated lymphadenopathy irrespective of the given scenario. Candidates correctly identified the appropriate investigations and the most important management step of excision/biopsy of the affected node.

Case 19

This case described the respiratory history of a 62 year old indigenous female patient along with the report from the CT scan of her chest. The history and examination findings along with the CT descriptors were classic for bronchiectasis. The diagnosis along with the possible predisposing conditions other than those in the detailed introduction for her was required together with management steps focussed on maintaining optimal lung function.

A good answer identified the diagnosis and relevant predisposing conditions , specific to her presentation though a common error was to list things already provided as possible causes or give broad topics such as ‘immunisation issues’, or ‘previous chest problems’. Some candidates focussed on COPD as an answer and subsequent causes. Likewise targeted answers scored well in the maintenance of her lung function and included mucous clearance, appropriate immunisation, medication and pulmonary rehabilitation.

Case 20

This case requires the identification and the appropriate immediate management of a 24 year old male patient presenting at the end of the day with facial trauma occurring earlier that day.

A good answer required candidates to demonstrate the important aspects of examination to exclude serious pathology in this presentation and identify the most likely diagnosis. The main error was in not giving a specific diagnosis but broad answers such as facial bone fracture and on assessment giving lists of examination findings under different headings or categories, rather than one specific feature of examination on each line. Imagine the patient in general practice and what findings you would look for.

Case 21

In this case the wife of a 36 year old man contacts you to inform that he has been bitten by a snake at a remote location and deals with the immediate first aid advice and subsequent management of the bite.

The essential management was pressure banding immobilisation and immediate transfer to hospital. If candidates washed the wound then the candidate scored zero for the first part of the case as this can literally be a life or death action and is absolutely contradicted in all management guidelines for snake bite.

A good answer to the onsite management once at a medical facility included the swab of the bite, IV access, monitoring for signs of envenomation, assessing for coagulopathy/baseline coagulation tests.

Case 22

In this case a 19 year old female presents with symptoms suggestive of a pneumonia, or acute severe viral infection and the requirement to develop a list of most likely differential diagnoses and elements of history relevant to the presentation. A chest x-ray film was provided and a decision on the next most important management step required given the findings on the x-ray.

A good answer identified the most likely diagnoses and key history features relevant to this presentation. Given the high fever and chest x-ray finding candidates were required to identify that this was an infective process. Some candidates focussed on a possible PE and so on the elements of history focussed on immobilisation, contraceptive pill use, or calf pain.

The x-ray showed significant consolidation and this in conjunction with the patient’s clinical findings and vital signs required immediate transfer to hospital for assessment and treatment. Some candidates provided diagnoses and their management options rather than the single most important management action. It is important to read the question and remember that if there if the question has a single most important step there will be one answer line and therefore to only provide one answer.

Case 23

A 12 year old girl presents with an itchy rash classic for a dermatomycosis and centres on the appropriate history and management of further lesions. The case then sees the girl being brought by her mother because of tender breast swelling and further information that there is a family history of breast cancer. The initial management of this new presentation is required.

Good answers identified the key features in the history confirming the diagnosis of a fungal infection as well as prior dermatological conditions and again required a concise and specific format, answers such as prior contact, bites or itch did not score as they were either too broad or given in the case.

This is a classic GP presentation and identifying the correct management is important and the development of further lesions is common and requires ongoing topical treatment and not referral or oral treatments.

The distractor of the family history of breast cancer does not require the patient to be investigated as the development of tender post areolar breast swellings is a normal pubertal occurrence and specific education/advice/reassurance to the fact that this is normal is all that is required. It is important that candidates identify normal changes in the body and do not over investigate.

Case 24

This case sees the progression of symptoms in a 51 year old female patient with a history suggestive initially of simple gastro-esophageal reflux. The case progresses from the initial diagnosis to subsequent identification of further diagnoses when the symptoms persist despite treatment and the subsequent single most important management step.

Good answers correctly identified the condition and subsequent differential diagnoses and looked at the breadth of possible conditions in this patient with the history given. Common errors were around focussing on acute cardiac events when the history clearly states progressive chronic symptoms. It is important to consider all the information in the case and question. All the information given is important and relevant to the questions then asked.

Case 25

In this case whilst undertaking a driving license medical in a 75 year old gentleman an irregular pulse is noted and an ECG is provided. The diagnosis and investigation are required along with the subsequent management

A good answer required the identification of atrial fibrillation and not a description of the ECG — absence of p waves, irregularly irregular etc. Likewise giving diagnoses that could not be inferred for the history or the examination and ECG did not gain marks; candidates offered causes of atrial fibrillation rather than answering the specific question about the diagnoses shown on the ECG.

Investigations needed to focus on determining the cause of the atrial fibrillation. The question asked for immediate investigations and therefore stress echocardiography or stress testing were not appropriate. Likewise simple baseline bloods rather than focussed bloods did not attract marks.

In respect to the question focussing on the principles of managing the atrial fibrillation a good answer required controlling the rate, the rhythm and the risk of embolic events.

Case 26

In the final case we see a 35 year old indigenous patient that has advanced glioblastoma that her husband and family have brought home as they are concerned about her care in hospital. The case requires the assessment of what is required to manage this patient in the home environment and the specifically managing evolving symptoms as the patient deteriorates. Good answers acknowledged the cultural setting and were sensitive to this and ensured appropriate engagement of agencies as well as considering the practicalities of ensuring holistic care in the home to address all aspects of patient care including physical, social, spiritual, legal aspects as well as appropriate symptom control. Also the demonstration of appropriate end of life planning was important. Poor answers focussed on one single aspect or symptom management, as well as not acknowledging the cultural needs of the patient and family.

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KFP 2016.2

Case 1

The first case focuses on a male patient presenting with a ‘funny turn’. The case scenario provides additional information about the event, along with pertinent past medical and social history. The questions explore the diagnosis and initial investigation.

This question was answered well, with the majority of candidates identifying the correct diagnosis.

The options for investigations were presented as a list for candidate selection. In general, diagnoses, history, examination and management questions in the KFP paper are usually ‘write-in’ questions, while questions about investigations are usually presented as a selection list. This reflects how GPs work in practice; when consulting with a patient, we collect and synthesise information to generate hypotheses around potential differential diagnoses and then set about the clinical reasoning process to establish a working diagnosis and generate management plans. Most clinicians would use computer systems and select investigations from a list rather than having to generate their own investigation list. There are variations to this, however, especially where candidates may be asked for single or a limited number of investigations.

In this case, candidates were asked for the immediate investigations required. It is important to answer the question asked. The list of investigations included those appropriate to later investigations as well as immediately necessary ones. It is important to reflect on our actual practice, as well as appropriate guidelines, and how we rationally approach investigating such a case and select those investigations that answer the question set.

The common error in this question was to select investigations that may be appropriate but are not required at the initial presentation.

Case 2

The second case focuses on the diagnosis and management of a range of ophthalmology presentations. There were classic descriptions as well as clinical photographs to guide candidates to the correct diagnoses. The presentations were those commonly seen in practice, as well as presentations such as the ‘red eye’ that are essential to identify the possible diagnoses, as failure to identify them could cause significant harm to the patient. The common errors in this case centred on not taking into account all the information and providing differential diagnoses that did not match the presentations.

Eye conditions are common in primary care and as such are regularly seen in the FRACGP assessments. It is important that candidates can safely manage the common presentations as well as identify serious conditions and ‘red flags’ in a patient’s history.

Case 3

This case describes classical features of a patient presenting with persistent shortness of breath over a defined period of time and an evolving story of chronic obstructive pulmonary disease (COPD). Candidates are taken through possible differential diagnoses, initial investigations and initiation of treatment.

The case follows the clinical reasoning process with investigations, candidates were then presented with a chest X-ray that was classic for COPD. The chest X-ray required interpretation, in light of the information already provided, and then initiating appropriate management. Candidates are regularly required to interpret X-rays with a clinical picture provided. In this case, despite the history and findings, many candidates focused on cardiac disease and management or identified pulmonary neoplasms that were not evident in the chest X-ray. It is important to read the case and answer in the context of the information given. This is a ‘key feature’ paper and not a simple short answer paper where all causes of shortness of breath are given. Remember to answer in the context of the question.

Candidates used many abbreviations in the management question and unfortunately they gave abbreviations such as LABA (long-acting beta agonist), but then provided examples that were incorrect and so effectively gave two or more answers. It was concerning that the wrong examples were provided for the different classes of medications for COPD – this raised the question whether some candidates actually knew what the abbreviations meant. There were also uses of abbreviations that the examiners could not understand and were therefore marked incorrect. Candidates are advised in the pre-exam materials not to use abbreviations.

In the KFP paper, we recommend that candidates do not provide examples unless they are specifically requested to, as this will lead to extra responses and associated penalties.

Case 4

This case features a patient presenting with a chronic haematological condition that, while previously stable, has developed new symptoms. Candidates were required to identify key features in the patient’s history to identify possible diagnoses and to select appropriate investigations to use to resolve the presentation.

In approaching this case, it is important to remember that candidates will not score if they simply repeat information in the case scenario, but only score marks if they correctly identify additional information that is required. The FRACGP assessments are specialist exams and providing answers that are vague or non-specific will not score. For example, answers such as ‘medications’, ‘trauma’ or ‘family history’ are not specific and therefore too vague to be considered correct. Answers need to be focused, specific and relevant to the case.

The main issues in this case were not being aware of the potential of chronic haematological conditions to rapidly progress and identifying those elements of the history that would indicate that this is occurring.

Case 5

In this case, candidates are presented with investigations and an accompanying clinical scenario that requires analysis and then ongoing management. This is a common case presentation. For all investigations, abnormal results are not highlighted, but normal ranges are provided for all results.

The patient had moderate renal disease from previously undiagnosed hypertension. Both of these conditions are common and candidates should know how to rationally investigate them.

Candidates were asked to select investigations, the common failing being that many candidates chose investigations that would not assist in the diagnosis. It is important to remember to select those tests that will be high yield in formulating a diagnosis or common underlying pathology, rather than selecting a blanket list of investigations.

In this case, the patient returns with other comorbidities and candidates are required to manage these in light of the whole presentation. For example, candidates would need to take into account the patient’s ongoing medications and renal disease when prescribing medications. Failing to identify these issues, and therefore failing to prescribe and/or manage the patient correctly, led to candidates not scoring well.

Case 6

This case provides candidates with a patient presenting with both dermatological and rheumatological issues. Candidates were given a description and clinical photographs to identify the lesions and asked to provide information on management. Dermatology forms a large part of our workload in general practice and in most KFP papers there are dermatology questions. It is important to look at the range of common conditions and how they are managed, as well as identifying more serious lesions.

In this case, some candidates chose to describe the lesion, despite a picture having been provided, rather than answer the question regarding management. As we have said before in previous cases, candidates should ensure they answer the question given and do not give examination findings or descriptors of lesions when asked about management.

The final question in the case describes the incidental finding at examination of gouty tophi in the fingers and asks about ongoing management. The picture was classic gouty tophi, but overall the question was a challenge, with the most common diagnoses offered being osteoarthritis or Heberden’s nodes.

Case 7

Case 7 centres on the investigation and management of an elderly patient presenting with acute onset of lower thoracic midline pain, with anterior wedging of vertebrae shown on an X-ray. Candidates were required to select appropriate investigations at this point and consider non-pharmacological management.

The most common error in response to this question was to provide pharmacological treatment, despite the question explicitly asking for non-pharmacological treatment. Many candidates lost marks by not reading the question carefully, or by inferring details that were not included in the clinical scenario, and suggested management such as reducing weight, reducing caffeine or using mobility aids; none of which were referred to in the scenario. While these might be appropriate, there is no evidence they are an issue in this scenario, so they should not be addressed when answering the question.

Case 8

Candidates are presented with an 18-month-old Aboriginal child coming for immunisation and need to provide the appropriate immunisations as well as address parental concerns about the vaccines. Many candidates listed diseases rather than vaccines. Candidates had to identify the additional vaccines required in this situation as well as the regular scheduled vaccines. Many candidates omitted the diphtheria, tetanus and pertussis vaccine (Infanrix), which is now scheduled for all children at 18 months.

In responding to parental concerns, rather than addressing those concerns, some candidates provided rote answers regarding Aboriginal and Torres Strait Islander health issues rather than addressing the specific queries from the parent.

In the question relating to the parental concerns, simply writing ‘provide handout’ or ‘refer to nurse’ is very nonspecific and does not show confidence in managing a very straightforward enquiry and one that is a regular issue in both consultations and the media.

Case 9

In this case, candidates had to consider the differential diagnoses and the immediate and longer term management of a female patient in her late twenties. The case describes new onset of symmetrical significant joint pains with initial investigations showing raised inflammatory markers.

While providing succinct differential diagnoses, some candidates did not focus on the information provided in the question and looked at more unusual diagnoses, rather than focusing on the more common diagnoses, or gave answers out of the context of the patient in this scenario, providing an ‘all cause’ list of joint pains.

In the management section, many candidates nominated medication or therapeutic options not appropriate for initial management, as well as using lots of abbreviations in their answers. Good answers identified the issues as presented, recommended the correct treatment, and included appropriately timed referral as the patient’s health issues deteriorate.

Case 10

Case 10 considers an extensive description of a female patient with several emergency department attendances with symptoms ultimately suggestive of underlying mental health issues. Candidates are required to analyse the information and develop a working list of differential diagnoses, assess and identify the most important risks within the presentation and develop an appropriate management plan.

Within this case, common errors included: focusing on organic causes of the presentation rather than looking at the detailed scenario; not identifying the risks to the patient and her infant; and using general terms when considering treatment or management, including recommending ‘antidepressants’, ‘counselling’, or ‘therapy’.

Despite the scenario stating to the contrary, there were answers referring to domestic abuse and acting on this. It is important to remember to read the scenario carefully and to respond in the context of that scenario.

Case 11

In this case, candidates are presented with a patient having potential side effects from her chosen contraception method – Mirena IUD. The case unfolds and considers initial advice and later ongoing management options.

Depending on candidates’ experience and practice demographics they may not have had exposure to all aspects of primary care.  When preparing for the assessments, it is important to identify areas where there may be a lack of experience and to ensure that the candidate is familiar with contemporary treatment and management.

In this case, one of the recurring issues in the examiners feedback was the lack of specific information and candidates using general terms rather than specific management, or simply referring to a specialist without actually managing the patient’s problems. The inference being that they were not familiar with this form of contraception, or its wider use within women’s health.

Case 12

This case presents a classic picture and clinical history of guttate psoriasis in a teenager. Candidates were asked to identify the diagnosis and then the appropriate management.

The condition was appropriately identified; however, in managing the condition, many candidates used emollients and symptomatic treatments, rather than managing the actual psoriasis. Some candidates utilised medications or approaches that were in the realm of specialist treatments, rather than those available to GPs. It is important to note that if using topical steroids, the potency needs to be given. A generic answer of ‘topical steroids’ will not score well and this is a common issue in dermatology cases.

Case 13

Candidates are provided with a history and clinical picture of a pigmented lesion. The story describes a lesion that is changing in size and asks what additional clinical features are required to assess the lesion and how it should be managed.

Many candidates reproduced information from the scenario and therefore did not gain marks. The question was assessing whether candidates have a possible framework for assessing pigmented lesions and identifying which of the elements in the assessment framework is not provided (such as the ABCDE or Glasgow framework). 

Many clinical presentations have well defined checklists or rubrics to assist the clinician as well as accepted guidelines. In the KFP exam, questions will always reference these resources in the development of the marking grids, hence it is important that candidates review appropriate Australian guidelines for common presentations in primary care.

When considering management, if candidates simply said ‘excise’ without reference to biopsy or histopathology then they scored zero. It is essential that histology is undertaken of any excised lesion as failure to do so and the consequences of such failure are a regular medico-legal issue.

Case 14

In this case, a coincidental finding is made at a routine medical of microscopic haematuria. Candidates are asked to outline the subsequent history and investigation. The scenario offers information that assists in the potential diagnosis for this patient.

In considering the patient’s history, if a case states there is no previous medical history of note or the weight is stable, then asking about radiation treatment or weight loss will not score marks. When a case provides a range of information, it is important to read the scenario a few times to ensure you have taken in all the information and that you are not providing answers contrary to the information that is already included.

When considering the investigations, it is important to look at the age and gender of the patient and provide answers appropriately.  A prostate-specific antigen (PSA) test would not be appropriate in a young man as an initial investigation, nor would a cystoscopy.

Whenever a case of haematuria presents in exams some candidates will reference beetroot. While beetroot consumption may produce a colour change in urine, it will not be detected as haematuria on urinalysis or microscopy. This is again about considering all of the information, rather than providing an ‘all cause’ list for haematuria.

Case 15

Case 15 presents the acute onset of a tender swelling in the neck of a young female patient and describes a tender goitre. Candidates were asked for differential diagnoses, appropriate investigation and therapeutic strategies.

In investigating the patient, choosing the tests that will help differentiate the causes of an acutely tender goitre in this patient will score, but generic tests that will yield little information will not.

The question asked candidates how to manage a patient while awaiting results of the investigations, so long-term treatments or treatments for symptoms not being experienced in the clinical scenario will not score. The question was assessing candidates’ ability to identify the immediate issues – the pain and tenderness – and manage these appropriately.

Case 16

This case presents a pet shop worker with symptoms of atypical pneumonia. Candidates were asked to identify the most likely diagnosis, further issues in the history, as well as most important investigations.

The most common error in responses was giving elements of the history but then giving multiple answers on each line, expanding on the answers and frequently having unrelated aspects of history together on the same line, such as, ‘night sweats, weight loss, anorexia’. Each answer is scored, so every additional answer above the number requested will attract a penalty. This is a key feature paper and requires focused and specific answers. When candidates provide multiple answers, create lists or provide multiple examples, penalties will apply.

Case 17

In this case, candidates are required to identify from the clinical history and findings an acutely unwell child presenting to a remote country hospital run by local GPs. The case directs candidates to a diagnosis of acute epiglottitis and seeks to identify additional history to support the diagnosis and immediate management.

The issue in this question was that some candidates could not identify the correct life-threatening diagnosis. Also the remote location was not taken into account in the management options provided by many candidates.

It is important to consider if a scenario gives a location for the presentation, as this may be pertinent to answering aspects of the case.

Case 18

This case focuses on a resident of an elderly care facility who presents with changes in her behaviour over the preceding few days. As well as pertinent information her medication list is provided.

Candidates are asked to give possible causes for the behaviour change and provide specific examples. This is a question that is explicit about needing examples. The question included an example of how candidates were expected to answer. Despite this, many candidates only gave general causes with no specific examples.

Candidates were provided with examination findings and bedside tests, and asked to select appropriate initial investigations. Many candidates wanted to organise radiological investigations including chest X-ray (CXR) and computed tomography (CT) scans. While in an emergency department this may be appropriate, in a residential facility this is not part of the initial investigations in the context of the clinical information provided.

In managing the patient, general answers such as ‘medication review’, ‘optimise medication’, ‘sedation’ or simply referring her to emergency did not score. Given the medication list was provided, there were specific therapeutic options available and candidates who scored well looked at a holistic approach to her presentation and possible management strategies.

Case 19

In this case, we are presented with a history and clinical picture of a penetrating injury to the distal phalanx in the index finger of a patient. Candidates are required to identify immediate management steps and possible complications.

Many candidates were keen to refer to a hand surgeon, but the presentation occurs in a rural location and such an answer does not address the immediate management. Analgesia was a common response, but many candidates did not specify which type, so did not score well (as this could range from simple analgesia such as paracetamol through to opiates).

In considering complications, some candidates only listed three different forms of infection rather than considering the impact of the injury on the different structures as well as infection. It is important to consider how you would group answers and have a framework to respond to such questions to consider specific complications relating to potential injury to nerves, bone and tendons.

Case 20

Case 20 describes a new patient who presents with investigations from a previous GP that were organised before moving to your area. The results show a macrocytic anaemia and low B12. Candidates are asked to look for relevant elements of her history and to consider ongoing management.

While many candidates correctly identified the possible underlying causes for the presentation in the history, they were then unable to progress the investigations to assess for pernicious anaemia. Schilling test was a common response, but this has not been available in Australia for several years so did not score. A gastric/small bowel biopsy is not an investigation that a GP would order, and is not appropriate in the initial investigations to determine if this is pernicious anaemia.

Case 21

This case presents an acutely unwell patient presenting with features classic of a leaking aortic aneurysm. The most common error was identifying this as a ruptured aortic aneurysm, a very different presentation, which generally does not present in the way the case describes. When considering the diagnosis, it is important to carefully read the scenario given. When asked for elements in his history, candidates should be aware that it is important to focus on history, not examination findings.

When considering the management in this case, urgent transfer by ambulance is imperative. A simple refer to emergency is not sufficient. When considering referral of patients as part of management, it is important that you consider where, who to and the degree of urgency, given examiners are looking for specific management and the ability to identify the urgency of a clinical scenario.

Case 22

In this case, we see a six-week-old baby brought by her mother with an inguinal swelling. There is an extensive description and clinical history provided. Candidates are required to identify the swelling, consider the differential diagnoses and the ongoing management.

In this scenario, while candidates could identify possible differential diagnoses, the urgency of the situation was not realised. Candidates often referred to ‘rules’ for hernias but these were for older children rather than a six-weekold. As in Case 21, identification of the need for an appropriate and timely referral scored the most marks.

Case 23

This case outlines the presentation of a resident of a group home presenting with increased aggressive behaviour and asks candidates to identify the possible underlying causes and appropriate management.

In answering the question, candidates should consider a logical approach rather than simply listing several infections or possible medications (especially when no medication list is provided). In the scoring grid, infection only scored once so listing several infections meant that marks were lost for other possible causes. This was another example of where candidates extrapolated the scenario beyond the information given.

In considering how to manage the situation, it was important that candidates take a holistic approach and consider the patient, the group home staff, and other residents given the information provided in the scenario.

Case 24

Case 24 considers a patient who presents with increasing abdominal pain and weight loss and asks candidates to consider the appropriate investigation. It also considers the issues faced when a patient fails to return to discuss abnormal results.

Candidates were able to identify the most important differential diagnoses and management, but some candidates struggled with how to manage abnormal results and the duty of care on them to follow up a patient’s results.

Medico-legal/ethical dilemmas will often appear in the KFP and duty of care is one important facet of this. It is important that candidates consider different scenarios and ensure they have an appropriate approach to such scenarios.

Case 25

In this case, candidates are presented with a female patient with right sided lower abdominal pain and asked to identify important differentials and ongoing management.

Given the focus on ensuring ectopic pregnancy is considered in any such scenario, candidates who did not list this possibility lost significant marks. Likewise, not looking at excluding pregnancy in the investigations meant marks were similarly lost.

It was important to give other differentials in line with the candidate’s age and presentation in the scenario. Candidates need to remember to address the scenario, not simply provide an all cause lists of lower abdominal pain.

Case 26

The final case centres on an older patient with bipolar depression and required candidates to identify key indicators in the history that would raise the suspicion of this diagnosis, then look to manage the patient in the primary care setting following referral to a psychiatrist. This focused on a holistic approach as well as essential monitoring of medications and regular bloods tests related to the medication. Candidates scoring well considered a holistic approach to managing the patient. In this case, a holistic approach meant not just focusing on the medication or clinical monitoring, but also considering ongoing targeted education (again just listing education is not specific enough to score marks), appropriate support for the partner/family, involvement of appropriate allied health and considering the development of crisis plans.

Answers such as education, regular review or ongoing preventive health strategies will not score, as they are either not specific or do not address the question.

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KFP 2017.1

Case 1

This case focused on an elderly male patient who presents with multiple symptoms. While several of these symptoms could be caused by hearing loss, candidates were asked to identify other possible differential diagnoses, interpret an audiogram and identify focused questions that may give rise to the pattern shown in that audiogram.

A significant number of candidates misread the initial question, which asked for ‘diagnoses other than hearing loss’ and provided answers related to hearing loss.

Failing to answer the actual question that has been asked is a common error made by candidates. It is important to read each question carefully, at least twice, before answering. It is also recommended to re-read the question after you have completed your answers to make sure you have answered the question exactly as asked.

The scenario described symptoms of six months’ duration, so differential diagnoses that have either an acute onset or are of greater chronicity did not score. The KFP exam requires candidates to carefully consider all of the information given in the scenario, including the demographics of the patient, and to answer each question in the context of the described patient.

The third question asked for aspects of history that would help to determine the causes of the bilateral hearing loss as demonstrated in the audiogram. Some candidates answered with history aspects related to unilateral hearing loss or congenital/early childhood hearing loss, which would not fit either the audiogram or the clinical presentation.

Hearing loss in the elderly is a common presentation and candidates should have a strategy for the assessment and diagnosis of possible causes.

Case 2

This case required candidates to demonstrate that they could appropriately assess and triage a child presenting in a rural hospital with a forearm fracture. Candidates also needed to identify that he presented with a grandparent and that there may be issues regarding appropriate consent, a point that was missed by many candidates.

The boy’s X-ray provided to candidates demonstrated a mid-shaft ulnar fracture and dislocation of the radial head. This is a fracture that can result in significant complications, such as potential neurovascular compromise, if not identified and managed appropriately.

Many candidates failed to recognise the seriousness of the fracture and therefore managed the fracture with simple treatment and follow-up, rather than the urgent orthopaedic referral that was required. In addition, many candidates did not include adequate analgesia or regular neurovascular assessment as part of their management strategy.

It is important to consider all of the individual elements of the scenario. In this case, as the treating doctor in a rural hospital, you need to provide appropriate initial management and be able to interpret X-rays, identifying potentially serious injuries such as this.

Case 3

This case focused on a young adult presenting with allergic contact dermatitis following time spent gardening. There is no mention of other possible contact allergens in the scenario.

Candidates were expected to identify the rash in the clinical photograph, provide appropriate specific treatment (including the potency level of topical steroid required given the severity), and other appropriate pharmacological and non-pharmacological treatments.

Candidates made errors in the diagnosis question by not appreciating the key information in the scenario, which suggested an irritant/allergic cause, and instead providing examples of infective causes or dermatological manifestations of systemic diseases as the most likely diagnosis.

When a question in the KFP exam asks for ‘specific’ treatment, it is appropriate to provide dose, frequency and duration (if applicable) of any medication listed. In this case, an answer of topical steroids, with no specifics given, scored a lower mark than answers in which details about potency and appropriate frequency were included.

Again, it is important to read the question carefully and ensure you have answered the actual question in appropriately sufficient detail in order to gain the maximum marks.

Contact dermatitis is a common presentation in general practice and candidates need to be able to identify this from the history and appearance, and to recognise common irritants.

Case 4

This case presented candidates with a patient suspected of having Lewy body dementia. They were required to identify key features in the history that would suggest this diagnosis, and look at the pharmacological and nonpharmacological management strategies as the dementia progresses.

Many candidates lost marks after separately listing several possible Parkinson’s-like motor symptoms rather than providing a broader range of answers. In order to make a diagnosis of Lewy body dementia, more than motor symptoms are required. Candidates who provided extensive lists of numerous causes of cognitive decline when asked about aspects of the presentation scored poorly, as they did not answer the actual question (which didn’t ask for causes). They were also penalised for providing more answers than requested.

In this case, there was a question about medication and a question about non-pharmacological strategies. Candidates commonly provided non-pharmacological strategies when asked about medications, and vice-versa when asked about non-pharmacological strategies. This again indicates misreading of the questions asked.

Quality responses to the two management questions required candidates to provide succinct and practical nonpharmacological strategies, identify possible medications that can exacerbate the cognitive decline, and suggest appropriate medication of assistance in behavioural management.

Case 5

This case presented candidates with an older male Aboriginal patient with a two-week history of a non-healing wound. Candidates were required to provide appropriate initial assessment and management, outline ongoing management as the wound failed to heal, and suggest strategies to increase the patient’s involvement in his care.

Given the patient’s associated comorbidities, as outlined in the scenario, it was important not to apply an initial compressive dressing, as no vascular assessment had been made.

One question asked for the, ‘single most important investigation’ when the patient returned with a non-healing wound after a protracted period. When answering this type of question, there may be tests that could be done, such as a wound swab, skin biopsy or diabetes monitoring; however, the single most appropriate test would be a Doppler arterial ultrasound of the patient’s legs, given his comorbidities of diabetes and hypertension.

Candidates who simply answered ‘Doppler’ scored zero. The KFP exam looks at clinical decision making and clinical reasoning and, to that end, candidates need to demonstrate what is appropriate to do in practice. Writing only ‘Doppler’ on an investigation form is insufficient and any doctor who did this in a real clinical scenario could expect a phone call from the radiology practice requesting more detail. Likewise, writing only ‘ultrasound’ or ‘X-ray’ without more detail will not score in the KFP exam.

It is easy to forget this in the exam environment, so candidates must ensure they are explicit in what they are requesting when asked about specific investigations.

When considering strategies to manage the patient’s adherence to treatment strategies, it was important candidates acknowledge his Aboriginal and Torres Strait Islander status and utilise appropriate services and strategies to engage the patient, such as involving an Aboriginal health worker. There are helpful resources available from RACGP Aboriginal and Torres Strait Islander Health and on gplearning.

It is common in the KFP exam for candidates to write ‘GPMP’, which is assumed to represent ‘GP management plan’. This is not considered a management strategy as such and will not score marks.

Case 6

This case presented candidates with a patient showing classic symptoms of a post-lumbar puncture headache, which they were expected to be able to identify and manage appropriately. The patient returns at a later stage with recurrent headaches of a different nature, suggestive of new pathology.

It is a common approach in the KFP exam to look at a patient with similar presentations at different points in time, but with different underlying pathologies, and therefore different management strategies.

Candidates often assume the subsequent presentation is related to, or the same as, the initial one. It is important candidates read and incorporate any new information given in subsequent questions.

This case is not trying to ‘trick’ candidates, but is simply presenting what often happens in real clinical situations. Having had one significant health episode, patients are more likely to present with similar symptom complexes, as they may be concerned about a recurrence. It is important to take in all of the information about the new presentation. If you are blinkered and focus on the initial presentation, you may neglect to consider new and possibly serious pathology.

Case 7

This case focused on the common situation of a patient presenting with the results of investigations from a community-based screening encounter. In this case, abnormal liver function results taken during a workplace medical.

Candidates were asked to provide the differential diagnoses, taking into account both the clinical information and test results.

A common error made by candidates was to list all possible liver pathology/diseases, rather than look at the specific pattern of abnormal liver function and provide relevant focused answers.

The final question in this case looked at the tests required for ongoing surveillance of the identified liver pathology. Candidates who scored poorly in this selection-style question chose tests that might be appropriate for ongoing general health surveillance, but which would not assist in identifying liver disease progression or its subsequent complications.

Case 8

This case presented the candidates with a clinical scenario of a male Aboriginal patient aged in his 40s with a chest X-ray that demonstrated a cavitating lesion. The questions focused on appropriate differential diagnoses and how to manage the patient’s reluctance to engage with medical services, taking into account the rural location and possible cultural issues.

The initial question asked for diagnoses, rather than findings, which means candidates who described the chest X-ray did not gain marks. This is a common error in the KFP exam when candidates are asked for differential diagnoses after being given investigations such as pathology results, X-rays or an electrocardiogram (ECG). It is important to answer exactly what the question is asking.

Regarding management, some candidates’ responses made inappropriate assumptions about the patient which gained no marks. If the question does not give information about a patient, do not make assumptions or judgements about that patient.

Case 9

This case focused on the initial assessment of a female patient presenting to an out-of-hours clinic in a rural location with symptoms suggestive of non-occlusive upper-limb venous thromboembolism. The patient returns several months later for pre-conceptual care.

Candidates who did not take into account the information in the scenario about the patient’s medications when developing the initial management strategy scored poorly in this question.

The first question asks about a specific investigation to confirm the diagnosis. Candidates who only answered ‘venous duplex’ or ‘Doppler’ without specifying the body part did not score well. When asked for a specific investigation, candidates must consider what they would write on a request form in order to ensure the correct and appropriate test is performed, minimising any delay in the patient’s care.

In managing the patient at the initial presentation, common errors included commencing medication such as warfarin and the new oral anticoagulants when they are licenced only for use in confirmed venous thromboembolism.

In the follow-on visit that centred on pre-conceptual care, the most common error was to not consider that the patient was at high risk of thromboembolism and therefore needed appropriate management, including appropriate specialist referral. Those who failed to appreciate this need for appropriate management gave answers that only outlined routine pre-conceptual care such as dietary modifications, folate supplement or assessing immunity to rubella.

This question was significantly ‘over-coded’ (too many answers given), with candidates providing lists of different tests, supplements or lifestyle changes. More than 20% of candidates provided one or more than the three components of the management required in the question and, upon more detailed analysis, it was identified that some candidates were providing lists of answers on each line.

Remember to look at your answer and see whether you have provided one answer per line and not created a list or given a range of examples to amplify your answer.

This KFP exam featured less ‘over-coding’ than in any previous exam; however, there was a small number of questions for which significant numbers of extra responses were given. These were generally where candidates provided lists or multiple examples on the same line.

Case 10

This case included a photograph with an accompanying clinical scenario describing a patient with severe rosacea. Candidates were required to identify the diagnosis, consider what history they would enquire about and outline their initial management.

In the history question, candidates often provided examination findings or asked questions about information already provided in the scenario, neither of which scored marks. If a question asks for history, do not provide management answers (and vice versa).

In terms of managing the patient, some candidates focused purely on pharmacological approaches rather than looking at the problem holistically and considering pharmacological and non-pharmacological approaches. Referring at initial presentation for a problem commonly encountered in general practice is not an appropriate management strategy and therefore did not score.

Case 11

This case focused on a presentation of mild-to-moderate postnatal depression in a new mother. It required identification of the initial key components of history and management in order to ensure the safety of the mother and child.

Questions assessing the risk of harm to the patient and the baby are the priority in this scenario.

Asking questions for which the answers are already given in the scenario does not score, and candidates should remember to take notice of all of the information provided before answering questions.

When providing answers to management questions, especially in the case of a breastfeeding mother, it is important to consider the strategies in the context of the case. Providing medication unsafe in breastfeeding to such a patient is inappropriate and potentially dangerous.

Providing non-specific answers such as ‘support’, ‘counselling’, ‘review’ or ‘reassure’ will not score marks in the KFP exam. These answers give no insight into a candidate’s understanding or specific management of the case, and do not demonstrate that a candidate is competent, or even safe.

Just as answering ‘GP management plans’ does not score marks, a ‘GP mental health treatment plan’ is not a strategy in itself and will not score a mark. An outcome of a mental health treatment plan, such as referral to a clinical psychologist, is considered a management strategy.

Case 12

This case presented candidates with the pathology results of a 68-year-old woman that demonstrated renal disease and anaemia. Candidates were required to select which of the patient’s medications might be contributing to her renal failure and anaemia, identify possible non-pharmacological causes for her anaemia, and provide an immediate management strategy at the follow-up appointment.

Common errors here centred on incorrectly identifying the type of anaemia and therefore its possible underlying causes, and not differentiating between immediate or long-term management.

It is important to answer in context of the patient. Blood donation was one a commonly provided cause for the patient’s anaemia. While this might be appropriate in a younger patient, this patient’s age and list of medications mean she would not be eligible to donate blood.

Remember, this is a key features paper, not an all-cause short-answer paper, so answer in the context of the scenario.

Case 13

This case focused on the assessment and management of a young child presenting with her parents, who are concerned about the child’s weight. The scenario identifies that her obesity is not due to underlying disease processes.

In order to accurately assess a child’s degree of obesity, you need to plot height and weight on a paediatric growth or paediatric body mass index (BMI) chart. Simply stating that you need to measure BMI is insufficient and did not score as well.

Despite the obesity being due to lifestyle factors, some candidates wanted to investigate the child at the initial presentation rather than give appropriate targeted lifestyle advice.

GPs should be familiar with the requirements for undertaking a GP management plan and subsequent team care arrangements. A description of eligible conditions can be found on the Department of Health’s website.

This presentation would not meet the strict criteria for a GP management plan and subsequent team care arrangements under Medicare. In addition, as mentioned previously, a GP management plan is not an answer that will attract marks in a KFP exam management question.

The case closed with the patient returning with skin lesions that are classic for a fungal infection, and candidates being asked to provide the appropriate management. Many candidates were not specific enough in their answer. While answers like ‘topical antifungal’ and ‘antifungal cream’ did score a mark, there were more marks available for being as detailed as possible about the medication and its regimen. Remember to be as explicit as possible when asked about pharmacological treatment.

Case 14

This case focused on a classical presentation of polymyalgia rheumatica and the subsequent investigation, management and complications of the disease.

The most common error in the question, which asked about the possible complications of untreateddisease, was describing complications of the disease treatment rather than the underlying polymyalgia. Remember to review your answer and ensure that it addresses the question.

While most candidates identified the underlying disease, there were some who did not grasp this common clinical presentation and therefore provided inappropriate initial investigations in response to the question regarding the ‘single most important test’ to confirm the diagnosis.

Many candidates were unable to provide an appropriate medication and starting dose, either going well over the range of recommended doses or providing an inadequate dose.

Case 15

This case included an older woman with suspected cardiac failure. Candidates needed to synthesise the information given and consider what other information was required to assess the severity of the disease. Candidates then needed to consider appropriate investigations to confirm the diagnosis and outline their initial management strategy, taking the patient’s current medications into account.

In the assessment component, common errors included asking the same question in different ways, such as writing ‘orthopnoea’ on one line and ‘ask how many pillows the patient sleeps with’ on another. You only score for one answer if your answers are too similar.

Remember to address the question asked. In this case, the most important components of initial management were requested. When formulating your answers, consider which responses are the key aspects of initial management and fit the context of the case. For example, checking flu vaccine and pneumococcal vaccine status may be appropriate opportunistic components of management, but are not key initial steps. Given that the patient is ambulant and does not have severe symptoms, referral to hospital or a cardiologist is likewise not a key initial management step.

Case 16

This case required candidates to identify acute care requirements from the given scenario and to arrange appropriate investigations and management. The patient had severe abdominal pain, prolonged vomiting for over 24 hours, and was known to have diabetes and to not have attended the practice for over a year.

Candidates’ common errors included not identifying the urgency of the presentation, focusing on long-term management of the patient’s alcohol use and failing to provide specific management steps.

The information provided in this scenario only stated that the patient had a significant amount of alcohol the day before he presented, not that he had a long-term problem with alcohol. It is important not to make unjustified assumptions or address issues not given in the scenario when answering KFP exam questions. In management questions, listing responses such as ‘analgesia’ without providing specific medication details does not gain marks.

Being able to triage and assess acute presentations is fundamental to safe clinical practice, no matter where you practise.

Case 17

This case focused on the presentation in a teenage girl with a three-month history of weight loss, amenorrhoea and diarrhoea. She had a preceding illness immediately prior to the development of symptoms. Candidates were required to explore the most likely initial differential diagnoses to fit the presentation and then investigate.

Most candidates provided a broad range of likely differential diagnoses and scored well. The candidates who did not score as well either listed several similar conditions (such as possible types of eating disorders) or focused on diagnoses that would not be the most likely initial differential diagnoses to consider.

Case 18

In this included an older man who initially presented with tinea cruris, as shown on the clinical image provided. Candidates were required to identify the rash and consider possible underlying conditions.

While identifying the rash was generally done well, identifying the important underlying conditions was not answered as well. Some candidates provided possible differential diagnoses of the rash, rather than conditions which predispose to tinea cruris.

In the second half of the case, the patient returned with a classic herpes zoster rash and candidates were required to identify appropriate medication regimens. The most common error was to provide treatment regimens appropriate for genital herpes rather than herpes zoster.

The final question concerned the patient’s request for the herpes zoster vaccination (Zostavax), assessing whether candidates were aware of the prescribing issues around the vaccination and a recent episode of herpes zoster.

Candidates must be aware of important changes to policy and guidelines, such as changes to immunisation schedules or new immunisations. The Immunise Australia Program website is a useful resource for Australian immunisation-related guidelines and updates.

Case 19

This case focused on a teenager who is bought in by her mother, who is concerned about her daughter’s symptoms of fatigue over the preceding three months.

This question addressed the recent NPS MedicineWise guidelines relating to the rational approach to the investigation and management of the non-specific presentation of fatigue. The NPS MedicineWise learning module is available online.

It is important to ensure that candidates are following contemporary guidelines and providing rational care to minimise cost to the individual and the health service. Fatigue is commonly over investigated with little yield from test results and investigations need to be appropriately focused.

The initial question asked about any further history, other than that related to mental health, which you would most like to obtain. Despite this prompt, many candidates focused on mental health. Another common response was family history, which is not a key focused aspect of history in this case, given the information in the scenario.

The investigation component was generally done well, with candidates selecting the key investigations in line with recent literature.

Case 20

This focused on a six-year-old boy presenting with his mother, who is concerned he is limping. The onset of the limp is acute; over the preceding few days only. Candidates were required to generate an initial list of differentials relevant to the presentation and choose useful initial investigations.

While generally approached well, some candidates did not take into consideration all of the information provided in the clinical scenario and listed all possible causes of limping in a child. Differential diagnoses such as trauma, congenital issues, and issues seen in older children with hip issues did not score marks.

It is important to ensure all information is utilised and not to provide answers inconsistent with that information.

The last part of the case asked for the appropriate management of molluscum contagiosum, which was found while examining the child, with the key answer that no treatment is required. Molluscum contagiosum lesions are benign and self-limiting. While there are various treatment options for this condition, they are not appropriate in this case given the child’s age and minimal impact of the lesions.

Case 21

This case required candidates to provide contraindications for prescribing the combined oral contraceptive. This was a straightforward question that was generally done well. The most common reason for scoring poorly was providing answers that were not specific enough, eg indicating obesity without specifying the BMI above which the combined oral contraceptive must not be prescribed, not defining what type of migraines are problematic, and writing family history without being specific as to what family history is most relevant.

In the second part of this case, candidates were advised that the patient does have a contraindication. The question asked what advice is important to provide when counselling a patient prior to prescribing the progestogen-only contraceptive pill.

There were two common errors in this question. The first was not providing key pieces of advice (ie what to do if pills were missed), but instead including less relevant answers (ie giving advice about interactions with specific drugs that the patient is unlikely to encounter). The second error was failing to make answers specific enough. Broad answers such as ‘advise on missed pills’ and ‘advise if has diarrhoea’ without actually stating what the patient had to do did not score marks.

Case 22

This case featured a young adult male with poorly controlled asthma. Candidates needed to identify that the patient’s asthma was deteriorating and follow the appropriate asthma guidelines in order to address the immediate and long-term management.

One question focused on medication choices and another on non-pharmacological issues such as reviewing inhaler technique and use of spacer devices. It is important to read the questions closely and not list nonpharmacological approaches when asked for pharmacological choices, and vice versa.

Candidates’ common errors included not utilising stepwise management of medication in line with guidelines, giving paediatric doses (the patient was 18) or other inappropriate treatment regimens, and providing answers such as ‘inhaled steroids’ without being specific about the drug and dose.

The final part of the case required candidates to identify a coincidental finding of a middle-ear effusion. The image included was classic for secretory or serous otitis media. Many candidates described it as acute otitis media; however, there was no evidence of inflammation or infection in the image to support this diagnosis.

Case 23

Candidates were required to identify atrial fibrillation on an ECG and then identify the aspects of history, other than those given in the scenario, needed to assess future risk of stroke.

This question was generally done well, with candidates demonstrating knowledge of the latest guidelines on stroke prevention in atrial fibrillation.

Case 24

Candidates were presented with a scenario in which a 31-year-old female patient presented with symptoms suggestive of a manic episode as part of bipolar disorder. There was no previous history of mania, but a confirmed prior history of depression.

Candidates were asked to offer a single differential diagnosis. The key component was that it was a manic episode/ phase of bipolar disorder. Mania alone scored fewer marks.

Quality answers in regards to immediate management considered both mental health and physical health/safety aspects. The scenario described behaviours that put the patient at risk of pregnancy and sexually transmitted infections, which were important to consider.

Candidates needed to consider pharmacological and non-pharmacological strategies when considering long-term management. Some candidates focused only on medication strategies rather than looking at appropriate referrals, specific elements of self-management and defined support networks.

Case 25

Candidates were required to identify symptomology of an acute pertussis infection in the married mother of a fivemonth-old boy.

The second question asked for the key single investigation. While generally done well, some candidates were not specific enough in their responses, giving answers such as ‘PCR’, ‘nose swab’ or ‘serology’. As discussed, candidates need to specify the exact test and site (if applicable) to gain full marks.

Key points in the management of the case were to provide appropriate medication to the mother, advise on an exclusion period from work (giving an appropriate duration), and treat the husband and son with an appropriate antibiotic.

Guidelines state that if there is a child under the age of six months in the household of a patient with pertussis, all people in the house should receive prophylactic treatment. Given the recurrent outbreaks of pertussis in Australia, it is important that the guidelines are known in order for those at risk of infection and severe adverse outcomes to be protected.

Case 26

The final case presented a 71-year-old female patient, for whom English is not her first language, who presented with a breast lump. Candidates were required to provide details of immediate management at the initial presentation, and ongoing management when further investigation showed a suspicious lesion.

Candidates’ common errors in this case were not identifying the need for a translator to assist in the consultation in either initial or ongoing management, involving family in decisions without the patient’s consent, and arranging ultrasound when the key investigation is a mammogram in the patient’s age group.

In terms of ongoing management, several candidates referred the patient for palliative care rather than curative treatment. At 71 years old, referral for consideration of curative treatment is more appropriate, unless the patient felt strongly otherwise.

In cases such as this, it is important that professional translators rather than family members are used whenever possible to translate, especially without patient consent.

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KFP 2017.2

Case 1

This case focused on a middle-aged male patient who presented with a history of prolonged fever, with initial investigations showing abnormal liver function tests. Candidates needed to consider the possible diagnoses, given the abnormal findings and the details in the history.

The most common error within this case was not taking all of the information into account and missing the details of the patient’s excessive use of paracetamol. When looking at the possible differential diagnoses, candidates failed to answer within the context of the case and listed all causes demonstrated by the liver function results, or described the results rather than providing a diagnosis.

Case 2

This case focused on a young adult male patient presenting with lesions on his shins, a history of joint pains and altered bowel habit. Candidates were asked to identify the lesions, provide differential diagnoses and those investigations required to confirm the possible cause of the clinical presentation.

In the investigation question, as with many of the investigation questions within the paper, candidates chose tests that would not assist in honing their diagnosis, but instead, selected those investigations that commonly form part of batch or baseline testing, such as full blood count, C-reactive protein, erythrocyte sedimentation rate, urea and electrolytes, liver function tests, and urine microscopy and culture. It is important that investigations are chosen rationally and are appropriate to the question.

Case 3

This case featured a middle-aged Torres Strait Islander male patient presenting with signs of acute gout.

Candidates were required to provide the specific pharmacological management of the initial acute presentation, as well as the longer-term non-pharmacological strategies to minimise further episodes.

The most common error in this case was not listing the range of management options, but focusing on three different nonsteroidal anti-inflammatory drugs (NSAIDs). The question requested specific management, namely the appropriate dosing regimen for acute management, not merely providing the drug name. While naming the drug would have gained marks, providing the appropriate regimen for each management option resulted in a higher score.

In the non-pharmacological management component of this case, candidates recommended that the patient quit smoking, when there was no history of smoking, or provided vague, non-specific answers, such as provide education or refer to various allied health professionals, without specifying the content of the education or the purpose of the referral. When referring to another health professional, candidates should consider outlining the nature and urgency of the referral.

Case 4

This case presented candidates with a clinical photograph and scenario of a middle-aged female patient presenting with new skin lesions that had not responded to over-the-counter topical preparations. Candidates were required to identify the lesions as basal cell carcinomas, identify risk factors in a patient’s history for developing these lesions and provide the appropriate management of the lesions in the photograph.

Candidates needed to be specific in their diagnosis, therefore answers such as ‘skin cancers’ or ‘sun damage’ did not score.

A common error in responding to the question of risk factors was to provide details of the lesions, such as size or progression rather than in the history as requested, or providing a list of different types of sun exposure rather than thinking broader and considering the range of risk factors. Likewise, when considering the treatment of the lesions, candidates cited management options that were inappropriate when managing basal cell carcinomas. They also discussed long-term prevention of skin cancer rather than the management of the specific lesions shown in the clinical photograph.

It is important when completing the KFP exam that candidates read the question and carefully review their answers in order to ensure the actual question has been addressed.

Case 5

This case focused on a young couple presenting with failure to conceive. Candidates were required to consider what history, additional to that provided in the scenario, would be relevant in exploring the possible causes of sub-fertility for the female partner, as well as the initial appropriate investigations for her. Finally, candidates were given the semen analysis for the male partner and were required to describe the result.

The most common errors in this case centred on not reading the question and providing answers relating to a generic pre-conception consultation rather than a sub-fertility consultation. Another common error was to focus solely on the patient’s symptomatology of polycystic ovarian syndrome, rather than considering additional diagnoses underlying a failure to conceive.

The investigation question specified initial investigations, with the most common error being to select secondary investigations, or investigations that were not relevant given the history provided, such as selecting serum prolactin when the history was not suggestive of a prolactinoma, in preference to other more common causes of sub-fertility.

It is important for candidates to consider all of the information provided in the clinical scenario, as it is pertinent to the subsequent questions.

Case 6

This case focused on a female patient presenting for follow-up of investigations from a workplace medical examination. The patient is asymptomatic, other than recently having had antibiotic treatment for cellulitis. The only abnormal results are liver function tests demonstrating a cholestatic picture.

Candidates were required to provide a focused history relevant for the presentation, as well as the differential diagnosis and secondary investigations.

This case demonstrated the need to ensure that candidates read through the case and questions carefully. The case states the patient had no pain, weight loss or stool changes, and defines her medical history and despite this information, candidates explored aspects of each of these. The history component of this case focused on aspects of the history that would help establish the diagnosis. When considering a response to this question, enquiring about pruritus, jaundice or rash are not going to assist greatly in establishing a diagnosis, as they are common to many causes of abnormal liver function.

When providing answers for possible differential diagnoses, it is important to ensure they are within the context of the information in the scenario. For example, acute cholecystitis or ascending cholangitis would not present asymptomatically as described in the scenario.

Case 7

This case has been removed from the paper due to poor statistical performance. Therefore, candidates’ scores in this case do not contribute to their final score.

Case 8

This case required candidates to interpret the presentation of a female patient’s four-week history of cough and shortness of breath, in conjunction with a chest X-ray, and provide differential diagnoses, as well as those features on examination that would assist in the diagnosis.

The question asked for specific signs on clinical examination, though many candidates offered answers focusing on history or investigations, or provided non-specific answers. Another common error was to provide explanations of answers which formed lists of responses on each line, which led to candidates being penalised for providing extra responses.

The new exam support modules provided by gplearning address the issues of ‘over-coding’ (ie too many answers provided). These modules provide candidates support and advice on how to approach all the RACGP Fellowship assessments by using recent exam cases. The two KFP modules explore the different style of KFP cases and take the candidate through each of the questions with correct responses, common errors and methods for avoiding them.

Case 9

This case focused on the presentation of an elderly male patient who is a retired miner. There is a history of progressive shortness of breath, cough and reduction in exercise tolerance. Candidates were provided with history features, examination findings and spirometry results. Candidates were required to identify the restrictive pattern demonstrated in the spirometry and provide possible differential diagnoses and investigations to determine the cause of the presentation.

Candidates frequently failed to identify the restrictive pattern demonstrated in the spirometry.

In providing diagnoses, the most common errors were in not considering all of the information within the scenario, including the spirometry, providing general diagnoses rather than specific disease processes, and listing diagnoses on each line that then led to penalties for over-coding. If candidates provide lists, use words like ‘and’/‘or’, or use forward slashes or commas, then they are providing lists and therefore extra responses, which are penalised.

Case 10

This case provided candidates with a young adult male presenting with acute onset of anterior chest pain and a prodromal viral illness. An electrocardiogram (ECG) was provided with changes typical of pericarditis. Candidates were required to describe the specific changes demonstrated on the ECG and provide a single diagnosis from the information in the scenario and the ECG.

The question asked for specific abnormal findings on the ECG, not diagnoses. In order to identify the changes, candidates needed to provide the specific abnormalities shown in the ECG, including the leads in which the changes can be seen. Answers such as ‘ST elevation’ or ‘PR depression’ could provide very different diagnoses depending on their location. Candidates who provided less specific answers such as these were still awarded marks, but to a lesser degree than those who were specific in their responses.

The final question in this case focused on pharmacological strategies for smoking cessation. It is important when responding to questions to consider how to group answers, in this case, providing two nicotine replacement strategies would not provide maximum marks. The patient has a history of epilepsy, so providing medication that may increase seizures did not score.

Case 11

This case focused on a female patient presenting with progressive reduction in her mood and mental wellbeing. Candidates were required to consider additional medication to improve the patient’s mental state, taking into account her current medication and other information provided. The scenario unfolds and the patient develops suicidal ideation, and candidates were required to assess her suicide risk by providing key elements of their suicide risk assessment.

In providing appropriate medication, candidates needed to take all of the information in the question into consideration, such as the fact the patient was taking tramadol. Candidates should therefore not prescribe medication that would interact and cause possible harm. The question also required specific dosing in addition to naming the drug chosen, and providing both name and dose regimen gained more marks than the name alone.

The suicide risk assessment was done well by the majority of candidates. The main sources of error were providing answers that would help explore her low mood, but that were not specific to assessing suicidal risk, and repeating information already provided in the case.

Case 12

This case focused on an older male patient with a previous history of prostate cancer, which was treated with prostatectomy and ongoing goserelin injections. The patient presents with a short history of low thoracic back pain and examination reveals localised spinal tenderness. Candidates were required to identify the possible differential diagnoses and options for pain management.

This case identified the need to consider how answers are grouped when considering pain management.

Candidates who provided a list of different opiates or different NSAIDs did not score optimum marks. It is important to consider the range of management options and provide options from different drug classes. The final component of this case focused on planning for future care in the event the patient is not able to make his own decisions. Candidates successfully identified the need for advanced care planning and appointing a medical power of attorney. There are variations to the naming of these processes across the country; when this occurs in questions, marking takes account of differences across the states and territories.

Case 13

This case featured an older male adult with a previous history of chest pain who now has acute shortness of breath that developed over the preceding two days. The patient’s full medical history, including medications, is provided.

Candidates needed to identify the differential diagnoses and investigation and, as the case unfolds, the immediate management of acute chest pain in the general practice environment.

The most common errors seen in this question were providing a list of all causes of shortness of breath and not focusing on the information provided, as well as providing non-specific answers. When considering which investigations to include, it is important to read the question; in this case, initial investigations were required to address the causes for the acute shortness of breath, not ongoing outpatient investigations such as stress echocardiography. Candidates need to consider which investigations will give the best return on information to assist in diagnosis, rather than selecting what are often seen as ‘baseline’ investigations.

In managing acute chest pain in the practice setting, candidates need to be aware of current guidelines, including those regarding the use of oxygen. The case required specific management steps, with candidates expected to provide appropriate drug regimens rather than just listing drug names.

Case 14

This case focused on a female patient with previously well-treated hypertension who is noted to have raised systolic and diastolic blood pressure during a consultation for repeat prescriptions. Candidates were required to provide possible causes for this raised systolic and diastolic blood pressure given the patient’s history, as well as ways to confirm whether this is an isolated reading or there are issues with blood-pressure control. The case continues and confirms that the patient’s blood pressure is not fully controlled and candidates were required to provide pharmacological strategies to address this situation.

When a question asks for lifestyle factors contributing to uncontrolled hypertension, providing pharmacological causes will not score. It is important to read the question and provide answers that address the question, as well as ensuring answers are not grouped. Writing ‘smoking’ and ‘alcohol’, or ‘high-fat diet’ and ‘high-salt diet’ on one line is providing more than one answer and will thus lead to over-coding penalties.

When responding to a question that asks for specific pharmacological management, simply listing medications or providing non-specific answers such as ‘titrate medication’, ‘maximise dose’ or ‘add diuretic’ will not gain marks. This was the most common error in this question and the primary reason candidates did not score well.

Case 15

This case featured a child who initially had minor upper-respiratory symptoms then deteriorated rapidly with clinical features suggestive of evolving epiglottitis. Candidates were required to identify possible differential diagnoses, examination features that would identify a seriously unwell child, and the immediate management of that child. In assessing and managing the child, the most serious diagnosis of epiglottis must always be considered. Therefore, anything that may distress the child and put the airway at risk during examination, such as examining the throat, caused the candidate to score zero for that question, but not the whole case. It is reassuring that the vast majority of candidates identified epiglottitis as a possible differential diagnosis and did not attempt to assess the airway.

The KFP exam may contain questions where answers are possibly considered dangerous, and such answers will result in a candidate score of zero for that question.

When providing differential diagnoses, it is important to provide specific diagnoses rather than a list of causative organisms given that they may cause a range of symptoms or diagnoses.

The KFP exam is assessing management in the context of a general practice environment. As such, when providing immediate management it is important to ensure that answers are contextualised for general practice.

In this case, many of the answers provided appeared to be emergency-department-focused, such as attempting to obtain intravenous access. The other common errors were not providing immediate management and failure to recognise the urgency of the situation; answers relating to reassuring the mother or educating about epiglottitis, or arranging follow-up. While these are important aspects, they did not address key elements of immediate management in general practice and thus did not properly address the question.

Case 16

This case focused on a female patient returning from overseas travel to south-east Asia who developed cough, back pain and fever in the few days following her return. The case scenario contained information on her pre-travel preparations, as well as malaria prophylaxis. This information is relevant while responding to the questions.

Candidates were required to identify possible differential diagnoses and history other than that contained in the scenario in order to assess the patient’s symptoms.

The most common errors were the failure to hypothesise appropriate differential diagnoses given the pattern of presentation, and to ask about aspects of history that were irrelevant, such as PR bleeding, given that the stem clearly indicated that there were no bowel or urinary symptoms.

In the case scenarios within the KFP exam, it is common to state that there is no past medical history of note. Consequently, any answers exploring a history of previous illnesses or, for example, enquiring about a history of asthma will not score marks. This was a common issue across the whole KFP exam paper.

The final question in the case presented a clinical description, as well as a photograph of scabies, with candidates required to give specific management.

Case 17

This case focused on a patient presenting for routine screening and who was noted to have an asymptomatic neck swelling, thought to be from a thyroid nodule.

Candidates were required to identify elements of the history that would suggest possible malignancy and provide the most useful initial investigations. Candidates often did not show an understanding of time sequence of investigations and provided investigations that formed at later stages of the investigation process.

Case 18

This case featured a female patient presenting with symptoms of secondary amenorrhea. Questions focused on providing the most likely differential diagnoses, and candidates were also asked to select the initial investigations according to the information in the scenario.

Common errors in this question included providing similar answers over two lines, such as ‘premature ovarian failure’ and ‘early menopause’, or ‘pituitary adenoma’ and ‘prolactinoma’. Candidates only gained one mark in such an instance. It is important candidates are specific in their answers, and responses such as ‘pituitary axis failure’ are too broad and are not a diagnosis, but cover a range of specific diagnoses.

Case 19

This case focused on a vulnerable adult with intellectual disability and who is a resident in a community group home presenting with recent behavioural changes. The questions assessed candidates’ ability to identify sources to corroborate the history, possible differential diagnoses for the presentation and selection of initial investigations.

A common error was to assume that, given the patient had intellectual disability, she would have mental health issues and would therefore require a mental health care team to assist in history. Many candidates did not seek to ask the patient herself. While she may have minimal verbal communication, this is not a reason not to approach the patient.

In providing differential diagnoses, it was a common error to enquire about information already provided in the scenario. For example, asking about medication side effects or interactions when the scenario stated that patient is on no medications, or enquiring about hearing aid problems when there is no mention of hearing difficulties in the scenario. Candidates should utilise the information in the scenario and not create and then solve problems that are not listed.

Case 20

This case focused on an older female patient presenting with acute onset of upper-back pain. Candidates were required to interpret the lateral spinal X-ray that was provided and identify the diagnosis of osteoporosis and provide appropriate initial investigations. These elements of the case were covered well by the majority of candidates; however, the final question requested non-pharmacological strategies to assist in ongoing management. This was not answered as well, with candidates providing either pharmacological advice or nonspecific advice, such as the commencement of vitamin D supplementation.

Case 21

This case focused on a middle-aged female patient with a short history of cough, shortness of breath and acute change in her exercise tolerance. Candidates were required to identify the specific consolidation on the chest X-ray and its location. In the KFP exam, the more specific an answer the more marks that are awarded. In addition to identifying the abnormality, candidates were required to identify risk factors in the history that may predispose to the diagnosis, and then those factors signifying the severity of the presentation.

In this case, the common errors were to repeat information in the scenario, make assumptions about the patient’s exposure to illnesses due to her name, and to provide symptoms when asked for examination findings.

Case 22

This case focused on the end-of-life care for a female Aboriginal patient with a high-grade glioblastoma. The patient’s family had chosen to remove her from the hospital due to concerns about her care. The questions focused on the key issues that need to be addressed both initially and as the patient’s condition deteriorates, taking into context her cultural, social and medical needs.

The common error in this question was to not read the scenario and identify the support that was already in place in the form of family, community and Aboriginal health workers, and provide these all as a ‘rote list’ without considering the information. No mark was given for repeating information given in the case scenario.

Other common errors included candidates listing reasons as to why the patient’s care may not have been appropriate in hospital and the issues of that environment, rather than those faced in the home environment. This reinforces the need to carefully read the case and its questions.

Case 23

This case focused on a male patient presenting with gastrointestinal symptoms of nausea, bloating and a sense of fullness in his upper abdomen after eating. From the additional information in the scenario, candidates were required to consider possible diagnoses for the presentation. The case evolves with evidence of Helicobacter pylori infection, and candidates were required to consider how to manage this infection, as well as the gastrointestinal symptoms.

While the differential diagnosis was covered well by most candidates, common errors in this case centred on nonspecific answers for the management component. Writing ‘eradication’ or ‘antacids’ as an answer would not score, given the question asked for specific management strategies. A good answer constituted specific pharmacological strategies and addressed lifestyle issues raised in the clinical scenario.

Case 24

This case featured an older male who is experiencing light-headedness, near-syncope attacks and reduced exercise tolerance. He has ‘red flag’ symptoms suggestive of a possible underlying malignancy. Candidates needed to be aware of the combination of symptoms and provide possible differential diagnoses and initial investigations that would assist in determining the most likely causes of the patient’s symptoms.

The common errors in this case centred on not identifying red flag symptoms and providing only cardiovascular causes of the patient’s presentation or, again, giving non-specific answers such as reduced fitness or weight gain, despite the scenario stating he had lost weight. The information in the scenario is both relevant and consistent with the expected answers.

Case 25

This case focused on a male patient with a three-month history of generalised pruritus. There is no preceding medical history of note and examination reveals that the patient’s skin is not dry and there is no inflammation. Candidates were required to provide differential diagnoses and appropriate investigations.

Despite the information given, candidates generated differential diagnoses that would have provided dermatological signs on examination.

The case continues and the patient returns a month later having developed night sweats and multiple lymphadenopathy. Candidates were required to identify the key investigations to further the diagnosis.

The most common errors in this section of the case were to offer further diagnoses rather than investigations, or providing non-specific investigations such as ultrasound, biopsy or computed tomography (CT) scan without specifying further details.

Case 26

The final case featured an adolescent male patient who collapses while having lunch at school. There was observed loss of consciousness and some associated muscle/limb jerking. Candidates were required to use the information given to identify the possible diagnoses in a patient presenting with fits, faints or dizzy spells.

Quality answers looked at the range of presentations possible rather than just neurological presentations, and considered causes such as cardiovascular, metabolic psychological and possible substance misuse. The most common error was to list different forms of epilepsy and not consider a broader range of possibilities.

The second question in the case required candidates to identify key features in a history with this presentation that assist in establishing a diagnosis. Candidates needed to appreciate the range of possible causes and their underlying distinctive clinical features to elicit in the patient’s history. Had the candidate focused solely upon different forms of epilepsy in the first question, and thus only focused upon on a neurological history in the second question, this would not have provided optimum marks.

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KFP 2018.1

Case 1

This case focused on an older male patient presenting with a compression fracture. Candidates were provided with the patient’s dual-energy X-ray absorptiometry (DEXA) results demonstrating the patient had osteoporosis. The case required candidates to consider the possible causes of the patient’s osteoporosis, appropriate investigations and the medications appropriate for this patient.

The most common errors in this case centred around not answering the case in the context of the question. Candidates provided responses that were wrong for the gender of the patient, providing causes and treatments for a female patient (8% of candidates listed raloxifene as an appropriate treatment).

Candidates provided non-specific answers such as ‘alcohol’, ‘medication’ or ‘lifestyle’ as a cause of the osteoporosis. These answers do not score marks since they provide no insight into a candidate’s knowledge. A better answer would include the level of alcohol consumption that would pose a risk, or a medication class that is known to reduce bone density.

Case 2

This case focused on a young female patient presenting with vaginal bleeding in early pregnancy. Candidates were required to consider the differential diagnoses, appropriate investigations and then offer appropriate advice regarding diet in pregnancy.

The common errors regarding the differential diagnoses were candidates providing answers that relied on history or details not provided in the scenario. It is important to consider the key features in the clinical scenario provided and not to provide answers based on collateral history not included in the scenario.

Case 3

Candidates were presented with a middle-aged diabetic patient who presents for routine diabetic review. They were required to analyse the case information, including results, and consider what complications were demonstrated and how these may be managed.

Although answered well by the majority of candidates, the main error this case demonstrated was failure to read the scenario and the questions. Candidates provided results or investigations as answers, rather than the diagnosis (diabetic nephropathy) as requested in the question. When asked for serious complications of the medication, candidates provided answers focusing on the complication of diabetes rather the medication, or on complications that were not serious. In relation to the management question that specifically asked for non-lifestyle measures, candidates provided lifestyle answers.

It is important to ensure that the case is read fully, all information is considered and that candidates read and re-read the question, and after writing their answer consider reading the question again to ensure their answer matches the actual question asked.

Case 4

This case focused on a middle-aged male patient who presented with two episodes of sudden loss of vision in one eye. Candidates were presented with his past medical history and medications. The initial questions focused on history and differential diagnoses, with a final question considering an incidental skin lesion found on examination.

A common diagnosis given was ‘amaurosis fugax’; this is not a diagnosis, but a term used for a symptom complex. For the history component of the case, common errors were to provide answers that were unfocused and not related to developing a working diagnosis, or that repeated information already in the stem. In the KFP exam, it is important to provide specific answers tailored to the scenario and question.

Candidates were given a clinical photograph of a skin lesion and required to provide the appropriate management. Dermoscopy was a common answer. This is not a management step, but an examination. Another common error was to consider full skin checks or advice on safe sun exposure, neither of which addresses the question, which was about the management of the lesion demonstrated.

Case 5

This case focused on a young female patient presenting with irregular periods. Candidates were required to consider the history and investigations required to develop a diagnosis for the patient’s presentation, then develop an appropriate management plan.

A common error was to only develop the history focused on one diagnosis, such as polycystic ovary syndrome, and not consider a broader list of diagnoses for this presentation. This was repeated in the investigation question as candidates selected investigations that only confirmed a diagnosis of polycystic ovary syndrome rather than, as the question asked, how candidates would investigate the causes of this patient’s symptoms. The initial questions in this case were developed to assess a candidate’s initial approach to a young patient with irregular periods, and provide focused history and investigation.

In the management question, the need for specificity cannot be stressed enough. Providing generic answers such as ‘diet’, ‘exercise’, ‘medication’ or ‘educate’ did not gain marks. Candidates need to expand and show to the examiner that they know what medications or dietary and lifestyle advice they are giving to the patient, and that such advice is both specific and appropriate to the clinical scenario.

Case 6

This case centred on a male patient presenting with a swollen elbow, and required candidates to provide appropriate diagnosis and management as well as the underlying pathology for the presentation.

This case was generally addressed well, but some candidates did not describe the underlying pathology or cause for the presentation. Instead, they gave further diagnoses or delivered management that was not appropriate and used abbreviations such as ‘RICE’. In this presentation, elevation was not appropriate and therefore RICE did not score. Candidates should not use abbreviations in their answers; in this case, if candidates had considered what RICE is an abbreviation for – rest, ice, compression and elevation – they would mostly likely have identified that one element was incorrect.

Case 7

This case presented an elderly man with a complex medical history, including dementia, who attends for his driving licence medical. This question was assessing the ability to consider all the information provided and demonstrate what further information is required to make a decision on the patient’s fitness to drive and his subsequent management. The marking grid for this question took into account all the different state-based and territory-based requirements.

Again, it was important to answer the question provided. Common errors were to list all the examination findings for one condition, such as Parkinson’s disease, or to list generic examinations such as ‘do a full neurological examination’. Such answers did not score.

The question required familiarity with the ‘fitness to drive’ requirements as well as the forms used in the assessment. In the management question, candidates provided management of his underlying conditions, such as performing investigations and optimising his diabetes control, but not the further management steps required to fully assess the patient’s fitness to drive, such as external assessment with occupational therapy or, with consent, a collateral history from relatives.

In the final question, candidates were asked to identify the required management following a decision that the patient was not fit to drive. This is an important component of assessing fitness to drive, and candidates need to be aware of their responsibilities should this be the outcome. The KFP exam can include questions from all five domains of the general practice curriculum, so candidates should include occupational and legal aspects of general practice in their exam preparation.

Common errors were to consider ongoing preventive health measures or assessments, discuss other transport options, or to provide generic answers such as ‘reassure’, ‘refer’, ‘empathise’ or ‘educate’. These did not gain marks as they do not give the examiners insight into a candidate’s knowledge or ability to manage a patient. It is paramount that answers are specific.

Case 8

This case focused on a young male patient, whose father had recently been diagnosed with symptoms suggestive of Huntington’s chorea. The question focused initially on the genetics of Huntington’s disease, but then looked at managing requests for genetic screening, as well as the options for in-utero testing, given the patient’s wife was in the early stages of pregnancy.

Following the KFP exam, there was significant social media discussion on why there was a question on this condition in the KFP exam. While not a common condition, the scenario provides a route into testing several domains, such as the candidate’s understanding of genetic testing requests, appropriate advice to provide, the available methods of antenatal screening and what should actually be screened for. GPs are at the front line for requests for genetic tests and should be able to give appropriate advice on testing and its implications.

Case 9

Candidates were presented with a young female patient experiencing repeated short-lived episodes of dyspnoea and palpitations. She had a history of well-controlled asthma. Candidates were required to identify appropriate investigations to look for causes of her symptoms, provide differential diagnoses, identify the most likely diagnosis given all investigations were normal, then provide an appropriate management strategy.

A common error for some candidates was to provide answers focused on the patient’s asthma, despite it being stated it was well controlled – such answers included spirometry with reversibility as an investigation, and overuse of salbutamol or assorted arrhythmias as a diagnosis, despite normal investigations.

In developing appropriate management strategies, responses such as providing a mental health care plan (which does not actually manage the patient unless it details the specific mental health treatment required) or non-specific referral will not score.

Case 10

Candidates were presented with a young girl who is found to have a hot, tender and swollen knee on a background of a recent sore throat.

The majority of candidates answered this question well. The most common error was in providing responses not appropriate to the age of the patient, providing management that did not respond to the urgency of the presentation or providing investigations based on secondary care.

The final component of the question required candidates to identify from a clinical photograph that the young girl had simple warts on her fingers, and then to provide appropriate management advice

Case 11

This case focused on an Aboriginal middle-aged female patient presenting with abnormal liver investigations and a diagnosis of chronic hepatitis C. Candidates were asked to consider the reasons why the patient may not have accessed care earlier and received appropriate treatment. Candidates had to also identify what investigations they would consider before commencing appropriate GP-based treatment for her hepatitis C.

The majority of candidates answered this question well. The most common errors were choosing investigations that were not essential prior to specifically assessing the appropriateness of providing GP-based hepatitis C treatment programs.

Case 12

This case consisted of a young adult male presenting to a rural hospital with symptoms and vital signs demonstrating evolving anaphylactic shock. Candidates were required to provide a specific diagnosis and specific initial and ongoing management.

Common errors involved not reading the question and identifying that the scenario was a remote rural location, or not identifying the urgency of the situation, so providing answers unrelated to the scenario or the questions asked. Some candidates also managed the patient as a case of envenomation despite no information in the scenario suggesting this.

While candidates knew the principles of managing acute anaphylactic shock, there were issues relating to awareness of dosages or providing medication no longer used in current guidelines. The question required candidates to identify this was a case of anaphylactic shock, evident from the vital signs, and not just anaphylaxis. Candidates should be familiar with managing the range of emergency presentations that may arise in general practice.

In the KFP exam there may be questions where an answer is either a ‘killer answer’ where undertaking this action is dangerous (refer to case 25), or an ‘important answer’ where without a specific management step the patient is at significant risk. In this case, failure to provide adrenaline meant that the candidate scored zero for that question – not for the whole case, but just for the question.

Case 13

Candidates were presented with a three-month-old baby with progressive respiratory signs suggestive of bronchiolitis. Candidates needed to make a correct diagnosis and identify the most likely causative organisms in bronchiolitis, then identify factors in the child’s history they would need to enquire about to assess if they are at risk of severe disease.

Common errors centred on not identifying organisms but offering differential diagnoses, and on providing examination or investigation findings when asked specifically about the patient’s history. Candidates also provided answers such as prematurity or being unimmunised, which were in conflict with the information in the scenario – the baby was born at term and fully up to date with immunisation.

In the final component of the case, candidates were required to identify a common self-limiting facial rash in young babies and offer appropriate management advice to the parents. This was answered well by the majority of candidates.

Case 14

This case focused on a young male patient who presents with acute onset of increased breathlessness on exertion. There was a history of recent viral infection. Candidates were asked to consider key elements of the history they required in order to formulate a diagnosis, interpret cardiovascular findings to provide a diagnosis, then appropriately manage this acute presentation

Common errors were in only obtaining history centred on one diagnosis – for example, pulmonary embolus/deep venous thrombosis or respiratory infection – rather than exploring more broadly relevant aspects of history. At times, candidates focused on the patient’s employment, even though a recent employment medical was normal. Another error was to provide non-specific answers such as ‘family history’ or ‘take respiratory history’.

Some candidates failed to correctly interpret the cardiovascular examination finding in light of the presentation, so did not identify the correct diagnosis or the urgency required for immediate referral or admission.

Case 15

Candidates were presented with an elderly female patient in a residential facility. The patient had a complex history and now presented with signs of a deep venous thrombosis. Candidates were required to identify specific examination findings that they would assess for in order to confirm the diagnosis as well as the subsequent investigation and appropriate management.

Common errors included not correctly synthesising the information within the scenario and developing an appropriate diagnosis, therefore focusing the examination on other diagnoses. When offering investigations, candidates were not specific in their request. The KFP is seeking to assess what candidates do in their day-today clinical practice. When requesting a duplex or Doppler scan, it is important to specify what the scan is of and where. Hence, maximum marks were for providing an answer such as venous Doppler/duplex of the deep veins of the left leg. Simply putting duplex or Doppler would not have gained marks.

In managing this particular patient, candidates needed to appreciate the implication of the patient’s recent and past medical history and that the patient therefore required urgent input from secondary care in regard to anticoagulation. Initiating GP-based treatments with anticoagulants was not appropriate.

Case 16

This case focused on an older female patient who presented with collapse. Candidates needed to provide the most likely differential diagnoses and initial investigations in light of relevant past medical history and medications.

While this question was generally answered well, the most common errors were in providing diagnoses not relevant or likely given the information in the scenario. As for some earlier questions, candidates appeared to develop a collateral history and so provided irrelevant diagnoses. The commonest incorrect investigations focused on candidates selecting investigations that would not be considered initial, or investigating those conditions that were not the most likely differential diagnoses.

Case 17

This case focused on an unimmunised eight-month-old baby girl presenting with her mother. The mother wished to enquire about immunisation and possible contraindications given the child’s allergies. Candidates were required to identify the contraindications to immunisation as well as manage the request for immunisation in light of the father, who is not present, being opposed to all vaccinations.

The scenario required candidates to identify the complex medico-legal and ethical aspects of this scenario and manage appropriately, and to also provide the limited medical contraindications to vaccination from current guidelines. In terms of the vaccination request, in this scenario, the key response was not to immunise at this point but explain why vaccination cannot proceed, seek to address paternal concerns and obtain appropriate legal advice.

The final component of this case required candidates to identify and appropriately manage a rash on the baby’s cheeks that required simple non-pharmacological intervention other than the use of emollients.

Case 18

Candidates were provided with the history of a late middle-aged female patient presenting with a history of persistent productive cough following a significant chest infection 12 months previously. Further medical and social history were provided to enable the candidate to provide the most likely differential diagnosis and initial investigations.

This question was answered well, but common errors centred on not taking the scenario information into account and providing diagnoses that were not the most likely given the patient’s demographic or history.

Case 19

This case focused on a patient presenting with progressive fatigue through the day, muscle weakness and being increasingly clumsy over a short, well-defined period. Information on the patient’s past medical history and clinical findings were provided. Candidates were required to identify that the most likely presentation was of myasthenia gravis and select from a list the appropriate investigations to confirm the diagnosis.

Although myasthenia gravis is uncommon, it needs to be considered when patients present with the symptom complex and examination findings described in the scenario.

The final part of the question required candidates to provide appropriate management of a suspicious pigmented lesion discovered during the examination.

The case was answered well by the majority of candidates.

Case 20

Candidates were presented with a post-menopausal female patient wishing to discuss the results of tests requested by her alternative health practitioner. These included a mildly raised CA 125 blood test. Information about the past medical and social history was provided.

Candidates were required to provide a focused history to explore the raised CA 125 and the patient’s symptoms and key examination findings that would raise the suspicion of serious underlying disease.

Given the inappropriate use of tumour markers for screening, the final component of the question required candidates to consider other diagnoses that may be the cause of a raised CA 125.

Common errors were either not reading the scenario in full or not synthesising the information provided when responding to the questions. Examples included repeating information given in the scenario; providing examination or investigations in response to the history question; providing diagnoses that would not be appropriate given the patient’s age and that she is five years post-menopausal; and providing male causes of a raised CA 125.

Case 21

This case presented candidates with a young female patient attending for follow-up of results. She initially presented with a history of increasing diarrhoea, amenorrhoea, abdominal pain and weight loss. Candidates were provided with her results, including a negative pregnancy test, in order that they should interpret these and provide the most likely diagnosis and key features of the examination they would assess in order to confirm a diagnosis. In the final component of the case the patient collapsed with acute shock, and candidates were required to identify the steps in their immediate management.

The case provided the key features of an evolving adrenal insufficiency/Addison’s disease.

Common errors centred on candidates describing the investigation results, giving a list of diagnoses when the question asked for the single most likely diagnosis, or providing diagnoses that focused on only one aspect of the history and not taking all information into account.

Despite the patient denying any eating disorder, some candidates focused their history on signs of an eating disorder or developed a collateral history not provided in the scenario, and so developed other examination findings and diagnoses unrelated to the scenario.

Case 22

Candidates where provided with a clinical scenario and photograph of an older male patient presenting with a facial palsy. Candidates were required to identify key elements of the patient’s history they would ask about in order to establish the cause of his presentation and then provide the most likely diagnosis.

While candidates were able to identify the relevant features of the history and the diagnosis, there were issues regarding the initial management of the presentation. Answers were either non-specific, such as stating ‘steroids’ without appropriate dosing regimens, or generic, stating ‘educate’, ‘reassure’, ‘refer’ or ‘analgesia’. These answers give the examiner no insight into a candidate’s ability to provide appropriate management or whether they actually know how to manage. Non-specific responses did not score in this question, nor will they in any KFP question.

Case 23

This case focused on an older male presenting in a remote setting with acute desquamation. The history included both his past and recent medical history as well as recent medication change and a clinical photograph. The case required candidates to identify the most likely diagnosis and the urgent nature of both the presentation and need for immediate supportive treatment.

This question was answered well by candidates. Common errors were in providing further diagnoses rather than providing a cause for the presentation, or being side-tracked by the patient’s past medical history and offering management strategies for these.

Case 24

Candidates were presented with a patient identified as having raised intra-ocular pressures by their optometrist. They were required to identify risk factors in the history that may predispose to the diagnosis, and provide appropriate management options.

Common errors included non-specific answers – for example, stating simply ‘ethnicity’ or ‘medication’ – providing examination findings rather than relevant elements of the patient’s history, or providing risk factors already included in the scenario. In the question focused on topical management, the most common error was to provide nontopical treatments such as oral or intravenous medication, or surgical options.

The last component of this case required candidates to correctly identify a skin lesion opportunistically discovered during the examination.

Case 25

This case presented a middle-aged female patient with a six-month history of both dysmenorrhea and menorrhagia. The scenario contained information about the patient’s past medical and social history, including her smoking history. Candidates were required to provide their initial investigation strategy to assess for the underlying cause of her symptoms, and their specific management when the investigations return as normal.

This case contained a ‘killer question’: given the patient’s age and smoking status, there was an absolute contraindication to using the combined oral contraceptive pill. If candidates chose this as one of their answers, their answer scored zero. This is appropriate given the serious complication of using this medication to manage this patient.

In investigation questions, it is important to read each question carefully and ensure answers address the question. A common error was for candidates to select investigations that assessed severity or complications of the condition, such as full blood count or iron studies, but not identify the cause of the patient’s abnormal menstruation. Similarly, candidates selected renal and liver function tests that are commonly performed, but did not assess the cause of the problem.

The final component of this case required the candidate to identify the management required for the patient’s abnormal cervical screening result. This required candidates to be familiar with the new screening guidelines that came into operation two months before the exam, and which had been widely published in the months prior to this.

It is important that candidates are aware of changes to key guidelines in their approach to the exams. If new guidelines are released in the immediate period before a KFP exam, marking grids will have been adapted to ensure candidates are not penalised. In this case, only the current guidelines were scored given the significant leadin time and the implementation date.

Case 26

The final case in this paper presented candidates with a young male patient presenting with a severe and protracted cough. He had not responded to a prescribed course of antibiotics. Candidates were required to identify other features in his history to define the diagnosis. A chest X-ray was provided for candidates to interpret.

Common errors in the history component centred on providing aspects already covered in the scenario, and providing questions not relevant for the patient demographics. It is important that candidates only consider the information provided and not develop a collateral history beyond the information provided and asking questions based on this.

With the normal chest X-ray, a common error was to provide a diagnosis rather than an interpretation or describe abnormal pathology.

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KFP 2018.2

Case 1

This case focused on a middle-aged male patient presenting with chronic pain and requesting an opiate script. Candidates were provided with further history regarding the origin and nature of his pain. This case required candidates to demonstrate a systematic approach to the assessment and management of chronic pain and the appropriate management of a request for Schedule 8 drugs in a patient presenting for the first time.

The common errors in this case centred on not addressing the questions actually asked; for example, providing physical triggers when asked for psychological triggers, and giving pharmacological answers when  non-pharmacological management was requested.

This is a common issue across both this paper and previous KFP papers. It is critical that candidates read the question carefully before answering and then read the question afterwards to ensure they have actually answered the question asked.

Case 2

Candidates were presented with an older female patient who has experienced a vaginal bleed. From the information provided, candidates were required to identify that this was a post-menopausal bleed, offer appropriate differential diagnoses and then investigate and provide subsequent management.

The common errors were not identifying that this was a post-menopausal bleed, which was clear from the timelines provided in the scenario, and failing to provide appropriate investigations and management in line with published guidelines.

Investigation questions are usually selection lists from which candidates choose the most appropriate investigations. When considering the investigations, it is important that candidates assess those that will give the highest yield in terms of what is requested in the question, which in this case was to determine the underlying diagnosis. A common error was to select tests that are often rationalised as ‘baseline tests’ rather than those tests that established the underlying cause of this patient’s bleeding.

The common errors regarding the differential diagnoses were candidates providing answers that relied on history or details not provided in the scenario. It is important to consider the key features in the clinical scenario provided and not to provide answers based on collateral history not included in the scenario.

Case 3

This case focused on an older Aboriginal male patient travelling to the Northern Territory to visit family. Candidates were required to identify the key elements of a routine health review for this patient and the immunisations required for this patient given his age and travel plans.

Common errors centred on selecting baseline tests rather than the key investigations outlined in appropriate guidelines for health screening in this patient. In the immunisation question, candidates failed to take into account his age and listed diseases that he should be vaccinated against rather than the actual immunisations. One way of considering questions on immunisation is that ‘one needle equals one answer’.

Case 4

Candidates were presented with a clinical scenario of an otherwise well older male who had developed acute chest pain. The case initially centred on the interpretation of the clinical information and an electrocardiogram (ECG). The final question presented the same patient attending a follow-up appointment several months later with the patient complaining of erectile dysfunction; candidates were required to select the initial investigations required for this presentation.

The common error in the diagnosis component was to provide differential diagnoses unrelated to the information provided or incorrectly identify arrhythmias or changes not evident on the ECG, which in this case was a normal trace. As the case unfolded and the patient’s condition deteriorated, candidates were required to describe their acute management of chest pain given further clinical information, including vital signs. Within the KFP paper, certain answers will zero a candidate’s score for that question (not the whole case) if they are considered to be dangerous or potentially fatal to the patient. In a case of acute chest pain, there will be drugs that should not be administered depending on the vital signs, such as severe hypotension or normal oxygen saturation. It is important that candidates consider all the information in the initial scenario as well as any further information within each subsequent question.

Case 5

This case focused on a female patient presenting with fatigue seven months post-partum with a history of gestational diabetes. Candidates were required to identify the most likely differential diagnoses and appropriate investigations to establish the underlying diagnosis, and interpret and offer specific management in light of results provided.

In this case, the common errors were in offering differential diagnoses that were not the most likely diagnoses and choosing investigations that would not have a high yield in defining those diagnoses given all the information provided in the scenarios. When being asked for specific management actions, answers such as ‘monitor thyroid to titrate dose’, ‘repeat levels in six weeks’, ‘repeat tests’ or ‘monitor thyroid function regularly’ are not specific enough to demonstrate a candidate’s ability to appropriately manage this case.

Case 6

Candidates were presented with an elderly female patient complaining of increasing symptoms of urge incontinence. Candidates were required to select appropriate investigations and then provide both pharmacological and non-pharmacological management plans. For the pharmacological management plans, candidates were required to provide the different drug classes and an example of each class. In the KFP, writing both the category (eg drug class) and an example should only be done when specifically requested, such as in this case.

Most questions only require the specific answer to be written (eg name and dose of a drug), not the category. Candidates need to ensure they answer the question as written.

The most common errors centred on non-specific management plans or on providing incorrect pairings of drug class and an example. It is important that candidates are aware of the appropriate drug classes and the drugs within those classes.

There were some candidates who recommended a drug for benign prostatic hyperplasia for this female patient.

Case 7

This case focused on the identification and management of a child presenting with an acute exacerbation of asthma in a rural location. A final question presented a picture of the child with severe peri-oral impetigo and required candidates to identify the appropriate pharmacological management.

A common error was not identifying the severity of the asthma exacerbation and therefore not delivering the optimum treatment, and for the impetigo prescribing medication contraindicated by information within the scenario. The question specifically stated ‘other than monitoring vital signs’, yet candidates listed different vital signs to monitor, which gained no marks. Questions are commonly written to exclude vital signs from management answers.

Case 8

Candidates were required to analyse the clinical information and results for a middle-aged male patient, identify that he was having an acute flare in his underlying gout and discuss how they would assess and manage the patient.

One question asked candidates to identify the signs they would be looking for on clinical examination to assess for complications of gout. A common error was identifying what the candidates would examine rather than the specific signs they were looking for. It is expected that candidates know how to examine a patient, so questions most commonly focus on findings of an examination rather than what or how a candidate would examine. The key features were the specific findings that a candidate would assess for complications of gout; that is, the abnormalities for which would you assess, not what physical examinations you would perform. It is essential that candidates read the question and ensure they address the specifics within that question.

Case 9

This case focused on a male medical student presenting with symptoms suggestive of an acute psychosis. Candidates were required to identify the key features in the history that would assist in determining the most likely diagnosis and address the concerns of his partner about whether the patient would be able to continue his studies.

In this latter part of the case, common errors included providing management and referral options rather than addressing the specific concerns. When treating colleagues, it is important that clinicians are aware of their professional requirements in addition to providing honest advice. This question addresses Good medical practice: A code of conduct for doctors in Australia from the Medical Board of Australia, as well as Domain 4 of the RACGP curriculum.

This question was not done well. Candidates need to be prepared for questions that address the whole curriculum and not just Domain 2 on applied professional knowledge and skills.

Case 10

Candidates were presented with a boy aged eight years with hip pain that has been ongoing for over a week. Candidates were required to identify the most likely differential diagnoses and the appropriate initial investigations and management options.

The common errors focused on not providing specific diagnoses, but providing either generic diagnoses or rare causes of hip pain that were not the most likely differential diagnoses given the information in the scenario. Some candidates gave different names for the same diagnosis on separate lines. When the same (or very similar) answers are given on separate lines in the KFP, the opportunity to gain marks for other answers is reduced..

Case 11

This case required candidates to interpret the histopathology findings of a biopsy to identify that the patient has a melanoma on his calf. The candidates then needed to provide appropriate initial management, followed by subsequent management when the patient returns with a swollen lymph node in his groin.

The common errors were in not understanding the urgency of the situation and the need for a wider excision with defined margins. In the investigations of the subsequent enlarged lymph node, a common response was to select the prostatic specific antigen, which was unrelated to the presenting condition.

Case 12

Candidates were presented with a female patient experiencing vaginal bleeding and discharge as well as pelvic pain. Candidates were required to identify the differential diagnoses and the immediate investigations required to establish the underlying diagnosis.

Despite the significant gynaecological history and examination findings provided, candidates delivered differential diagnoses that were unrelated to this information or that would have been excluded had all the information provided been taken into consideration. It was also important that candidates recognised that the patient may have been pregnant.

In the KFP paper, all the information provided is relevant and needs to be considered when answering the questions, otherwise appropriate diagnoses will be missed.

Case 13

This case centred on an elderly female patient in a residential facility who had developed delirium. Candidates were required to select appropriate investigations for this acutely confused patient and identify precipitating causes, given the results and other information in the scenario. The second component of the case required candidates to identify a severe scabies infection and then outline how they would treat the patient and the public health measures required given she is in residential care.

While candidates managed the initial components of the case well, they struggled when it came to treating the patient and preventing an outbreak at the facility. Candidates outlined non-pharmacological management despite the question asking for pharmacological management, and some were limited in the knowledge of managing an infectious disease within a vulnerable population.

Case 14

Candidates were required to interpret the detailed history provided, determine the most likely diagnosis in a toddler returning from an overseas trip with diarrhoea and provide appropriate management. The subsequent history described classic transient post-infectious lactose intolerance, and candidates were required to identify the cause of the changed pattern of diarrhoea and outline a specific management plan.

Despite the management question stating no dosage regimen was required, several candidates added medication dosages or provided generic answers that showed a potential lack of insight into the management of an acute infective diarrhoea as described in the scenario.

In managing the transient lactose intolerance, some candidates failed to identify the need for lactose exclusion for a defined period of time. Despite information stating there was no evidence of dehydration, some candidates chose to provide rehydration as an answer or refer to emergency for intravenous therapy (IV) hydration, which was not appropriate. As previously discussed, candidates need to ensure all the information in the scenario is considered and that the answer is provided in the context of that scenario.

Case 15

This case centred on a middle-aged female patient presenting with mid-to-distal foot pain and symptoms suggestive of an interdigital neuroma. Candidates were required to identify the most likely diagnosis, discuss examination findings that would be used to confirm the diagnosis and offer appropriate management.

Common errors included not reading the question thoroughly, providing investigations rather than examination findings and not identifying the most appropriate management plan.

Case 16

Candidates were presented with two skin lesions and were required to identify both from the clinical history, description and photograph and provide the appropriate management.

The initial lesion was a classic dermatofibroma, and the second was an amelanotic melanoma.

The common errors centred on not correctly identifying the lesions despite the information provided and not providing specific management, such as appropriate excision margins for the melanoma or stating they would reassure without any detail. Generic terms such as ‘reassure’ or ‘excise’ with no details are not specific enough to demonstrate a candidate’s ability to appropriately manage this case.

Case 17

This case focused on a new patient presenting with polypharmacy; their management plan included medications that may cause interactions or were inappropriately prescribed. Candidates were asked to identify the possible prescribing issues, interpret thyroid investigations and offer an appropriate management plan. Candidates were also required to describe how they would handle the situation when the patient refused to accept their management and insisted on all prescriptions as previously prescribed.

Common issues seen in the responses were identifying medications and then not providing clear medication regimen of dose and duration, not identifying unopposed oestrogen being prescribed in a patient with an intact uterus, and not giving appropriate rationales for recommended changes or for declining request to continue with existing faulty medication regimen.

Case 18

Candidates were presented with a scenario in which an older Aboriginal male patient is brought in by his children, who are concerned by his progressive cognitive decline. The patient had a history of smoking and previous alcohol use. Candidates were required to identify the most likely diagnoses, appropriate investigations and key elements of a management plan.

In this case, candidates failed to identify that the most common causes would be vascular and Alzheimer’s disease. They instead prioritised alcohol-related dementias, potentially stereotyping the patient within the scenario. In relation to management, candidates were looking to admit the patient to hospital despite no evidence of acute decline, not taking responsibility for the patient and referring to the ‘usual GP’.

In general, providing more responses to questions than asked for (ie extra responses) has significantly reduced across all candidates in the KFP exam. However, candidates responded to this case by providing lists of answers on each line or giving lists of further investigations, despite the previous question focusing on the appropriate investigations.

Case 19

Candidates were presented with a clinical picture of a patient’s hand that, along with the clinical history, indicated Dupuytren’s contracture. Candidates were required to provide an initial diagnosis, outline the tests they would do to establish possible underlying causes and provide the underlying risk factors for developing the condition. The final component of the case requested an appropriate management plan.

The common errors were in choosing investigations not related to the possible causes of Dupuytren’s and providing risks posed by the diagnosis where the question asked for conditions predisposing to Dupytren’s contracture. As stated previously, it is important to read and re-read the question. In the final management question, candidates wanted to refer for surgical correction despite this being very early stage of Dupytren’s with no obvious contractures.

Case 20

Candidates were presented with a patient with deteriorating type 2 diabetes. Candidates were required to identify the key components of a diabetic assessment, then describe the potential medication options for optimising his diabetic control both at his initial appointment and then when he returns several months later having not adhered to an agreed management plan.

The common errors were in answers to the management questions, as candidates offered drug names without any indication of the intended regimen changes, including listing medication the patient was already on without defining whether they were increasing, decreasing or ceasing. The question was not about listing diabetes medications but whether candidates could apply their knowledge to a specific scenario and develop a coherent plan.

The question asked for diabetes management, but several candidates chose to manage the patient’s lipids of hypertension where there was no evidence that these were outside of recommended ranges.

In the KFP exam, it is important to not create scenarios or a history outside of that given, and ensure you address the case specifics.

Case 21

This case presented an infant with symptoms of stridor classic for croup/laryngotracheitis. Candidates had to provide their initial differential diagnoses and then, given the symptoms and findings, provide the best management. This patient returns after a rapid deterioration and candidates need to use the vital signs and examination findings to identify that this is severe croup and provide emergency management.

The common issues seen were in identifying the markers of severe croup and that nebulised treatment was required, and the patient needed urgent transfer to the emergency department. It was common for candidates to offer reassurance and educate the parents without adequate details of the case. This did not score points, as these answers again give no insight into whether the candidate can manage a situation.

Case 22

Candidates were presented with a young adult male patient who has ingested significant amounts of alcohol and methamphetamine on a background of medication for bipolar disorder and has developed symptoms suggestive of serotonin syndrome. Candidates were required to identify key findings in examination to confirm the most likely diagnosis of serotonin syndrome and then manage him given he refuses admission to hospital.

The common errors were assessing the patient for signs of other substances of abuse and other causes of his confusion, and undertaking history questions to explore his confusion and agitation. In the management component, candidates failed to consider the patient’s capacity to make decisions and the requirement for an involuntary admission.

Case 23

Candidates were presented with investigations and an X-ray that had classic changes for Paget’s disease and signs suggestive of a background of significant osteoarthritis. Candidates were required to describe the features, not the diagnosis, seen on the X-ray. A common error was to provide a diagnosis rather than describe the findings.

Candidates were also required to consider further investigations to assist in clarifying the diagnosis. The most common error was to choose a bone densitometry when there was no evidence of osteoporosis.

Case 24

This case focused on an older male patient who presented with progressive bilateral loss of his peripheral visual fields. Candidates were required to identify examination findings in the eyes to assist in defining the diagnosis and offer the most likely differential diagnoses.

In this question, the most common error was in not reading the question correctly and providing general examination findings that may be related to pituitary disease rather than answer the actual question, which specified only eye examination findings.

Case 25

Candidates were required to assess and manage a patient in whom abnormal findings found on a Pap smear were not followed up in the required 12-month period and who is presenting two years after that original test. Candidates required knowledge of the current cervical screening guidelines to discuss how they would manage this result and to consider the practice processes that need to be in place to manage abnormal results to ensure that this does not happen again. Candidates struggled with the practice management component of this case.  It is essential that candidates be aware of practice processes, such as the handling of abnormal results.

Case 26

The final case of the 2018.2 KFP exam presented an older female patient who is taking lithium for bipolar disorder along with other medication and has developed deteriorating renal function and raised lithium levels since her last tests in the preceding months. She also has hypertension that had not previously been noted.

Candidates were required to identify the possible causes and further investigations and develop an appropriate management plan.

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KFP 2019.1

Case 1

This case focused on a middle-aged female patient presenting with significant weight gain.

Candidates were given more information about the past medical history and her medications. They were required to use this information to select appropriate investigations and further manage her presenting issues.

The common errors in this case were to focus on her past medical history rather than presenting symptoms, and misinterpret results provided and offer incorrect diagnoses.

Case 2

Candidates were presented with a female patient presenting with her six-week-old baby. The patient had concerns regarding her baby’s weight gain and ability to continue to breastfeed. The case evolved to then focus on the mother’s rapidly deteriorating mental health.

Candidates were required to manage the initial presentation of poor weight gain in the baby and then identify and manage the mother’s acute mental health problem.

Common errors in the initial part of the case were not reading the question correctly and offering incorrect management or advice on feeding of the baby. The main error in the second part of the case was not identifying the urgency of the situation and therefore not providing the correct management.

Case 3

This case focused on an older male patient who was travelling interstate and is admitted following a myocardial infarction. Candidates were provided with information about his medication and past medical history. The patient presented for follow up after his discharge.

Candidates were required to assess and adjust the patient’s medications in order to optimise his management, and provide appropriate post-infarct advice relating to specific concerns raised by the patient.

Common errors were to focus on changing long-term medications that were not relevant to his post-infarct management, such as asthma medication, when there were key medications that needed to be adjusted or included in his management. Further common errors centred on not addressing the patient’s concerns, giving non-specific advice or simply repeating information already given in the case.

Case 4

This case focused on a male patient presenting with symptoms suggestive of chronic rhinosinusitis.

Candidates were required to identify the most likely differential diagnoses given the information presented and then manage the patient’s presenting problem.

Common errors were on not reading the question and providing symptoms rather than diagnoses, or providing rare esoteric differential diagnoses rather than the most likely differentials.

It is imperative in the KFP exam paper – and all assessments – to ensure that you answer the question provided.

Case 5

This case centred on a female patient requesting a medical termination of her pregnancy. The initial question focused on the contraindications of a medical termination in the context of the information provided in the case stem. The case evolved, with candidates required to identify that the patient was presenting with symptoms suggestive of retained products of conception and provide appropriate management.

Comments have been made that this is not an appropriate topic given it may be considered specialised general practice; however, candidates would be expected to respond to a patient’s request for information and discuss the suitability for medical termination.

The latter part of this case focused on managing complications related to retained products of conception, which is applicable to any patient presenting with the symptoms described and not unique to medical termination.

Case 6

This case focused on a male patient presenting with symptoms suggestive of photodermatitis secondary to sunscreen.

The case required candidates to interpret clinical material in order to develop differential diagnoses and then provide appropriate measures to manage this acute presentation, as well as identify and manage long-term consequences of sun damage.

Common errors were not reading the question and assuming this was simple sunburn, or embellishing a collateral history of other causes for the patient’s rash. In providing the management of this presentation, the errors centred on non-specific answers that did not directly address the presenting problem, or offering sunscreen when the question specifically asked for management other than sunscreen.

Case 7

In this case, candidates were presented with an elderly male patient presenting for follow-up of blood and X-ray results, which were provided in the stem along with further information on the patient.

Candidates were required to describe the lesions on the X-ray, and provide the most likely differential diagnoses and any further investigations required.

The common errors were not reading the question correctly, therefore providing diagnoses rather than findings on the X-ray, and also providing differential diagnoses that did not consider all of the information provided.

Case 8

This case focused on a female patient requesting that the candidate take on the care of her complex medical issues, including the prescribing of multiple scheduled drugs.

Candidates were required to explore further history around the scheduled drug use, identify sources to corroborate the patient’s request and describe how they would rationalise her management.

Common errors in this case were to provide management answers when further history was required, or seeking assistance for managing the patient’s opiate use as opposed to managing her scheduled drug request.

Case 9

In this case, candidates were required to use the information provided to identify that the patient was presenting with a history suggestive of endometriosis and identify what further history and investigations they would undertake to confirm the most likely diagnoses.

The common errors were in repeating information within the stem, which will never score marks within the KFP, providing non-specific answers, or choosing investigations that would not be key in establishing the diagnosis.

Case 10

This case focused on a female patient with a previous history of musculoskeletal problems but presents with symptoms suggestive of an evolving neurological condition.

Given the extensive information provided, candidates were required to establish a list of appropriate differential diagnoses and the investigations they would choose to refine their diagnosis.

Common errors centred on not identifying the new neurological symptoms within the history, and only managing the musculoskeletal diagnoses provided as part of the patient’s past medical history. It is important that all information in the stem is considered and the answer provided is within the context of the case.

Case 11

In this case, candidates were required to use the case description to identify the possible causes of male factor infertility. As the case evolved, semen analysis and test results were provided to refine the diagnosis and then offer appropriate responses to the patient’s concerns regarding his future fertility.

Common errors were not correctly identifying appropriate elements of a history to refine a diagnosis, and providing either non-specific or false reassurances in response to the patient’s concerns about his future fertility.

Case 12

This case centred on an adolescent female patient presenting with significant acne that has failed to respond to specific oral and topical medications.

Candidates were required to identify possible precipitants for the failure to respond to treatment, as well as other management options available. In the latter part of the case, candidates needed to identify that at a follow-up appointment several months later the patient has symptoms and clinical findings of a facial palsy and offer specific immediate management.

Common errors regarding the acne presentation were in not reading the question, and providing diagnoses rather than causative factors or providing treatment that was contraindicated due to past medical history. In respect of the Bell’s palsy, the errors focused on providing diagnoses rather than immediate management, or generic answers such as ‘reassure’ or ‘review’ despite the question asking for specific management options including dosage. These answers will not gain marks in the KFP exam paper, as they are non-specific and give no insight into a candidate’s actual knowledge and ability to specifically manage a given presentation.

Case 13

In this case, candidates were required to consider the information provided on a young adult female patient presenting with increasing gastrointestinal symptoms. Past medical and family history was included.

The case required candidates to formulate an appropriate list of working differential diagnoses, the key features in the history about which they would enquire, and the essential investigations required to refine and establish their diagnosis.

Common errors centred on repeating information or diagnoses in the stem, providing examination findings rather than further history questions, and exploring issues in the past medical history unrelated to the presenting problem.

Case 14

In this case, candidates were presented with a female patient presenting at two weeks postpartum with symptoms and signs of thrombophlebitis. It also included a history of similar episodes and prior medical history that was key in resolving the case. 

Candidates were required to give the single most likely diagnosis, the key investigations required to assist in the diagnosis and then how to manage the patient, which could potentially be impacted by the prior history that was provided.

Common errors centred on not identifying the thrombophlebitis as superficial (a clinical photograph was provided) or not using all of the information in the case to address the best management approach.

Case 15

This case focused on an adult male patient presenting to a remote hospital with a history of chest pain and other associated symptoms. The case included relevant family history, as well as social history and examination findings.

Given all this information, candidates were required to initially provide the key differential diagnoses and further history they would enquire in order to clarify the diagnosis. Candidates were then given investigation results, including an electrocardiogram (ECG) to interpret, and required to outline the management taking this further information into consideration.

Common errors centred on enquiring about history already provided, focusing only on cardiac diagnoses despite the case offering information relevant to other diagnoses. In the management component of the case, candidates focused on managing the patient’s smoking when it clearly stated he did not smoke, managed issues that were not part of the case, or providing non-specific generic answers, such as ‘educate’ or ‘reassure’, which has already been stated will not gain marks.

Case 16

In this case, candidates were presented with a female patient returning from travel in the Northern Territory.  The patient presents with high fevers, myalgia and arthritis affecting several joints.

Candidates were required to consider the possible infectious causes, taking into account all of the information provided, and what they would look for in the physical examination to assess for infection.

Common errors were not providing infectious causes for the symptoms, despite the specific request in the question, then providing examination process answers such as ‘examine abdomen’ or ‘check for temperature’, rather than specific clinical finding as requested, such as ‘enlarged liver’ or ‘fever’.

Case 17

This case presented candidates with a clinical photograph and description of a male patient presenting with dry and irritated eyes. Key past medical history and clinical findings were provided.

Candidates were required to consider what further eye examination findings they would look for to confirm the diagnosis and how they would appropriately manage the presentation.

Common errors were not identifying the correct diagnosis, and providing diagnoses unrelated to the photograph or case description.

Case 18

This case focused on an older patient presenting with resistant hypertension. The patient’s past medical history and medications were provided.

Candidates were required to provide the possible causes for, and investigation of, the patient’s hypertension, taking into account all of the information provided in the case. The final component of this case required candidates to optimise his medications to improve his hypertension.

Common errors centred on not considering all of the information in the stem, and providing answers that either directly contradicted the information or answers not relevant to a patient of this age. In the management question, candidates wanted to optimise treatment of his stable medical conditions rather than manage the obviously raised blood pressure, or assign the medications to and treat conditions the patient did not have.

Case 19

In this case, candidates were required to use the history and chest X-ray provided in order to identify the possible diagnoses in an older male patient presenting with haemoptysis. The clinical picture was that of possible tuberculosis. 

In addition to identifying why spirometry was not appropriate on such a patient, candidates were required to consider what further investigations were required and provide the immediate management of the patient, including public health and infection control measures.

The most common error was to provide non-specific answers, or answers already in or excluded by the stem.

Case 20

In this case, candidates were presented with a palliative patient who was developing increasing shortness of breath and pedal oedema. They were provided with his medical history, current medication and investigation results.

From all the information provided, candidates were required to identify the cause of the patient’s symptoms, precipitating factors and ongoing pharmacological management for symptom relief.

Common errors were to misinterpret the blood results, provide causes or factors unrelated to the stem information, and provide pharmacological management strategies when the question specifically asked for non-pharmacological.

Case 21

Candidates were presented with a young female patient presenting with fatigue. The case included key aspects of the patient’s history and examination that would direct candidates to specific differential diagnoses they needed to identify and the further history they would elicit to confirm the diagnosis.

As the case evolved, the patient’s symptoms persisted despite lifestyle measures being implemented, and candidates were required to select the most appropriate investigations. This question, as with all KFP exam questions, is derived from common, readily available guidelines with which candidates should be familiar. 

Common errors were to repeat information, and provide diagnoses or undertake investigations that were already reported in the case.

Case 22

In this case, candidates were presented with an unwell young child and needed to identify what examination findings they would look for to assess the severity of the illness, the most likely diagnosis and how they would manage the patient given all the information provided. This question was answered well by the majority of candidates.

The main errors were providing the same non-specific and generic answers, such as ‘reassure’ or ‘review’ with no clarification or further information.

Case 23

This case focused on a female patient presenting with amenorrhoea and included her prior medical history and examination findings.

All of the information was key information for candidates to identify the most likely differential diagnoses given, interpret a list of investigations, and offer the possible complication of the underlying diagnosis and a tailored pharmacological management plan.

The most common errors were not providing answers for which the question asked, such as treating conditions in the patient’s past medical history rather than the presenting problem identified on the investigations or providing non-pharmacological management options.

Case 24

This case presented candidates with a clinical colleague who had been involved in a surgical near-miss event during an operation. The colleague had not managed well since the episode and developed a symptom complex suggestive of post-traumatic stress disorder.

Candidates were required to identify further key elements of history that would confirm the diagnosis and provide an appropriate immediate management strategy, and then address the colleague’s concerns about his career and fitness to practise.

Common errors involved misidentifying the symptom complex, managing just one individual symptom and taking this out of context in the subsequent questions involving or referring to agencies that were inappropriate given his presentation and concerns.

Case 25

This case presented candidates with the partner of a female patient contacting the practice with concerns about the rapid deterioration of the patient’s mental health.

The patient’s past medical and mental health history, and medications were provided.

Candidates were required to initially identify the potential diagnoses, as well as the immediate management of the acute deterioration in the patient’s mental health. A final question centred on the patient returning several months later having been appropriately managed and seeking preconceptual advice in the context of the medication and health issues with which she presented.

Common errors were not identifying the significance of the presenting symptoms and behaviours, and thus not involving the appropriate agencies, or providing unclarified non-specific answers as discussed in previous cases.

Case 26

In this case, candidates were presented with an Aboriginal child with recurrent prolonged fevers. They were accompanied by a non-parental family member.

From all of the information provided, candidates were required to develop an appropriate list of differential diagnoses and key investigations, and determine how to address consent for treatment, given that the parents are not available.

Common errors included providing a list of diagnoses unrelated to the scenario information and then not correctly identifying processes to acquire consent for investigation and treatment.

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KFP 2019.2

Case 1

This case focused on a middle-aged male patient presenting with low-back pain that had not responded to simple measures. Candidates were given further information on the patient’s past medical history. Given the information provided, candidates were required to consider the differential diagnoses, appropriate initial investigations and provide an appropriate response to the patients, request for a WorkCover certificate for his injury.

Common errors in this case centred on not taking all of the medical information provided in developing a differential diagnosis, and not addressing the specific issues relating to WorkCover.

Case 2

In this case, candidates were given the results and past medical history of a male Torres Strait Islander patient. From this information, they had to identify the most likely differential diagnoses, any further information that may be required to assess his cardiovascular risk, and the initial management that would be required.

Common errors included repeating information already provided in the stem, and giving management options not related to the specifics of the question.

Case 3

This case presented candidates with a female patient who was 31 weeks pregnant and presenting with symptoms of acute dizziness and nausea following a recent upper respiratory tract infection. Candidates were required to provide further history required from the patient in order to clarify the diagnosis. The case evolved with the disclosure of domestic violence, and candidates were required to address this disclosure.

The most common error was to provide lists within the history component of the case, and thus provide more answers than required. In the KFP exam, it is important that candidates only provide the number of answers requested; any extra answers will attract a penalty.

Case 4

In this case, candidates were presented with a female patient who had developed a rash over her hands that had not responded to medication provided over the counter. Candidates were required to use the information and picture provided to identify the diagnosis and appropriate management of the rash. The patient also requested advice on travel vaccination.

The common error in this question was to provide vaccinations that were not relevant to travel, or that the patient would have had already, given her age, as part of routine scheduled vaccinations.

Case 5

This case focused on a 12-month-old child presenting with noisy breathing. Using the information provided, candidates were required to formulate a differential diagnosis and identify the specific examination findings that would require an urgent transfer to hospital. This case concludes with the mother returning when the child is 18 months of age to discuss her concerns related to measles, mumps and rubella (MMR) vaccination.

The common errors in this case included candidates not being specific in their answers, using generic descriptors in either their examination findings or about vaccination in general, and not focusing on the mother’s concerns about the MMR.

Case 6

Candidates were presented with an older male patient returning for the results of blood tests, as well as information relating to his original presentation and past medical history. Candidates were required to use this information in order to identify the possible underlying causes for the abnormal results, further investigations required, and provide the appropriate medication changes required.

A common error was to list causes of abnormal results that did not take the context of the patient, including all information provided, into account. The KFP exam assesses a candidate’s ability to make appropriate clinical decisions that are specific to the patient or case, and that require the assimilation and interpretation of the information provided. It is key that answers are context-specific, otherwise they will not score marks.

Case 7

In this case, candidates were required to identify from both the clinical images and information the diagnosis of a penile rash, as well as interpret results of a hepatitis blood screen and provide appropriate non-pharmacological management.

Common errors focused on misidentifying the lesions and misinterpreting the pattern  of results seen on the hepatitis results.

Case 8

In this case, candidates were provided with a medical history and clinical images of two skin lesions in a female patient, and were required to identify and manage the lesion. The case concludes with the patient wanting to complain about having had a complication subsequent to removal of a lesion without having been fully informed that this may be an outcome of the excision, which in this case was a keloid scar. Candidates were required to document how they would approach the patient’s complaint.

A common error was not addressing the complaint, but rather managing the keloid. In answering KFP exam questions, it is important to review answers to ensure they address the actual question.

Case 9

This case focused on a female patient presenting to a rural hospital with severe abdominal pain. Candidates were given the history and clinical findings, and were required to provide the most likely differential diagnoses, key investigations and details of immediate management prior to transfer to a larger hospital.

As in previous cases, the lack of specificity in answers was a common problem.

Case 10

This case centred on an older male patient with diabetes presenting with gastroenteritis. Past medical history and current medications were also provided. Candidates were required to provide their pharmacological management of his acute presentation. The case concludes with the results of a diabetic review six months after the initial presentation and the requirement to address what specific changes candidates would undertake in light of these results, including dosing regimens.

A common error was to not address the pharmacological management of the patient’s presentation, but rather provide generic statements about managing gastroenteritis in any patient.

Case 11

This case focused on an older male patient presenting with altered cognition and mood. Candidates were provided with past medical and relevant social history, and were required to use all information, develop appropriate differential diagnoses and provide relevant key investigations, as well as address issues relating to power of attorney.

The common error was in not addressing the issues relating to the patient’s specific request about the power of attorney, but rather addressing generic issues and legalities.

Case 12

In this case, candidates were provided with a chest X-ray, spirometry results and past medical history to assist in the interpretation of a patient’s presentation and provide the specific diagnosis and management given all the information including the spirometry results.

Common errors were to misinterpret the information given or provide incorrect examples of medication. The question did not ask for examples. While no penalties were given if a candidate provided a single correct example, a penalty was applied if the example given was wrong, as this effectively constitutes two answers. In the KFP exam there is no requirement to provide examples unless explicitly requested to do so, and to do otherwise risks the penalty for extra answers should the example be incorrect.

Case 13

Candidates were required to consider all information provided about an adolescent female patient presenting with headaches and missing after-school activities, then provide further psychosocial aspects of the history about which they would wish to enquire. In this question, candidates commonly repeated information already in the stem, which will not gain any marks.

The remainder of the case focused on the headaches with which the patient presented and looking at a rational management plan given the most likely diagnosis obtained from the key information provided. Dosing regimens were required. In the KFP exam, candidates may be required to provide dosing regimens for commonly used drugs.

Case 14

In addition to the clinical information, candidates were given the X-ray of a shoulder and were required to formulate the most likely diagnosis and relevant short- and long-term management plan, and address specific requests for information made by the patient (such as recovery and return-to-activity time frames).

As before, the common error in most parts of this case was to not provide specific answers related to the patient’s request.

Case 15

In this case, candidates were required to appropriately manage an Aboriginal female patient presenting to a rural clinic with an infected animal bite. The candidates were required to identify what key findings in their examination they would look for, and manage both the medical presentation and the request not to be transferred to a hospital away from the area.

The main error in this question was not identifying in the case scenario the delayed presentation and the key abnormal vital signs. This resulted in providing answers that did not assess for complications of the bite, but rather managing it as if the bite had just occurred.

Case 16

This case centred on an adolescent female patient with primary amenorrhoea despite the normal progression of other signs of puberty. Candidates were required to formulate differential diagnoses and a management plan, including appropriate investigations.

Common errors included not recognising that, given the patient’s age and information provided on other secondary sexual characteristics, the amenorrhoea was not normal. Candidates also provided answers in conflict to information in the stem; for example, listing medications when the stem states the patient is on no medication.

Case 17

This case focused on a female patient presenting with vaginal bleeding in the third trimester of her pregnancy. Candidates were given details of her current presentation, as well as her past obstetric history. From the information provided, candidates were required to provide their differential diagnoses and appropriate investigations. The case progressed to a normal delivery at term and candidates were required to identify a lesion on the newborn’s skin.

The common error was to provide answers not relevant to a newborn, but to an adult. This was most likely due to candidates not reading the extra information within the question. As we have seen in the case descriptions above, it is common in KFP exam questions that the case progresses and the focus changes away from the initial presentation. This allows a greater breadth of topics to be tested, and reflects what actually happens within general practice.

Case 18

In this case, candidates were presented with an older male patient presenting with a rapidly developing lesion on his face. Using the image and clinical details provided, candidates were required to identify and describe both the short- and long-term management of the lesion and its sequelae.

Candidates were required to be specific in their diagnosis and management. As in all cases within the KFP exam, providing an answer with less specific detail will be awarded fewer marks than a more specific and complete answer.

Case 19

Candidates were provided with the clinical history of a patient presenting with persistent nasal discharge and blockage, that had not responded to previous treatments. Candidates were required to identify key red flags in the history suggestive of more serious pathology, and offer appropriate investigations and an initial management plan with appropriate medication dosing regimens.

The most common issue was candidates’ failure to prescribe antibiotics in line with contemporary guidelines for the management of the presentation, as well as incorrect dosing. If a candidate is unsure of the dosing regimen, providing the appropriate antibiotic will score marks – but not as great as the full dosing regimen. Questions state when dosing regimens are required.

Case 20

This case presented candidates with a female patient in her first trimester of pregnancy presenting with excessive fatigue and weight gain, and provided details of her past medical and obstetric history. Candidates were required to identify the most likely underlying diagnosis, relevant investigations and a specific management plan.

The common error was to not take into consideration the fact the patient was pregnant and provide the correct review and management timelines.

Case 21

This case focused on a female patient being reviewed after discharge from the local rural hospital following an episode of visual hallucinations, preceded by three months of increasing social isolation. The patient had been treated appropriately, with resolution of the hallucinations, but then presents with tenderness and discharge from both breasts. Candidates were required to identify the most likely cause of the new symptoms and the appropriate management.

The most common error was not identifying medication as a possible cause of the breast symptoms.

 | RACGP Education  Exam report 2019.2 KFP

Case 22

In this case, candidates were presented with a female patient presenting for a commercial driver’s licence medical. The case provides information about the patient’s medical history, which contains contraindications for a commercial licence. Candidates were required to identify this and provide appropriate information to the patient. The case unfolds and, because the patient is unable keep their driving job, they present various options for claiming Centrelink benefits. Candidates were required to address the patient’s requests and rationale for their decisions, and what documentation they need to maintain.

A common error across all three questions was not responding to the specific requests of the patient, but rather managing the patient’s comorbidities and not understanding the requirements of the various forms or applications. The KFP exam seeks to test the critical thinking in all domains of general practice, and not just the domain of applied professional knowledge and skills.

Case 23

In this case, candidates were presented with an older male patient presenting with a recent deterioration in health associated with weight loss, night sweats and pruritus. Candidates were given his past medical history and relevant examination findings, including a mass extending up under the left rib margin. Given all of the information, candidates were required to identify possible differential diagnoses and the relevant investigations. The final part of the case required candidates to identify from further information that the patient has developed gout secondary to his presenting illness and manage this appropriately, and give dosing regimens where required.

The common errors were not identifying that this was most likely a haematological malignancy in the initial component of the case, and then not treating the gout in line with current guidelines.

Case 24

This case focused on a male patient presenting for review following a recent accident overseas that required orthopaedic surgery on his leg. The patient has experienced increasing pain, altered sensation, swelling and erythema of the leg. Candidates are given information regarding his medications, which include opiates, and relevant examination findings. From this information, candidates were required to identify the relevant investigations to explore their differential diagnoses. In the light of all investigations returning normal, the decision is made to reduce the opiate prescription. Candidates were required to describe what other medication changes they would implement.

The main error was in repeating medications already in the stem, or focusing on the opiate reduction plan when the decision had already been made to reduce the opiates.

RACGP Education  Exam report 2019.2 KFP |

Case 25

Candidates were presented with the electrocardiograph (ECG) of an older male patient presenting with dull central chest pain on a background of previous ischaemic heart disease. Candidates were given the patient’s past medical and social history, as well as other symptoms he was experiencing. Using this information, candidates were required to provide an appropriate pharmacological management plan, and address the social issues the patient is facing. The case concluded with the patient returning for review, with candidates required to identify the age-appropriate investigations needed.

Common errors in this case were focusing on the medical component and ignoring the request for input into the social situation, and not being specific with the required vaccines or listing vaccines not recommended as part of the schedule for older adults.

Case 26

In the final case, candidates were presented with a 12-month-old baby being brought by their parent for immunisation. Candidates were required to provide the specific advice they would give regarding possible symptoms experienced following these vaccinations. The child develops a reaction immediately following the vaccination, and candidates were required to provide their immediate management plan. The case concludes with the identification of a potential breach in the cold chain for the vaccines administered. In light of this information, candidates were required to describe their approach to managing this breach. 

The main error in this case was not knowing the required actions following a potential cold-chain breach at a patient or practice level, or both. As discussed in previous case descriptions, the KFP exam is assessing domains other than professional knowledge, in this case population health, and practice management and processes. These questions are generally poorly answered by candidates, but are essential areas in which to have knowledge and understanding in order to practise unsupervised within Australia.

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KFP 2020.1

Case 1

This case focused on an infant presenting with features suggestive of developmental delay. Candidates were presented with a history and examination findings. In light of this information, candidates were required to consider the differential diagnoses and arrange further investigations to establish the most likely underlying cause. They were also required to provide specific immunisation advice with reference to the National Immunisation Program Schedule.

Common errors included providing answers that lacked specificity, not reading the stem in full, and providing responses that did not take into consideration all of the key features of the case.

Case 2

This case presented candidates with a school-aged child presenting with symptoms of recurrent abdominal pain and nausea. Candidates were provided with a detailed history and examination findings. With this information, candidates were tasked with establishing the likely differential diagnoses and appropriate initial pharmacological management options. As the case evolves, the child represents with a breast lump.

Candidates were tasked with outlining their management actions of the lump.

Common errors included providing non-pharmacological interventions when the case focused upon pharmacological interventions, as well as providing medication options incongruent with the age of the patient.

Case 3

This case focused on a middle-aged male presenting with an exacerbation of a long-standing rash. Candidates were presented with a detailed past medical history, and were required to consider factors that may have caused the exacerbation. Candidates were then required to consider topical pharmacological options as well as appropriate investigations in view of the most likely underlying diagnosis.

Common errors included providing oral medication options when the question focused upon topical management options, as well as providing exacerbating factors that lacked relevance with reference to the presented case.

Case 4

Candidates were presented with a middle-aged male for whom a skin lesion was found incidentally during a routine medication review. Candidates were required to cite their initial management action, as well as outline what risks they would consider as part of obtaining the patient’s informed consent. As the case evolves, the patient is found to require further surgery. In view of this, candidates were tasked with optimising his medications prior to the procedure.

The most common errors included citing information already provided within the stem, and providing more answers than required. In the KFP exam, it is important that candidates only provide the number of answers requested; any extra answers will attract a penalty.

Case 5

This case focused on a child presenting with symptoms of a persistent cough and fevers. Candidates were required to consider the most likely causative pathogens as well as outline what public health management actions they would take in view of this. The child represents a few months later with an ongoing persistent cough as well as nasal discharge, for which candidates were required to outline suitable management options.

The common errors related to a lack of knowledge regarding common pathogens, and providing management actions that did not focus upon public health issues.

Case 6

Candidates were provided with the clinical history of a young adult male presenting with symptoms of delusions and social withdrawal. Candidates were tasked with outlining key specific aspects of history and the most likely differential diagnoses. As the case evolves, the patient is appropriately managed in a psychiatric facility and represents for ongoing clinical care. Candidates were required to outline appropriate investigations in view of the recent admission.

The most common errors included the provision of answers not relating to the tasked questions. Such examples included the provision of differential diagnoses rather than specific aspects of history, and providing differential diagnoses not in keeping with the demographics of the patient.

Case 7

This case focused on an older male presenting with an acute swollen knee. Candidates were presented with the results of investigations, and in view of this information were required to establish their differential diagnosis. The case then focused upon the investigation and pharmacological management in view of recurrent episodes of knee pain and swelling.

Common errors included providing multiple pharmacological management options within the same line, leading to overcoding, and a lack of specificity regarding pharmacological management options.

Case 8

This case focused on a young adult female presenting with chronic headaches.

Candidates were tasked with considering the most likely differential diagnoses as well as suitable pharmacological management options. The patient later represents with a rash for which candidates were required to consider appropriate management options.

The most common error related to providing differential diagnoses that lacked specificity, such as ‘daily headaches’. In answering KFP examination questions, it is important to provide answers specific to the case scenario.

Case 9

Candidates were presented with an older female patient complaining of symptoms of urinary incontinence. Candidates were required to establish the most likely differential diagnoses, specific examination findings in view of the presentation and appropriate non-pharmacological management options.

As in the previous case, common errors related to provision of differential diagnoses lacking specificity, as well as providing more answers than required.

Case 10

This case focused on a young female adult requesting cervical screening. She later represents with post-coital vaginal bleeding for which candidates were required to outline appropriate investigations. Finally, candidates were required to consider emergency contraception options in view of an episode of unprotected sexual intercourse.

Many candidates failed to address the requirement for emergency contraception, instead providing contraception options which were not appropriate to the case presentation.

Case 11

Candidates were presented with an older female complaining of symptoms suggestive of an endocrine disorder. Candidates were required to establish a differential diagnosis given the clinical presentation and to arrange further investigations. As the case evolves, appropriate management is commenced with no improvement to the clinical presentation. Candidates were required to consider factors which may have contributed to the ineffectiveness of the treatment.

Common errors included the provision of factors not relevant to the case presentation.

Case 12

This case focused on a 34-year-old female presenting with a facial rash. Candidates were required to consider further specific aspects of history, establish a differential diagnosis and commence appropriate management strategies.

The most common errors related to provision of answers not addressing the case presentation, and providing repetitive answers through paraphrasing the same response several times.

Case 13

This case focused on a male Aboriginal patient in a rural setting presenting with symptoms of tiredness, weight gain and nocturia. Candidates were required to consider the differential diagnoses and arrange appropriate investigations. The patient presents a year later with microscopic haematuria and proteinuria, for which candidates were required to arrange further investigations given the clinical presentation.

The most common errors included repeating information provided in the stem, as well as providing differential diagnoses and arranging investigations incongruent to the presenting features of the case.

Case 14

This case focused on a young female adult presenting with a skin lesion and a vulval lump. Candidates were required to consider the differential diagnoses for both presentations as well as outline specific aspects that they would discuss with the patient prior to performing a vaginal examination.

Common errors included a lack of knowledge regarding plausible differential diagnoses, particularly pertaining to the skin lesion, as well as failing to consider the rights of the patient with respect to the process of informed consent prior to performing a vaginal examination.

Case 15

Candidates were presented with an incidental finding of a deranged magnesium level in an older female with a complex past medical history. In view of the information provided and the result, candidates were required to consider contributing factors and specific management strategies, and outline further investigations.

As with previous questions, the most common error related to the provision of contributing factors incongruent to the case presentation.

Case 16

This case focused on an older female presenting with symptoms of hot flushes and vaginal dryness. Candidates were required to outline appropriate investigations, pharmacological management options and address the patient’s concerns relating to a family history of breast cancer.

The most common errors related to lack of knowledge regarding the management of menopausal symptoms, as well as failing to address the patient’s concerns given her specific family history.

Case 17

Candidates were initially presented with a 40-year-old male presenting with an ear lesion for which they were required to consider the most likely differential diagnoses and initial management actions. As the case develops, the patient presents with his wife of a similar age who is pregnant and concerned about the likelihood of fetal abnormalities. Candidates were tasked with outlining specific aspects of advice to address their concerns.

As with previous cases, the most common errors related to providing answers incongruent to the case presentation, as well as failing to fully understand the role of screening and diagnostic tests in the antenatal period.

Case 18

This case focused on an Aboriginal child in a rural context presenting with acute knee pain and fever. Candidates were required to consider the most likely differential diagnoses, initial investigations and immediate management actions.

The most common errors related to failing to appreciate the acuity of illness, hence providing management actions that were inappropriate with respect to the urgency of the clinical presentation.

Case 19

This case focused on a child with a past medical history of Down syndrome presenting with symptoms of acute diarrhoea and abdominal pain. Candidates were required to consider the likely differential diagnoses and outline specific public health management actions in light of this. As the case progresses the acute illness resolves but the patient represents with ongoing diarrhoea and abdominal pain, for which candidates were required to outline appropriate investigations to establish the underlying diagnosis.

As with previous cases, several candidates provided management actions that did not focus upon public health actions.

Case 20

This case focused on a child presenting with a 10-month history of hip pain.

Candidates were presented with a detailed clinical presentation and a radiological image, and were required to establish the most likely differential diagnoses and initial management actions. Later in the case, the child’s mother calls the practice wishing to make a complaint in view of her concerns of a delayed diagnosis; candidates were tasked with outlining their actions to address the situation.

The most common errors included providing management actions that were inappropriate in the initial period, as well as a lack of knowledge regarding the management of complaints.

Case 21

This case focused on an older male presenting with worsening vision. Candidates were required to establish the likely differential diagnoses, outline management strategies while awaiting ophthalmology assessment, and consider the eyesight standards required in view of assessment of fitness to drive.

Common errors included a lack of knowledge regarding the differential diagnosis, as well as a lack of knowledge relating to the assessment of fitness to drive.

Case 22

This case focused initially on an older nurse presenting with acute abdominal pain and nausea. After the GP considers the likely differential diagnoses, the patient is managed appropriately and returns six months later for follow-up. Candidates were required to interpret the results of a blood investigation. The patient later presents with a lesion on her finger for which candidates were tasked with outlining appropriate management actions.

In line with previous examination cycles, many candidates failed to correctly interpret the pattern of liver function test dysfunction. The KFP examination paper regularly assesses the interpretation of commonly ordered blood investigations within the primary care context.

Case 23

Candidates were presented with an adolescent female complaining of a facial rash.

They were required to outline non-pharmacological advice as well as pharmacological management options pertaining to the presentation. The patient is later referred to a dermatologist who commences an oral medication. Candidates were required to consider adverse effects relating to this medication. On a further presentation, the patient requests advice prior to conception.

As with previous questions, common errors included a lack of specificity in answers, as well as providing answers inappropriate to the key features of the case.

Case 24

This case focused on a snowboarder presenting with chronic shoulder pain and stiffness eight weeks after sustaining a clavicle fracture. Candidates were required to consider the likely differential diagnoses as well as address the patient’s requests for magnetic resonance screening (MRI) and strong painkillers.

Common errors related to provision of incorrect differential diagnoses, providing answers that did not address the patient requests for investigations, and prescribing medications not currently indicated.

Case 25

Candidates were presented with a young adult male with acute alcohol intoxication in a rural context. Candidates were required to outline specific examination findings as well as initial investigations. The patient is appropriately managed and later presents wishing to cease alcohol consumption. Candidates were required to consider appropriate pharmacological management options.

The common errors in this case included candidates using generic descriptors in their examination findings rather than providing specific examination findings.

Case 26

This case focused on a young Aboriginal woman presenting with an unexpected pregnancy. Candidates were initially required to organise appropriate investigations and outline advice relating to whether to proceed with the pregnancy. Some months later in the case, after the patient had decided to proceed with the pregnancy, the mother presents with her new daughter, complaining her child has inward eye movements.

Candidates were required outline their assessment of specific examination findings in view of the clinical presentation.

Common errors included providing factually incorrect advice to the patient, as well as failing to provide specific examination findings rather than generic examination descriptors.

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KFP 2020.2

Case 1

This case focused on a mother presenting in the early post-partum period with features of mastitis. Candidates were tasked with taking a specific targeted history and were then required to formulate appropriate pharmacological management options. As the case evolves, the patient represents some time later with a breast lump. Candidates were required to outline initial investigations to determine the most likely diagnosis.

Common errors included articulating elements of the history that lacked specificity to the case presentation and did not add diagnostic value. As the KFP exam is a test of clinical reasoning, it is important that candidates provide answers that are specific, concise and relevant to the information provided.

Case 2

This case presented candidates with a middle-aged woman concerned regarding her risk of developing bowel cancer. Candidates were required to outline measures to reduce her risk of developing bowel cancer. She represents several years later, having been diagnosed with adenocarcinoma and presenting with abdominal pain after a hospital admission. Candidates were required to identify likely differential diagnoses.

After being appropriately managed, the patient represents a few months later having deteriorated clinically and not wishing to engage in further therapy.

It is important for candidates to consider all of the information provided in a case stem.

Common errors included providing preventive health measures that were not tailored to the clinical case presentation, and did not take into account the key features of the case.

Case 3

This case focused on a late middle-aged woman presenting with features of raised intraocular pressures after a routine optometry screen. Candidates were required to identify risk factors pre-disposing to the finding. The patient also presented with clinical features of blepharitis, for which candidates were required to provide non-pharmacological management advice. She further presents with a skin lesion on her face, for which candidates were required to determine the likely diagnosis.

Common errors included providing listing symptoms of raised intraocular pressures rather than providing risk factors. Candidates also frequently provided advice relating to managing conjunctivitis rather than blepharitis, per se.

Case 4

Candidates were presented with an infant and her mother for routine childhood immunisations. Candidates were provided with the infant’s past medical history and tasked with identifying potential medical contraindications. As the case evolves, it transpires that her father is opposed to all forms of vaccinations, and candidates were required to appropriately manage the situation. The infant also presents with a facial rash, for which candidates were tasked with providing suitable non-pharmacological advice.

The most common errors included a lack of medical knowledge pertaining to identifying contraindications, as well as a lack of knowledge regarding the legal framework relevant to the evolving clinical scenario. The KFP exam assesses all aspects of the RACGP Curriculum for Australian General Practice, including broader domains relating to clinical governance, ethical dilemmas and medico-legal aspects of general practice.

Case 5

This case focused on a woman presenting with heavy periods. Candidates were provided with history and examination findings and asked to identify appropriate initial investigations. The investigations return as normal and candidates were subsequently tasked with initiating pharmacological management actions. Candidates were also presented with findings of a recent cervical screening test and were expected to manage the abnormal findings.

The common errors related to a lack of knowledge relating to the pharmacological management of heavy periods, as well as a lack of understanding with respect to the interpretation of cervical screening test results.

Case 6

Candidates were presented with an adult male requesting a second opinion for signs and symptoms suggestive of rhinosinusitis. Candidates were provided with recent medical records, tasked with arranging initial investigations and then expected to commence pharmacological management actions. As the case evolves, the patient represents over the next few months with inappropriate and aggressive conduct, which candidates were required to manage accordingly.

The most common errors included answers that did not demonstrate a candidate taking responsibility for arranging onward clinical care, as well as answers that focused on identifying an organic cause of the demonstrated conduct rather than managing the conduct directly.

Case 7

This case focused on an adult woman presenting with a wide variety of symptoms including fatigue, weight gain and joint pains. Candidates were provided with detailed clinical features and tasked with outlining the most likely differential diagnoses, as well as initial investigations. The patient later represents having been appropriately managed but requiring assistance with facilitating weight loss, for which candidates were required to outline potential pharmacological options.

Common errors included providing differential diagnoses which were not consistent with the detailed clinical features provided within the case. Candidates are expected to use the key features of the case to provide answers that are congruent to the clinical case presentation. 

Case 8

This case focused on a young adult female presenting with chronic headaches.

Candidates were tasked with considering the most likely differential diagnoses, as well as suitable pharmacological management options. The patient later represents with a rash, for which candidates were required to consider appropriate management options.

The most common error related to providing differential diagnoses that lacked specificity, such as ‘daily headaches’. In answering KFP exam questions, it is important to provide answers specific to the case scenario.

Case 9

Candidates were presented with an older female patient complaining of symptoms of urinary incontinence. Candidates were required to establish the most likely differential diagnoses, specific examination findings in view of the presentation and appropriate non-pharmacological management options.

As in the previous case, common errors related to providing differential diagnoses lacking specificity, as well as examination findings which were not relevant to the question.

Case 10

This case focused on a child presenting with his mother with hearing impairment.

Candidates were required to interpret an audiogram provided, to provide further specific aspects of history, and to provide the most likely differential diagnosis. As the case evolves, the child’s mother advises that she wishes to make a complaint relating to the care provided.

Many candidates failed to interpret the findings of the audiogram, and subsequently failed to provide specific aspects of history and differential diagnoses congruous with the clinical case presentation.

Case 11

Candidates were presented with an older man wishing to engage with proactive care of his health, having been non-compliant with medication previously prescribed.

Candidates were presented with a detailed past medical history and the results of blood investigations, and asked to provide appropriate pharmacological management actions.

The patient later asks for a medical certificate, which candidates were expected to appropriately manage.

Common errors included providing pharmacological options which had already been cited in the case stem, as well as citing pharmacological management options that did not address the key features of the case.

Case 12

This case focused on a 27-year-old woman presenting to a rural clinic in the antenatal period. Candidates were required to provide advice related to nutrition, as well as interpret the results of first trimester genetic screening tests. The patient later represents in the third trimester with severe abdominal pain and vaginal bleeding, for which candidates were expected to initiate appropriate management actions. 
The most common errors related to answers that were pharmacological in nature rather than nutritional. Candidates are encouraged to ensure that answers provided address the question posed.

Case 13

This case focused on a woman presenting to clinic for the first time requesting a repeat opiate prescription. Candidates were required to undertake focused management actions prior to dispensing the prescription. The patient represents a few days later stating that she had lost her repeat prescription, and candidates were expected to manage the situation appropriately. As the case evolves, the police suspect that the patient’s partner is stealing the prescriptions and contact the practice requesting further information regarding her past medical history.

As per the previous case, the most common errors included answers that were already provided within the case scenario. Other errors included providing further aspects of history rather than management actions, and answers that were not relevant to the case presentation.

Case 14

This case focused on an elderly man with multiple comorbidities presenting for results of routine annual blood tests. Candidates were presented with a detailed past medical history and the blood results revealing a raised haemoblogin level and mean cell volume. Candidates were required to cogitate upon a differential diagnosis, outline specific examination findings that would support the likely differential diagnoses, and to arrange further investigations.

The KFP exam frequently assesses candidates’ abilities to interpret the results of common investigations. Common errors included a lack of knowledge pertaining to the interpretation of the provided blood investigations, with the provision of differential diagnoses and examination findings that did not address the blood investigation results.

Case 15

Candidates were presented with a young man who presents to a rural general practice with a hand injury sustained in a workplace accident. Given a detailed clinical context and the results of an X-ray, candidates were required to identify the most likely diagnosis and to initiate immediate management actions. As the case evolves, the patient is appropriately managed but later represents with ongoing hand symptoms requesting opiate medications. Candidates were expected to identify the most likely differential diagnoses at this stage, as well as arrange onward non-pharmacological management actions.

As with previous questions, common errors related to vague answers that lacked the specific details required to achieve marks, as well as answers that failed to appreciate the rural context of the case presentation. The KFP exam assesses clinical scenarios across metropolitan and rural contexts, and candidates are expected to be able to contextualise their responses to the presenting geographic location.

Case 16

This case focused on a young adult woman presenting with the results of routine blood testing taken at a workplace health screening session, revealing an elevated fasting blood glucose, for which candidates were expected to provide appropriate non-pharmacological management advice. The patient represents a couple of months later with a positive home pregnancy test. Candidates were expected to undertake specific immediate management actions, in view of the likely underlying diagnosis.

The most common errors related to answers that did not consider the patient holistically and did not consider their past medical history. Other errors included answers that were not management actions and hence did not answer the questions posed.

Case 17

Candidates were initially presented with a 35-year-old woman presenting with clinical features of hypothyroidism. They were required to identify appropriate investigations and to initiate appropriate pharmacological management. As the case develops, the patient represents eight weeks later with symptoms of tiredness and an itchy rash, for which candidates were required to identify appropriate investigations to determine the underlying cause.

The most common errors related to pharmacological management actions that lacked the correct dosing. Where a specific dosage is required, the question will indicate this clearly, and answers without this information will attract lower marks.

Case 18

This case focused on a middle-aged man presenting with new-onset back pain.

A detailed clinical presentation and past medical history were provided, and candidates were required to consider specific aspects of his clinical presentation which increased the likelihood of a serious underlying diagnosis, as well as identify suitable investigations. As the case continues, a serious underlying diagnosis is excluded, but the patient fails to return to full workplace duties. Candidates were required to identify specific aspects of the patient’s history that would suggest a poor onward prognosis with respect to his return to full workplace duties.

As per previous questions, common errors relate to answers that lacked specificity, as well as answers that were unclear and not relevant to the clinical scenario presented.

Case 19

This case focused on a young adult woman presenting with a new mole. After identifying clinical features suggestive of a serious underlying diagnosis, candidates were then informed that patient attended a different GP for excision of the lesion and had since acquired a keloid scar. Candidates were required to identify suitable management options. The patient later represents wishing to make a complaint regarding the care provided. Candidates were tasked with outlining their actions to address the situation.

Several candidates provided answers that did not address the case presentation.

Dermatological conditions are commonly assessed within the KFP exam, and candidates are expected to be able to manage them in line with current clinical guidelines. 

Case 20

This case focused on an elderly man presenting with his wife with new symptoms of disorientation, inattention and limb stiffness. Candidates were required to identify the most likely differential diagnosis and to arrange initial investigations. The patient returns with worsening behaviour and confusion. Candidates were required to outline evidenced-based non-pharmacological actions to enable the patient’s wife to manage his behaviour.

The most common errors included pharmacological actions that were not specific or relevant to the case presentation. Candidates were expected to give advice relating to appropriate specific non-pharmacological actions in context of the case presentation and the likely differential diagnoses.

Case 21

This case focused on a young adult man who identifies as Aboriginal presenting with acute limb swelling and an abnormal clinic urinalysis result. Candidates were required to identify the most likely diagnosis and to arrange appropriate investigations. As the case evolves, the patient is managed appropriately and represents three months later with an itchy rash, for which candidates were required to arrange non-pharmacological management actions.

Common errors included a lack of knowledge regarding the differential diagnosis, as well as answers that were pharmacological in nature when the question had asked for non-pharmacological management actions. These answers did not attract marks irrespective of whether they were clinically appropriate or not.

Case 22

This case focused initially on a seven-year-old boy presenting with his mother to a rural clinic with symptoms of coughing and shortness of breath, for which candidates were required to identify appropriate initial management actions. Three weeks later the patient develops acute worsening symptoms. Candidates were required to identify specific examination findings which would suggest hospital admission is warranted, as well as to initiate immediate management actions while awaiting ambulance transfer to hospital.

In line with previous examinations, many candidates failed to demonstrate sufficient knowledge of the necessary immediate actions required for an acutely unwell patient.

These scenarios are commonly tested in the KFP exam, and candidates are expected to be able to initiate immediate management actions in capacity as a GP.

Case 23

Candidates were presented with an elderly woman with clinical features and an ECG diagnostic of atrial fibrillation with a rapid ventricular rate. Candidates were required to identify the ECG abnormality, select diagnostic investigations and instigate appropriate pharmacological management actions.

As with previous questions, common errors included a lack of specificity in answers, as well as providing answers inappropriate to the underlying diagnosis.

Case 24

This case focused on an adult man presenting with acute shoulder pain sustained after a sporting injury. Candidates were required to outline the most likely diagnosis, articulate appropriate investigations and to identify appropriate pharmacological and non-pharmacological management options.

Common errors related to incorrect differential diagnoses, providing investigations that did not address the likely differential diagnoses, and the prescribing of medications that were not indicated.

Case 25

Candidates were informed about a young adult woman presenting with cyclical irritability and anger related to her menstrual cycle. Candidates were required to identify the most likely diagnoses, as well as to commence initial appropriate pharmacological actions. As the case evolves, the patient represents three months later having disclosed to you that she has commenced a sexual relationship with her psychologist, a situation candidates were required to manage appropriately.

The common errors in this case included answers that failed to appreciate the severity of the alleged relationship. As per previous cases, the KFP exam assesses candidates’
abilities to interpret and apply the relevant medicolegal and regulatory frameworks into clinical practice.

Case 26

This case focused on a young adult man presenting with a new-onset rash.

Candidates were required to outline the most likely differential diagnoses and to consider appropriate pharmacological management options. Later that day the practice receives a call from the patient’s father making enquiries regarding his diagnosis. Candidates were required to outline initial actions to manage the situation.

Common errors included management actions that were not applicable with the case presentation provided.

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KFP 2021.1

Case 1

This case focused on an infant presenting with acute respiratory features who was admitted for hospital intervention. Candidates were required to identify specific physical examination features that would warrant admission, and then to outline onward management after being discharged from hospital. As the case evolves, he is brought in by his grandmother with unexplained bruising, which candidates were required to manage.

Common errors included articulating elements of physical examination that lacked specificity to the case presentation and that did not add diagnostic value. As the KFP exam is a test of clinical reasoning, it is important that candidates provide answers that are specific, concise and relevant to the information provided.

Case 2

This case focused on a man presenting with acute shoulder pain sustained after a sporting injury. Candidates were required to outline specific physical examination signs that would help confirm the most likely diagnosis. The patient re-presents some time later enquiring about a subacromial injection. Candidates were required to outline specific risks. The patient indicates that he would like to make a complaint relating to the care provided, which candidates were required to manage.

It is important for candidates to consider all of the information provided in a case stem.

Common errors included providing aspects of complaint management not tailored to the clinical case presentation and that did not take into account the key features of the case. The KFP exam assesses all aspects of the RACGP curriculum, including broader domains relating to clinical governance, ethical dilemmas and medico-legal aspects of general practice.

Case 3

This case focused on an infant presenting with multiple acute features, including a fever and a rash, upon returning from overseas. Candidates were required to consider the most likely differential diagnoses, outline specific examination features that would help determine the most likely diagnoses and articulate necessary immediate management actions.

Common errors included a lack of knowledge relating to the assessment and management of common infectious illnesses in children returning from overseas, and as such, worse performing candidates provided answers that lacked specificity.

Case 4

The case focused on a woman with a complex past medical history seeking a repeat prescription of clonidine and oxycodone. As part of her presentation, an electrocardiogram was undertaken. Candidates were required to identify the most likely diagnosis, outline immediate management actions and manage the prescription requests.

The most common errors included a lack of medical knowledge pertaining to interpretation of the electrocardiogram findings, as well as a lack of knowledge relating to the safe management of repeat prescription requests for high-risk medications.

Case 5

This case focused on an infant presenting for routine immunisations and with parental concerns regarding the appearance of his external genitalia. Candidates were required to manage parental concerns regarding the immunisation schedule, as well as outline appropriate management actions related to the abnormal scrotal examination findings.

Common errors related to a failure to sufficiently address the specific concerns raised regarding the immunisation schedule and a lack of knowledge of the management of the scrotal examination findings. The KFP exam assesses all aspects of immunisation in the primary care context.

Case 6

This case focused on a 28-year-old woman presenting with a positive home pregnancy test. Candidates were required to arrange appropriate initial investigations. The patient later re-presents with vaginal bleeding, for which candidates were expected to outline likely differential diagnoses and subsequently arrange onward management.

The most common error included the provision of answers that did not consider the key features of the case, and as such, were not applicable for the stage of gestation.

Candidates are expected to use the key features of the case to provide answers that were congruent to the clinical case presentation.

Case 7

This case focused on a young adult woman presenting with acute abdominal and pelvic pain. Candidates were provided with detailed clinical features and tasked with outlining the most likely differential diagnoses and initial investigations. After being appropriately managed, she later re-presents with symptoms of dyspareunia, for which candidates were required to outline potential non-pharmacological options.

As with case 6, common errors included providing differential diagnoses that were not contingent with the detailed clinical features provided within the case. As such, candidates provided a range of answers that were not applicable to the clinical presentation.

Case 8

This case focused on an elderly woman presenting to a rural clinic with a wrist injury.

Candidates were required to outline initial management options. The patient later re-presents with ongoing unresolved clinical features, which candidates were required to manage, as well as outline appropriate management options to reduce her risk of a future fracture.

The most common error related to providing management options that were not evidence based and did not feature in the relevant clinical guidelines. In answering KFP exam questions, it is important to provide answers that are evidence based and in line with contemporary clinical guidelines.

Case 9

This case focused on an adult man presenting for a general check-up. A detailed past medical history and blood investigation results were provided. Candidates were expected to interpret the results provided, outline differential diagnoses and identify specific physical examination findings that would help to confirm the most likely differential diagnoses.

As in previous cases, common errors related to the provision of differential diagnoses lacking specificity and examination findings that were not relevant to the question.

Case 10

This case focused on a woman seeking assistance to lose weight. A detailed past medical history was provided, and candidates were required to identify potential management options that would aid her to lose weight. Following a gastric bypass procedure, the patient re-presents for follow up. Candidates were required to arrange initial investigations.

Many candidates failed to demonstrate a breadth of knowledge in congruence with current guidelines and did not address the key features within her past medical history.

A smaller cohort of candidates duplicated answers with respect to management actions, reducing their ability to demonstrate the range of knowledge required to score the full range of marks available.

Case 11

This case focused on a woman with a complex past medical history presenting for routine prescriptions. Candidates were presented with a detailed past medical history and the results of blood investigations, and were asked to interpret the results and provide appropriate non-pharmacological management actions. The woman later presents with auditory hallucinations, which candidates were required to manage.

Common errors included the provision of pharmacological management actions when the question was assessing non-pharmacological management actions. It is important that all answers directly answer the questions asked within the case.

Case 12

This case focused on an older adult presenting with a new skin lesion. Candidates were required to outline expected dermatoscopy examination findings, suitable management options and measures to reduce her risk of future skin cancer.

The most common errors related to the provision of examination findings that were general in nature and not congruent with the information provided. Candidates are encouraged to ensure that answers provided addressed the question posed.

Case 13

This case focused on a man, who identifies as Torres Strait Islander, presenting with acute foot swelling. Candidates were required to identify the most likely diagnosis and initiate appropriate management actions. The patient later presents for review.

Candidates were required to arrange non-pharmacological management actions to further manage his initial presenting features.

As per case 12, the most common errors included the provision of answers that were general in nature and did not address the key features of the provided clinical case presentation.

Case 14

This case focused on an elderly woman with multiple comorbidities presenting with a chronic cough. Candidates were presented with a detailed past medical history and spirometry findings. Candidates were required to consider appropriate management actions and outline specific examination findings that would support an admission to hospital. The patient later presents with symptoms of acute visual deterioration, which candidates were required to appropriately manage.

The KFP exam assesses candidates’ abilities to interpret the results of common investigations. Common errors included a lack of knowledge pertaining to the interpretation of the provided spirometry investigation results, with the provision of management actions that did not address the full clinical presentation.

Case 15

This case focused on a woman presenting with fatigue after having recently delivered a healthy, full-term baby. Candidates were required to identify the most likely diagnosis and to arrange initial investigations. As the case evolves, the patient seeks advice regarding ensuring sufficient breast milk volume after returning to work, for which candidates were expected to provide appropriate advice.

As per previous cases, common errors included the provision of pharmacological management actions when the question was assessing non-pharmacological management actions. It is important that all answers directly answer the questions asked within the case.

Case 16

This case focused on a man with an intellectual impairment presenting with an acute painful rash. The patient was accompanied by his sister. Candidates were required to identify the most likely diagnosis and initiate appropriate management. The patient later re-presents six months later with a new skin lesion. Candidates were expected to outline appropriate actions required to obtain informed consent.

The most common errors related to the provision of answers that did not consider the patient holistically and did not consider his past medical history in relation to the process of obtaining informed consent. The KFP exam assesses broader aspects of the RACGP curriculum, including within the domains of clinical governance and medicolegal dilemmas.

Case 17

This case focused on a four-year-old boy of Aboriginal descent presenting with symptoms of acute ear pain and fever. Candidates were required to identify the most likely differential diagnosis and initiate appropriate pharmacological management.

As the case develops, he re-presents six weeks later with symptoms of persistent purulent ear discharge, for which candidates were required to manage accordingly.

The most common errors related to the provision of pharmacological management actions that lacked the correct dosing. Where a specific dosage is required, the question will indicate this clearly, and answers without this information will attract lower marks.

Case 18

This case focused on an elderly woman presenting with chronic urinary frequency.

A detailed clinical presentation and past medical history were provided, and candidates were required to identify the most likely differential diagnoses, initiate pharmacological management actions and provide lifestyle advice that would reduce the severity of her symptoms.

As per previous questions, common errors related to answers that lacked specificity, as well as answers that were nebulous and not relevant to the clinical scenario presented. Examples of such answers include ‘acute pelvic inflammatory disease’, which is a less common acute presentation in the elderly population.

Case 19

This case focused on a woman of Aboriginal descent presenting to a rural clinic with symptoms of cough with purulent discharge and intermittent haemoptysis. Candidates were presented with detailed examination findings and the results of a chest X-ray, and were required to outline the most likely differential diagnoses and arrange appropriate initial investigations.

Several candidates provided answers that did not address the case presentation.

Presentations suggestive of a serious underlying diagnosis are commonly assessed within the KFP exam, and candidates are expected to be able to manage common presentations in line with current clinical guidelines.

Case 20

This case focused on a woman presenting with acute symptoms of dizziness, nausea and vomiting. Candidates were required to identify the most likely differential diagnosis and outline specific examination findings that would be suggestive of a central cause of her clinical presentations. The patient also presents with a skin lesion, for which candidates were required to outline the most likely diagnosis.

The most common errors included providing examination findings that were not specific to the question asked and were repetitive in nature. Such answers do not allow candidates to demonstrate the range of knowledge required to score the full range of marks available.

Case 21

This case focused on an elderly man, who was recently admitted to a local nursing home, requesting an advanced care plan. Candidates were required to articulate specific information required within the advanced care plan. As the case evolves, the patient’s cognitive state deteriorates and he further develops symptoms of acute agitation and shortness of breath. His family later ask for advice to hasten his death.

Candidates were required to manage the request and provide suitable management options to manage his symptoms.

Common errors included a lack of knowledge regarding the preparation of advanced care plans, as well as answers that were vague or non-pharmacological in nature when the question had asked for pharmacological management actions. These answers did not attract marks, irrespective of whether they were clinically appropriate or not.

Case 22

This case focused on a man of Aboriginal descent presenting with symptoms of shortness of breath, ankle swelling and fatigue. Candidates were provided with a detailed past medical history, drug history and a series of investigation results, and were required to instigate appropriate pharmacological management actions.

Candidates were also required to identify specific aspects of the clinic environment important in providing culturally safe healthcare, as well as articulating key features to establishing a successful chronic disease recall system.

In line with previous examination cycles, many candidates failed to demonstrate sufficient knowledge of the necessary aspects required to deliver healthcare that is culturally safe. Such scenarios are commonly tested in the KFP exam.

Case 23

This case focused on an acutely unwell woman presenting to a rural clinic with acute abdominal pain. Candidates were provided with detailed examination findings, and were required to arrange initial investigations and instigate immediate management actions. The patient is eventually managed with a surgical procedure and later re-presents after discharge with further abdominal pain and fever, for which candidates were subsequently required to identify the most likely differential diagnoses.

As with previous questions, common errors included a lack of specificity in answers, as well as providing answers inappropriate to the rurality of the clinic. The KFP exam assesses clinical presentations within both metropolitan and rural contexts, and candidates were required to tailor their responses relative to the geographical location of the practice setting.

Case 24

This case focused on a man presenting with acute eye redness and pain. Candidates were required to outline specific examination features that would support the most likely diagnosis, arrange appropriate investigations to establish underlying causes and instigate immediate management actions.

Common errors related to the provision of incorrect differential diagnoses and providing investigations that did not address the likely underlying causes.

Case 25

This case focused on a young adult man presenting with malodorous feet.

Candidates were provided with a detailed past medical history and examination findings, and were required to identify the most likely diagnosis, commence initial appropriate pharmacological actions and provide appropriate lifestyle advice to manage the presenting complaint.

Common errors included providing answers that exceeded the number requested, leading to overcoding. The KFP exam assesses clinical reasoning in context of the key features of a case presentation, and it is crucial that candidates only provide the number of answers requested within the question.

Case 26

This case focused on a woman presenting with chronic tinnitus. Candidates were required to outline specific examination features suggestive of a serious underlying cause, arrange initial investigations and advise on suitable non-pharmacological management actions.

Common errors included the provision of management actions that were not congruent with the case presentation provided and lacked specificity to the case presentation provided.

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KFP 2021.2

Case 1

This case focused on an adult male presenting for the results of his investigation after sustaining a shoulder injury at work. Candidates were required to identify aspects of his clinical presentation that increased the likelihood of a poor prognosis, and to advise regarding appropriate non-pharmacological management strategies.

Common errors included providing responses that lacked specificity and which did not add diagnostic value. As the KFP exam is a test of clinical reasoning, it is important that candidates provide answers that are specific, concise and relevant to the information provided.

Case 2

This case focused on an adult male presenting with nasal congestion and intermittent nasal discharge. Candidates were required to outline specific education pertaining to the use of his currently prescribed therapy, and to provide additional pharmacological management actions. The patient also presents with a new skin lesion for which candidates were required to identify the most likely diagnosis.

It is important for candidates to consider all the information provided in a case stem.

Common errors included providing aspects of education not tailored or relevant to the clinical case presentation, and which did not consider the key features of the case.

Case 3

This case focused on an adult male presenting with new-onset rectal discharge.

Candidates were required to consider the most likely differential diagnoses and to articulate necessary immediate management actions.

Common errors included a lack of knowledge relating to the assessment and management of common sexually transmitted infections in this population cohort, and as such, worse performing candidates provided answers that lacked relevance to the case presentation.

Case 4

Candidates were presented with an elderly female with increasing shortness of breath, tiredness and a cough. Candidates were required to identify the most likely diagnosis, to outline appropriate investigations and to provide non-pharmacological management actions considering the clinical presentation. 

Common errors included providing pharmacological management actions when the question was assessing non-pharmacological management actions. It is important that all answers directly address the questions asked within the case.

Case 5

This case focused on an adult female presenting with a tender area of skin and worsening skin changes. Candidates were required to identify the most likely diagnosis and to commence pharmacological management strategies.

Common errors related to a lack of knowledge relating to the diagnosis and onward management of the skin lesion. As with previous examination cycles, the KFP frequently assesses dermatological presentations in the primary care context.

Case 6

This case focused on a 45-year-old female presenting with new-onset leg pain occurring after walking. Candidates were required to identify the most likely diagnoses and to provide advice regarding non-pharmacological management actions. The patient later re-presents with worsening calf pain, for which candidates were expected to arrange onward management.

The most common errors included providing answers that did not take into consideration the key features of the case, and as such were not applicable for the evolving clinical presentation. Candidates are expected to use the key features of the case to provide answers that are congruent to the clinical case presentation.

Case 7

This case focused on an adult male truck driver presenting for routine review health assessment and wanting to reduce his alcohol consumption. Candidates were required to identify additional aspects of history, and to provide education relating to his pharmacological management strategy. The patient is later observed contravening his driver licence conditions, for which candidates were required to outline appropriate immediate actions.

This question was answered sub-optimally by the entire cohort, and the examiners were surprised at the lack of knowledge pertaining to a common presentation within the primary care context. The KFP exam assesses all aspects of the RACGP Curriculum, including broader domains relating to clinical governance, ethical dilemmas and medicolegal aspects of general practice.

Case 8

This case focused on an adult male with a past medical history of schizophrenia presenting to a rural clinic with signs and symptoms of agitation and muscular rigidity.

Candidates were required to relay the most likely diagnosis, to commence immediate management actions and to arrange initial investigations.

The most common error related to providing management options that were not evidence based and that did not feature in the relevant clinical guidelines. In answering KFP exam questions, it is important to provide answers that are evidence based and in line with contemporary Australian clinical guidelines.

Case 9

Candidates were presented with a child with new-onset vaginal itch and rash. Candidates were expected to outline differential diagnoses, and to commence appropriate pharmacological and non-pharmacological management actions.

As in previous cases, common errors related to providing differential diagnoses lacking specificity, as well as outlining management actions that were not relevant nor appropriate in the paediatric context.

Case 10

This case focused on an adult female presenting for a general health assessment.

A detailed past medical history was provided, and candidates were required to identify specific cancer screening recommendations relevant to her, and to discuss strategies that may help her to make necessary lifestyle changes.

Many candidates failed to demonstrate a breadth of knowledge in congruence with current guidelines, and therefore did not provide recommendations that addressed the key features within the patient’s past medical history.

Case 11

Candidates were presented with a child with intermittent recurrent abdominal pain.

Candidates were provided a detailed past medical history and were required to identify the most likely differential diagnoses, to arrange initial investigations and to provide advice relating to appropriate non-pharmacological advice.

As per previous cases, common errors included providing pharmacological management actions when the question was assessing non-pharmacological management actions. It is important that all answers directly address the questions asked within the case.

Case 12

This case focused on an adult female presenting with a new skin lesion. Candidates were required to outline expected examination findings, to outline suitable investigations and to outline measures to reduce her risk of future skin cancer.

The most common errors related to providing measures that were general in nature and not in congruence with the information provided, nor holistic in their considerations.

Candidates are encouraged to ensure that answers provided address the question posed and the clinical case in its entirety.

Case 13

This case focused on an adult male who identifies as Aboriginal presenting with acute respiratory signs and symptoms. Candidates were required to identify the most likely diagnosis. As the case evolves, the patient is reluctant to be transferred to a hospital environment. Candidates were required to formulate an appropriate management plan.

The most common errors included providing answers that were general in nature and failed to appreciate the clinical acuity and urgency of facilitating transfer to a hospital environment.

Case 14

This case focused on an adult female presenting to a rural emergency department with acute foot pain, vomiting, headache and hypotension. Candidates were required to identify the most likely differential diagnosis, to arrange appropriate initial investigations and to instigate initial management actions.

The KFP exam frequently assesses candidates’ abilities to manage patients who are acutely unwell. Common errors included providing management actions that did not address the full clinical presentation or demonstrate sufficient knowledge to manage the clinical acuity of the presentation.

Case 15

Candidates were presented with an adult female attending for her annual diabetes health assessment. A detailed past medical history was provided, and candidates were required to identify specific examination findings and to arrange initial investigations.

As the case evolves, the patient seeks advice regarding her desire to start a family, for which candidates were expected to provide appropriate advice.

Common errors included providing advice that was general in nature and did not address the patient’s specific concerns. It is important that all answers directly address the questions asked within the case.

Case 16

This case focused on an elderly male presenting with tiredness and back pain.

Candidates were provided with a detailed past medical history and were required to identify the most likely diagnosis and to initiate appropriate investigations. As the case evolves, the patient’s son attends enquiring about the diagnosis and seeks advice relating to his own health, and candidates were expected manage the situation appropriately.

The most common errors related to providing answers that did not interpret the scenario holistically and did not consider the implications of maintaining patient confidentiality.

The KFP exam frequently assesses broader aspects of the RACGP Curriculum, including within the domains of clinical governance and medicolegal dilemmas.

Case 17

Candidates were presented with an adult male with new-onset neck pain and finger tingling. They were required to identify the most likely differential diagnosis and to identify specific examination findings that would confirm the most likely diagnoses.

As per previous cases, the most common errors related to providing examination findings that lacked specificity relating to the likely underlying diagnoses.

Case 18

This case focused on an elderly male presenting for the results of his annual health assessment. A detailed past medical history and investigation results were provided.

Candidates were required to arrange further investigations, to initiate pharmacological management actions and to provide appropriate dietary advice.

Examiners were surprised at the volume of answers that failed to appreciate the implications of pharmacological interactions and contraindications when commencing further medications. When considering pharmacological management actions, it is important to consider the appropriateness of adding further medications when cessation of a currently prescribed medication may be a more appropriate strategy.

Case 19

This case focused on an elderly male presenting with symptoms of itchiness and jaundice. Candidates were presented with a detailed clinical presentation and were required to outline the most likely differential diagnoses, to identify relevant aspects of history and to arrange appropriate initial investigations.

Several candidates provided answers that did not address the case presentation.

Presentations suggestive of a serious underlying diagnosis are commonly assessed within the KFP exam, and candidates are expected to be able to recognise high-risk clinical presentations in line with current Australian clinical guidelines.

Case 20

This case focused on an adult Aboriginal male presenting with a non-healing leg ulcer.

Candidates were required to identify specific patient factors that may have contributed to the delay in healing, to outline specific examination findings that would support the most likely diagnosis and to arrange initial investigations.

The most common errors included providing examination findings that were not specific to the question asked, and that were repetitive in nature. Such answers do not allow candidates to demonstrate the range of knowledge required to score the full range of marks available.

Case 21

Candidates were presented with an infant with fever and jerking observed by her mother. Candidates were required to identify the most likely underlying cause, to provide advice in the instance that the observed symptoms recur, and to provide advice relating to childhood immunisation administration.

Common errors included a lack of knowledge relating to Australia’s National Immunisation Program. Immunisations are frequently assessed in the KFP exam as a core component of the RACGP Curriculum.

Case 22

Candidates were presented with an adult female with tiredness and a sensation of leg-crawling. Candidates were provided with a detailed past medical history, and were required to identify the most likely diagnosis, to identify specific patient risk factors and to identify onward appropriate pharmacological management actions.

Common errors included providing answers that were vague or non-pharmacological in nature when the question had asked for pharmacological management actions. These answers did not attract marks, irrespective of whether they were clinically appropriate.

Case 23

Candidates were presented with a Torres Strait Islander female with clinical features of psychosis in the postpartum period. Candidates were required to identify the most likely differential diagnosis, to identify suitable initial investigations and to present a holistic management plan.

Common errors included providing answers inappropriate to the rurality of the clinic.

The KFP exam assesses clinical presentations within metropolitan and rural contexts, and candidates are required to tailor their responses relative to the geographical location of the practice setting.

Case 24

This case focused on an adult male presenting with acute foot pain and coolness.

Candidates were required to outline the most likely diagnosis, to arrange appropriate investigations and to instigate immediate management actions.

Common errors related to providing incorrect differential diagnoses and management actions that were less appropriate in the immediate context.

Case 25

This case focused on an adult female presenting with hair loss. Candidates were required to identify the most likely diagnosis, to outline specific examination features and to advise on suitable pharmacological management actions.

The common errors in this case included providing answers that did not demonstrate the expected range of knowledge pertaining to the assessment and management of hair loss.

Case 26

This case focused on an adult female presenting with lower abdominal pain, having reported that she was sexually assaulted by her partner. Candidates were required to identify specific aspects of history that would aid in determining the likely diagnosis, and to commence appropriate immediate management actions considering the patient’s clinical presentation.

Common errors included providing items of history that were already provided within the case presentation, and management actions that did not consider the patient holistically.

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KFP 2022.1

Case 1

This case focused on a child of Aboriginal descent presenting with his grandmother with a new itchy rash. Candidates were required to identify the most likely diagnosis and to advise on appropriate non-pharmacological and pharmacological management strategies.

It is important for candidates to consider all the information provided in a case stem.

Common errors included providing aspects of education not tailored or relevant to the clinical case presentation and that did not consider the key features of the case.

Case 2

This case focused on an adult male presenting with back pain and stiffness.

Candidates were required to outline additional aspects of history that would suggest a further underlying diagnosis, to arrange appropriate investigations and to provide pharmacological management strategies.

Common errors included articulating elements of the clinical case presentation that lacked specificity and did not add diagnostic value. As the KFP exam is a test of clinical reasoning, it is important that candidates provide answers that are specific, concise and relevant to the information provided.

Case 3

This case focused on an infant presenting with fever and a rash after returning from overseas. Candidates were required to consider the most likely differential diagnosis and to articulate necessary immediate management actions.

Common errors included a lack of knowledge relating to the assessment and management of infective illnesses in the early childhood period, with diagnoses and subsequent management actions being offered that were not congruent with the case presentation.

Case 4

This case focused on an adult female presenting to a rural practice with new onset heavy vaginal bleeding. Candidates were required to identify aspects of her history that increased the risk of serious underlying disorder and to outline appropriate investigations. As the case evolves, she reattends with heavy vaginal bleeding.

Candidates were required to commence immediate management actions. 
Common errors included providing aspects of history that were already provided in the case presentation. It is important that all answers directly address the questions asked within the case.

Case 5

This case focused on a male child presenting with his mother with bedwetting.

His parents had amicably separated. Candidates were required to find specific aspects of history to help determine the underlying diagnosis and to advise on nonpharmacological management strategies.

The next day, his father, who was not present at the appointment, requests his medical record, which candidates were required to appropriately manage.

Common errors included providing aspects of history that were already provided in the case presentation. Further errors also included a lack of knowledge pertaining to the relevant legislation governing the release of medical records. The KFP exam assesses all aspects of the RACGP Curriculum, including broader domains relating to clinical governance, ethical dilemmas and medicolegal aspects of general practice.

Case 6

This case focused on an adult female presenting with headaches and fatigue.

Candidates were required to identify initial pharmacological management actions and to arrange appropriate initial investigations.

The most common errors included the provision of answers in excess of the number of answers required, increasing the risk of overcoding. Candidates should only provide the number of answers requested.

Case 7

This case focused on an adult female presenting with progressive shortness of breath.

Candidates were provided with her spirometry findings and required to identify initial pharmacological and non-pharmacological management actions. She represents nine months later with a new rash, for which candidates were required to outline the most likely diagnosis.

Common errors related to providing pharmacological management actions in lieu of non-pharmacological management actions. It is important to bear in mind that when the question asks for actions, these refer to a series of actions that need to be enacted in series. When the question asks for options, the inference is that it might not be expected or reasonable for all of the cited options to be commenced simultaneously.

Case 8

This case focused on an adult male presenting with an itchy rash. He had previously seen a colleague at the practice who provided antibiotic therapy. Candidates were required to relay the most likely diagnosis and to commence pharmacological management actions. He later attends wishing to make a formal complaint relating to the colleague’s actions, which candidates were required to appropriately manage.

The most common error related to providing differential diagnoses that were not congruent with the case presentation.

Case 9

This case focused on an adult female presenting with a new mole. A detailed past medical history and current drug history was provided. Candidates were expected to outline additional examination findings that would increase the risk of a serious underlying diagnosis and to enact appropriate initial management actions. She attends the next day with a positive home pregnancy test, for which candidates were required to undertake appropriate pharmacological management actions.

As in previous cases, common errors related to providing additional examination findings that lacked specificity, as well as outlining management actions that were not appropriate in the context of the case presentation.

Case 10

This case focused on an adult female presenting with a progressively itchy vulva.

Candidates were required to identify the most likely diagnosis and to commence appropriate pharmacological management actions. She later presents with a facial rash, for which candidates were required to further instigate appropriate pharmacological management actions in view of the facial rash.

Many candidates failed to demonstrate sufficient knowledge pertaining to pharmacological actions. The KFP exam frequently assesses knowledge of commonly prescribed medications, including pertaining to specific dosages. When this information is required, the question will indicate this requirement explicitly.

Case 11

This case focused on an elderly man presenting with groin and knee pain. Candidates were provided a detailed past medical history and an X-ray image. Candidates were required to identify radiological features on the X-ray supportive of the most likely differential diagnoses and to provide advice relating to appropriate non-pharmacological advice.

Many candidates failed to provide non-pharmacological management advice that was congruent with current evidence-based guidelines. The KFP exam frequently assesses contemporary best practice for common presentations in context of the current supporting evidence base.

Case 12

This case focused on an adult female presenting with facial pain and headaches, for which candidates were required to outline appropriate pharmacological management options. She reattends later presenting with persistent headaches and a rash, for which candidates were required to arrange appropriate investigations, as well as to outline appropriate non-pharmacological management advice.

As per previous cases, many candidates failed to demonstrate sufficient knowledge pertaining to pharmacological actions. The KFP exam frequently assesses knowledge of commonly prescribed medications, including pertaining to specific dosages. When this information is required, the question will indicate this requirement explicitly.

Case 13

This case focused on an elderly adult male presenting to a rural emergency department with acute abdominal pain. Candidates were required to arrange appropriate initial investigations and to commence immediate management actions. As the case evolves, the patient makes a full clinical recovery and later presents for advice pertaining to fitness to drive, which candidates were expected to appropriately manage.

The KFP exam frequently assesses candidates’ abilities to manage acutely unwell patients. Common errors included providing management actions that did not address the full clinical presentation or demonstrate sufficient knowledge to manage the clinical acuity of the presentation.

Case 14

This case focused on an adult female presenting with fatigue and tongue soreness from nutritional deficiency. Candidates were required to identify the most likely differential diagnosis, to identify risk factors pre-disposing to the likely diagnosis, to arrange appropriate initial investigations and to instigate appropriate management actions.

The most common errors included providing answers that were general in nature and failed to appreciate the clinical presentation, particularly pertaining to instigating appropriate management actions.

Case 15

This case focused on an adult male presenting with worsening shortness of breath. A detailed past medical history was provided, and candidates were required to identify the most likely differential diagnoses and to instigate appropriate management actions.

Common errors included providing differential diagnoses and subsequent management actions that were too narrow in scope and did not take into consideration all aspects of the detailed past medical history provided.

Case 16

This case focused on an adult male with long-term disability and limited communication skills presenting with his mother with weight loss, vomiting and abdominal pain.

Candidates were provided with a detailed past medical history and were required to identify the most likely diagnosis. As the case evolves, he makes a full recovery and later attends with his mother who enquires regarding eligibility for funding from the Australian National Disability Insurance Scheme, for which candidates were expected to provide suitable advice.

The most common errors related to providing answers that did not interpret the scenario holistically and did not take into account broader considerations pertaining to the case presentation. The KFP exam frequently assesses broader aspects of the RACGP Curriculum, including within the domains of clinical governance and medicolegal dilemmas. 

Case 17

This case focused on an adult female presenting with long-term widespread pain and fatigue. A detailed past medical history and drug history was provided, and candidates were required to provide suitable non-pharmacological and pharmacological management options. They were also expected to identify specific patient factors predictive of a poor long-term prognosis.

The most common errors related to providing pharmacological management options that did not take into account past medical history provided, and as such, increased the risk of harm to the patient in context of the current drug history. When considering pharmacological options, it is important to consider potential interactions and adverse effects.

Case 18

This case focused on an elderly male presenting for the results of his annual health assessment. A detailed past medical history and investigation results were provided.

Candidates were required to identify likely causes of the abnormal investigation results, to initiate pharmacological management actions and to provide appropriate nonpharmacological management advice.

Examiners were surprised at the volume of answers that failed to appreciate the implications of pharmacological interactions and contraindications when commencing further medications. When considering pharmacological management actions, it is important to consider the appropriateness of adding further medications when cessation of a currently prescribed medication could be a more appropriate strategy.

Case 19

This case focused on a male infant of Aboriginal descent presenting with his mother to a remote practice with symptoms of fever and a cough. Candidates were given a detailed clinical presentation and were required to outline the most likely differential diagnoses, to identify relevant aspects of history that would predispose him to risk of more serious illness and to provide advice relating to likely onward management actions.

Several candidates provided answers that did not address the case presentation.

Presentations suggestive of a serious underlying diagnosis, as well as relevant risk factors, are commonly assessed within the KFP exam, and candidates are expected to be able to recognise high-risk clinical presentations in line with current Australian clinical guidelines.

Case 20

This case focused on an elderly female presenting for the results of her annual health assessment. A detailed past medical history and investigation results were provided.

Candidates were required to identify likely causes of the abnormal investigation results, to arrange further appropriate investigations and to initiate immediate management actions.

The most common errors included providing answers that were not specific to the abnormal investigation results provided. Such answers do not allow candidates to demonstrate the range of knowledge required to score the full range of marks available.

Case 21

This case focused on an elderly male presenting with palpitations. A detailed past medical history and the results of an electrocardiogram were provided.

Candidates were required to arrange further investigations, to commence immediate pharmacological management actions and to provide onward further nonpharmacological management advice.

The most common errors included providing answers that did not take into consideration the key features of the case, and as such, were not applicable for the evolving clinical presentation. Candidates are expected to use the key features of the case to provide answers that are congruent to the clinical case presentation.

Case 22

This case focused on an adult female with symptoms of insomnia, fatigue and low mood, for which candidates were expected to provide initial pharmacological management actions. As the case evolves, she attends eight weeks later with a progression of her symptoms. Candidates were expected to recognise the most likely diagnosis and to arrange immediate non-pharmacological management actions.

Although well answered overall, many candidates failed to appreciate the severity of the evolution of her symptoms, and as such, provided management actions that were not appropriate to the clinical acuity of the case presentation.

Case 23

Candidates were presented with a pregnant female seeking advice relating to immunisation during pregnancy, after having had a previous local reaction, for which candidates were required to provide specific advice. She later presents in the postpartum period with persistent vaginal discharge Candidates were required to specify further additional aspects of history that would suggest a serious underlying cause and to provide a differential diagnosis.

Common errors included a lack of knowledge relating to the National Immunisation Program. Immunisations are frequently assessed in the KFP exam as a core component of the RACGP Curriculum.

Case 24

This case focused on an adult male presenting with acute abdominal pain, diarrhoea and fever. Candidates were required to outline the most likely diagnosis, to arrange appropriate investigations and to provide onward lifestyle advice.

Common errors related to providing incorrect differential diagnoses and management actions that were less appropriate in the immediate context, including with respect to lifestyle advice that is no longer reflective of current evidence-based practice.

Case 25

This case focused on an adult female presenting with hearing loss and ear pain, for which candidates were required to advise on suitable pharmacological management actions. Having made a full recovery, she reattends six months later complaining of bilateral hearing loss. Candidates were required to provide the most likely diagnosis and to provide appropriate non-pharmacological management advice.

The common errors in this case included providing answers that did not demonstrate the expected range of knowledge pertaining to the assessment and management of hearing loss.

Case 26

This case focused on an adult female presenting for the results of her work health assessment. A detailed past medical history and investigation results were provided.

Candidates were required to identify the likely diagnosis and to arrange further investigations. She later reattends with a painful red eye, for which candidates were required to provide the most likely diagnosis.

Common errors included a lack of knowledge pertaining to a common presentation within the primary care context. The KFP exam assesses all aspects of the RACGP Curriculum, including broader domains relating to medicolegal aspects of general practice.

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KFP 2022.2

Case 1

This case focused on a woman presenting with new-onset localised breast redness. Candidates were required to outline appropriate pharmacological and non-pharmacological management advice, as well as to provide specific advice pertaining to breastfeeding.

Common errors included articulating management advice that lacked specificity, as well as a lack of knowledge relating to breastfeeding. As the KFP exam is a test of clinical reasoning, it is important that candidates provide answers that are specific, concise and relevant to the information provided.

Case 2

This case focused on an elderly man presenting with new-onset pain and swelling. Candidates were provided with examination findings and the results of an X-ray. They were required to outline the most likely diagnoses, identify specific findings on the X-ray and provide nonpharmacological management strategies.

It is important for candidates to consider all the information provided in a case stem. Common errors included providing aspects of management not tailored or relevant to the clinical case presentation, and that did not consider the key features of the case.

Case 3

This case focused on a woman presenting with heavy and painful periods. Candidates were required to arrange appropriate initial investigations, consider the most likely differential diagnosis and articulate appropriate pharmacological management actions.

Common errors included a lack of knowledge relating to the assessment and management of common diagnoses in this population cohort, and as such, worse performing candidates provided answers that lacked relevance to the case presentation.

Case 4

Candidates were presented with an elderly man who reports increasing urinary frequency.

Candidates were required to identify aspects of his history that would help to establish the severity of the symptoms, and to outline specific potential examination findings and appropriate initial pharmacological options.

Common errors included providing answers not consistent with the case presentation, particularly with reference to gender-specific differential diagnoses. It is important that all answers directly address the questions asked within the case.

Case 5

This case focused on a woman presenting with new-onset fatigue and weight loss in the postpartum period. Candidates were required to identify the most likely differential diagnoses and to outline initial investigations. The woman also presented with a wrist lump, for which candidates were required to outline the appropriate management strategy.

Common errors related to a lack of knowledge relating to the diagnosis and management of the lump. As with previous examination cycles, the KFP exam frequently assesses dermatological presentations in the primary care context.

Case 6

This case focused on a man presenting for the results of investigations taken as part of a routine workplace medical assessment. Candidates were presented with a detailed past medical history and the results of the investigations. They were required to identify the most likely diagnosis, arrange additional investigations and outline appropriate pharmacological management options.

The most common errors included providing answers that did not take the key features of the case into consideration, and as such, were not applicable to the clinical presentation. Candidates are expected to use the key features of the case to provide answers that are consistent with the clinical case presentation.

Case 7

This case focused on a child of Aboriginal descent presenting with his mother to a remote practice with symptoms of fever and a sore elbow. Candidates were presented with a detailed clinical presentation and were required to outline the most likely differential diagnoses, arrange initial investigations, and provide advice relating to likely further management actions.

Common errors related to answers that lacked the sufficient breadth of expertise in context of the case presentation. It is important to provide answers that are specific to the context of each individual case, including consideration of the rurality of the context.

Case 8

This case focused on an elderly man presenting with a skin lesion. Candidates were required to give the most likely diagnosis and to outline definitive management options available.

Candidates were also required to outline risks associated with the definitive management options available.

The most common errors related to a lack of knowledge of potential risks of the likely management action. The KFP exam assesses all aspects of the RACGP Curriculum, including broader domains relating to clinical governance, ethical dilemmas and medicolegal aspects of general practice.

Case 9

Candidates were presented with an elderly man with behavioural change. A detailed past medical history and current drug history were provided. Candidates were expected to identify the most likely differential diagnoses, arrange initial investigations and undertake appropriate initial pharmacological management actions.

As in previous cases, common errors related to providing differential diagnoses lacking specificity, as well as outlining management actions that were not relevant nor appropriate to the context.

Case 10

This case focused on a woman presenting with recurrent miscarriage. Candidates were required to identify the most likely underlying diagnoses, arrange initial investigations and provide nonpharmacological management advice.

Many candidates failed to demonstrate a breadth of knowledge of current guidelines, and therefore, did not provide recommendations that addressed the key features within the patient’s past medical history. 

Case 11

This case focused on a woman presenting with difficulty sleeping. Candidates were required to state the most likely differential diagnoses. As the case evolves, the woman later returns asking for advice relating to general and preventative health measures appropriate for her age and the information already provided in the case.

As with previous examination cycles, common errors included a lack of knowledge relating to general and preventative health measures. It is important that all answers directly address the questions asked within the case.

Case 12

This case focused on a woman presenting with a rash on her face and neck. Candidates were required to identify the most likely diagnosis and outline appropriate non-pharmacological management options. The woman also presents with a vaginal discharge, for which candidates were required to outline appropriate pharmacological management options.

The most common errors related to providing measures that were general in nature and not consistent with the information provided, nor holistic in their considerations. Candidates are encouraged to ensure that the answers they provide address the question posed and the clinical case in its entirety.

Case 13

This case focused on an elderly man presenting with a bald patch. Candidates were required to identify additional aspects of history that would support the most likely diagnosis, state the most likely diagnosis and instigate initial topical management.

The most common errors included providing answers that were general in nature, as well as a lack of specificity in identifying appropriate topical management options.

Case 14

This case focused on a man presenting with shoulder pain. Candidates were required to identify the most likely differential diagnoses, as well as identify examination findings that would support the most likely diagnosis. He also discloses his concern that he might lose his job because of his condition, for which candidates were required to appropriately manage.

The KFP exam frequently assesses candidates’ abilities to manage musculoskeletal presentations, as well as issues focused on fitness to work. Common errors included providing examination findings that did not address the full clinical presentation.

Case 15

This case involved a man presenting with fluctuating abdominal pain. A detailed past medical history was provided, and candidates were required to identify the most likely diagnosis, instigate appropriate pharmacological management actions and provide specific dietary advice. 

Common errors included providing dietary advice that was general in nature and did not address the patient’s specific presentation. It is important that all answers directly address the questions asked within the case.

Case 16

This case focused on a woman presenting with intermittent chest pain. Candidates were provided with a detailed past medical history, and were required to identify additional aspects of history suggestive of a sinister cause of the pain and provide non-pharmacological management advice. As the case evolves, the woman makes a full recovery and later attends asking for advice to reduce her risk of bowel cancer, for which candidates were expected to provide nonpharmacological advice.

The most common errors related to providing answers that did not interpret the scenario holistically and did not consider the implications of her specific case presentation. The KFP exam frequently assesses broader aspects of the RACGP Curriculum, including the domains of preventative medicine and population health.

Case 17

This case focused on a woman presenting for the results of her investigations. Candidates were provided with a detailed past medical history, and were required to identify additional symptoms potentially associated with the abnormal results, arrange further investigations and state the most likely underlying causes of the abnormal investigation results.

As with previous cases, the most common errors related to providing symptoms that lacked specificity for the likely underlying diagnoses, as well as the provision of examination findings rather than symptoms.

Case 18

This case focused on a woman presenting for the results of investigations ordered because of a persistent cough and shortness of breath on exertion. A detailed past medical history and investigation results, including a CT scan of the chest, were provided. Candidates were required to identify likely diagnoses accounting for the abnormal investigation results and to arrange further investigations. The woman’s son later calls asking for the results of the scan, and candidates were required to manage this request appropriately.

Examiners were surprised at the lack of knowledge pertaining to a common presentation within the primary care context. The KFP exam assesses all aspects of the RACGP Curriculum, including broader domains relating to clinical governance, ethical dilemmas and medicolegal aspects of general practice.

Case 19

This case focused on a man presenting to a rural emergency department with symptoms of chest pain. Candidates were given a detailed clinical presentation, and were required to outline the most likely diagnosis, arrange initial investigations and instigate initial appropriate pharmacological management actions.

Several candidates provided answers that did not address the case presentation. Presentations suggestive of a serious underlying diagnosis are commonly assessed within the KFP exam, and candidates are expected to be able to recognise and initiate management in high-risk clinical presentations, in line with current Australian clinical guidelines.

Case 20

This case focused on a woman requesting assistance with quitting smoking. A detailed past medical history and drug history were provided. Candidates were required to identify appropriate pharmacological management options and provide advice regarding the use of e-cigarettes. The woman later presents with drooping of her left eyelid, for which candidates were expected to provide the most likely underlying diagnosis.

The most common errors included providing pharmacological management actions that were not specific to the question asked, and that were repetitive in nature. Such answers do not allow candidates to demonstrate the range of knowledge required to score the full marks available.

Case 21

Candidates were presented with a child refusing to walk and complaining of hip pain. A detailed past medical history and examination findings were provided. Candidates were required to identify the most likely diagnosis, arrange further investigations and outline appropriate pharmacological management options.

Common errors included a lack of knowledge relating to causes of hip pain in children, with diagnoses more consistent with an adult presentation being provided.

Case 22

Candidates were presented with an elderly woman with fever and a cough. Candidates were expected to identify the most likely diagnoses and arrange initial pharmacological management actions. As the case evolves, the woman returns for review, having fully recovered, and candidates were expected to provide advice relating to appropriate immunisations to administer.

Common errors included a lack of knowledge of Australia’s National Immunisation Program.

Immunisations are frequently assessed in the KFP exam as a core component of the RACGP Curriculum.

Case 23

Candidates were presented with an elderly woman complaining of tiredness. Candidates were provided with a detailed past medical history, and were required to identify the most likely diagnosis and specify risk factors within her history that would support the most likely diagnosis. The woman is managed appropriately and later re-attends with a new skin lesion, which candidates were expected to manage.

Common errors related to providing incorrect differential diagnoses and management actions that were not appropriate in context of the case presentation, and that lacked the required specificity.

Case 24

This case focused on an elderly woman presenting to a remote emergency department complaining of feeling hot. Candidates were provided with a detailed past medical history and examination findings, and were required to outline the most likely diagnosis, arrange appropriate investigations and provide lifestyle advice to prevent recurrence.

Common errors included providing answers inappropriate to the rurality of the clinic. The KFP exam assesses clinical presentations within metropolitan and rural contexts, and candidates are required to tailor their responses relative to the geographical location of the practice setting.

Case 25

This case focused on a child presenting to a remote emergency department with fever and a dry cough. Candidates were required to identify the most likely diagnosis, provide advice on suitable immediate non-pharmacological management actions and commence immediate pharmacological management actions.

Common errors included providing answers that did not demonstrate the expected range of knowledge pertaining to the assessment and management of a child who was acutely unwell.

Case 26

This case focused on a woman of Aboriginal descent presenting for an initial health assessment after entering a local correction facility. Candidates were presented with a detailed clinical and psychosocial presentation, and were required to outline specific predisposing factors and social determinants within her history for incarceration. They were also required to outline specific and culturally appropriate principles of trauma-informed care to use within the consultation, and to provide non-pharmacological management actions to manage her reported flashbacks.

Examiners were surprised at the lack of knowledge relating to the holistic health and wellbeing of Aboriginal and Torres Strait Islander persons. Common errors included providing items of history that were already provided within the case presentation, and management actions that did not consider the patient holistically. The KFP exam regularly assesses candidates’ abilities to provide culturally appropriate care.

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KFP 2023.1

Case 1

This case focused on a girl, aged 17 years, presenting with symptoms suggestive of polycystic ovary syndrome (PCOS). Candidates were required to synthesise the information in the presentation and identify the most appropriate investigations to determine the primary diagnosis and the possible long-term conditions associated with PCOS that need to be discussed with the patient. The final question required candidates to provide appropriate medication strategies to assist in regulating the patient’s menstrual cycle.

In this case, candidates who scored well were able to identify the diagnosis from the information given and provide a broad range of long-term conditions associated with PCOS. The most common errors in this were was not considering the information in the scenario when providing medication for regulation of the patient’s periods, and prescribing medication that was either contraindicated by pre-existing conditions or not related to cycle regulation.

Case 2

Candidates were provided with a clinical photograph and patient information that required them to identify the primary diagnosis of hand, foot and mouth disease in a man, aged 45 years, and the appropriate nonpharmacological advice that needs to be discussed with the patient. The last question in the case included another clinical photograph and information, and required candidates to identify a pyogenic granuloma.

The most common issues seen in this case were not providing appropriate information to the patient and advocating pharmacological management when the question specifically asked for non-pharmacological management.

Case 3

This case focused on a woman, aged 59 years, presenting with symptoms relating to changes to her tongue.

A clinical photograph supplemented the written scenario. Candidates were required to identify the primary diagnosis of geographic tongue. In the second half of the case, the patient presents several months later with a rash on their palms and feet. Candidates were required to identify that the patient had developed psoriasis and to provide appropriate pharmacological management in line with current guidelines.

In this case, the most common errors were providing treatments that either the patient was already documented as using in the case scenario or were non-pharmacological treatments. In the KFP exam, it is important to ensure that all information in the scenario is considered and that the answers are provided in the context of the patient described.

Case 4

Candidates were presented with a man, aged 28 years, with painful lesions on his penis. His current presentation and his past medical history were provided, as well as a clinical photograph. Candidates were required to identify the diagnosis of genital herpes and appropriate investigations, and provide the key nonpharmacological advice relevant for this condition and patient.

The most common error was not being able to provide essential non-pharmacological advice relevant to the patient.

Case 5

This case focused on the management of a man, aged 66 years, with comorbidities of diabetes, hypertension and asthma, whose renal function was deteriorating and blood pressure was above the range recommended for treatment goals according to current guidelines. The case evolves, and the patient requires a colonoscopy and, due to progression of the diabetes, needs to transition to insulin use.

Candidates were required to manage his polypharmacy to optimise his treatment, and provide appropriate advice on how to manage his medications, how to manage his medications prior to a colonoscopy and on insulin administration.

The most common issues in this case were not identifying the relevant medications to adjust or change to optimise health outcomes, and not providing appropriate advice regarding the self-administration of insulin.

Case 6

Candidates were presented with a man, aged 67 years, with an abnormal lipid profile and a calculated cardiovascular risk. Candidates were asked to provide appropriate lifestyle advice, pharmacological management and complications of this management that need to be discussed with the patient to ensure that the patient can make an informed decision about treatment.

While this case was generally answered correctly, the most common errors were not providing specific lifestyle advice or discussing side effects specific to statins, or providing non-specific answers, such as
‘lose weight’ or ‘exercise more’ for lifestyle advice and ‘nausea’, ‘diarrhoea’ or ‘headaches’ for side effects of medication.

Case 7

This case focused on a woman, aged 42 years, presenting with symptoms indicative of Ramsay Hunt syndrome. Candidates were required to provide the initial investigations to confirm the diagnosis, the immediate management and then the subsequent management of post-herpetic neuralgia when the patient returns a few months later with persistent pain. Candidates were asked to provide treatments from different drug classes and to provide the name of both the drug and the drug class. Dosages were not required.

The most common errors in this case were not correctly identifying the diagnosis from all the information provided, and therefore providing incorrect medications. For the post-herpetic neuralgia question, some candidates mixed up drugs and their relevant drug classes or listed drugs from the same class, but assigned them different classes.

From 2023.2 onwards there will be no drug doses required within the KFP, although candidates might still be required to provide route of administration or frequency of administration.

Case 8

This case focused on an Aboriginal boy, aged 14 years, presenting with symptoms and signs suggestive of volatile substance use. Candidates were required to identify the risk factors for volatile substance use, and discuss how they would approach harm minimisation and develop a management plan in partnership with the patient’s family and community following a subsequent admission to the local emergency department.

In this case, the question relating to harm minimisation was not answered well. It is important to remember that we need to develop approaches to support our patients, ensuring we are non-judgemental, and that the principles of harm minimisation are similar, regardless of what might be increasing the risk of harm, and these principles can be adapted to the context of the patient. 

Case 9

Candidates were presented with a boy, aged 18 months, with symptoms of a respiratory tract infection.

Candidates were required to identify what further history would assist in determining a significant cause for the presentation, rather than a simple upper respiratory tract infection. Candidates did well with this question, but the most common errors for those not scoring well were centred on non-specific answers or answers irrelevant to the question and not addressing serious underlying causes.

The second half of the case changes direction when the mother of the child asks for the results of her husband’s tests that were ordered when they were in an appointment together. Cases will often change direction to assess across the domains of general practice.

Case 10

Candidates were presented with an Aboriginal woman, aged 21 years, who had a two-week history of intermittent bilateral eye discomfort associated with thick discharge. A clinical photograph suggestive of trachoma was provided.

The questions required candidates to address the non-pharmacological management of the patient’s presentation, the preventative public health measures that are relevant, and strategies used to ensure culturally safe, appropriate and effective communication in the consultation.

The most common errors in this case were not providing answers both specific and relevant to the diagnosis, not ensuring culturally safe communication and using broad terms that do not demonstrate an understanding of the issues.

Case 11

This case focused on a young woman with borderline personality disorder and chaotic lifestyle who presents with a series of different presentations, including requesting a medical termination of pregnancy, alcohol detoxification and an acute postnatal deterioration in her mental health. Candidates were required to identify key relevant elements in the management of each presentation.

The most common errors were not providing answers relevant to the question or the patient and location.

Candidates often answered the acute mental health issues from the position of an emergency department, and not from general practice, and focused on the baby rather than the mother. While considering that the baby is important, the questions were specifically about managing the mother’s presentation.

The KFP exam is designed to assess whether candidates can apply their knowledge and skills to an individual patient, tailoring their investigations and management to the individual, and ensuring all information is taken into account. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 12

Candidates were presented with a woman, aged 35 years who had 12 months of symptoms highly suggestive of migraines. Candidates were also provided with details of her past medical history, medication and social history.

The questions in this case required candidates to provide appropriate pharmacological and non-pharmacological management for the management of her migraines and then consider prophylaxis options when the migraines continue.

The most common errors were providing medications already being used by the patient, providing nonspecific lifestyle advice that was not relevant to the case given the information provided in the case scenario.

Some candidates provided drug classes rather than specific medication, or provided drug classes and then an example that was often incorrect. In the KFP exam, only provide examples when asked for them. Extra marks are not awarded for examples unless they are asked for.

Case 13

Candidates were presented with a woman, aged 69 years, who had symptoms suggestive of urge incontinence. Candidates were provided with her past medical history, medication summary and social history.

The questions required candidates to identify elements, from all the information provided, that could be exacerbating her symptoms, provide the relevant examination findings that could confirm the diagnosis, and finally, and identify the key non-pharmacological management to try to improve the patient’s symptoms.

The most common issues with candidates’ answers to the history question were providing contributing factors that were not in the detailed history. In the management question, some candidates provided pharmacological management options or non-specific referrals, without demonstrating what they were being referred for.

Case 14

This case focused on a man, aged 42 years, presenting to a rural emergency department with a rapid pulse. Further information on the presenting symptoms and patient history were provided, as well as an electrocardiogram. The information converges on a diagnosis of paroxysmal supraventricular tachycardia.

Candidates were then required to provide the emergency management and long-term management to prevent recurrence.

This question was answered well, but a common error, as in other cases, was to provide nonpharmacological treatments when asked for pharmacological treatments.

Case 15

Candidates were presented with a child with symptoms and signs of pneumonia. Candidates were required to the provide the most appropriate investigations and treatment based on the severity of the clinical findings.

The most common errors were not identifying the severity of the illness and not prescribing the most appropriate antibiotics. The clinical scenario provided clear details that this was a severe community acquired pneumonia.

It is important to consider all the information provided in the scenario, and provide answers that relate to the specific patient and their individual circumstances.

Case 16

This case focused on a woman, aged 57 years, presenting with a rash on her chest that was becoming worse and tender. Candidates were required to identify the rash from both the description and clinical photographs as actinic keratoses, and then provide the appropriate topical management. The final part of the case required candidates to provide an appropriate response to the patient when she submits a complaint about an adverse outcome following a biopsy that was undertaken by a colleague.

While this question was generally answered well overall, some candidates did not correctly identify the widespread rash, and therefore provided inappropriate treatment.

Case 17

In this case, candidates were required to identify and manage appropriately a new mother presenting with increasing pain and swelling in her wrist. As the case evolves and further information provided, candidates needed to be able to identify and manage evolving postnatal depression.

While most candidates correctly identified the correct diagnosis of the wrist pain, answers on how to manage the initial presentation were often non-specific, did not take the patient’s context into account or were medication based when this was a non-pharmacological management question.

In KFP questions that focus on the management of musculoskeletal presentations, candidates will often respond with ‘rest, ice, compression and elevation’ either on a single line (which means four answers on one line and subsequent extra responses) or across four lines. These answers do not demonstrate to the examiner any understanding of the patient’s context, and are either impractical or incorrect given the context;
therefore, are not awarded marks.

Case 18

This case focused on a man, aged 64 years, with complex comorbidities who presents with symptoms indicative of a ruptured Achilles tendon. Candidates were required to identify the diagnosis, provide examination findings that would support the diagnosis, and then, considering his comorbidities, provide the appropriate management.

The main errors for candidates not scoring well in this case were not correctly identifying the Achilles tendon rupture, and therefore not providing the correct management.

Case 19

This case focused on the management of a man, aged 91 years, who is a resident of an aged care facility, and has a history of increasing falls and a change in his gait on a background of complex comorbidities. Candidates were provided with his medical and medication history, as well as recent investigations. From the information provided, candidates were required to identify the most appropriate further investigations, the underlying cause for his gait change, and both pharmacological and non-pharmacological interventions required.

While most candidates were able to provide the appropriate diagnosis for the falls and investigations, some candidates were unable to provide appropriate changes to his medications to either optimise his management, or provided treatment contraindicated by the information in the scenario.

In the non-pharmacological question, non-specific answers regarding generic referrals with no details, or not managing the presenting problem, were common errors.

Case 20

This case focused on a woman, aged 48 years, presenting with new onset of symmetrical swollen joints with associated stiffness and pain. Candidates were required to identify appropriate investigations to confirm the diagnosis, provide appropriate management while awaiting referral to a rheumatologist, and then correctly identify complications secondary to the disease modifying drugs she is given by the rheumatologist.

The most common errors for this case were not providing management that took into account the information in the stem, or medication that would be contraindicated, and in the final question, not identifying the correct diagnosis from the detailed information provided for the complications due to the second-line drug treatment.

Case 21

Candidates were presented with a girl, aged 15 years, who had symptoms highly suggestive of coeliac disease. Candidates were required to provide the diagnosis, confirmatory investigations and non-pharmacological management from the detailed information provided.

While this question was answered correctly by most candidates, the most common errors were related to the non-pharmacological management question, with candidates providing non-specific advice and non-specific referrals.

Case 22

This case focused on a woman, aged 87 years, who presents following a fall at home. Candidates were required to identify the appropriate management, including subsequent dressings for an elderly patient presenting with a large skin tear.

This question was not answered correctly by most candidates. While most candidates provided appropriate initial management of the wound, they did not identify the correct dressing and the appropriate advice to offer the patient for ongoing wound care.

Case 23

This case focused on a woman, aged 61 years, presenting to a rural emergency department with symptoms and signs of an acute dental infection, which candidates were required to diagnose and manage appropriately. Candidates were also provided with a clinical photograph. The final question required candidates to identify from further information that the patient had deteriorated and required emergency management, the priority of which was to secure her airway.

The most common errors in this case were providing medication management that was contraindicated by either established allergies to medication or by the patient’s comorbidities or medication, and in the final part of the case, not identifying the severity of the presentation and looking to medication to manage the situation rather than securing the airway.

Case 24

This case focused on a man, aged 74 years, presenting with recurrent abdominal pain. The patient had a past history of adenocarcinoma of the colon, which was successfully treated at the time with surgical resection and chemotherapy. Candidates were required to provide further aspects of the history they would enquire about and the investigations that would be appropriate to establish the diagnosis. The final question in this case required candidates to provide appropriate advice to the patient’s son who enquires about relevant screening tests, given the details provided about his father’s history.

The most common error was in the final question, where candidates did not provide the appropriate advice in line with current guidelines.

Case 25

Candidates were presented with a woman, aged 21 years, with the symptoms, and examination and spirometry findings, of exercise-induced asthma. Candidates needed to provide the further history required to confirm the diagnosis and then subsequently manage her treatment. In the final question, candidates were required to detail the non-pharmacological steps required when the patient did not respond to the correct initial treatment.

The most common errors were not providing appropriate management in line with current guidelines, in terms of prescribing medication and when to use the medication, as well as simply increasing medication in the final question, when the question specifically asked for non-pharmacological management.

Case 26

Candidates were presented with a man, aged 68 years, who has a diagnosis of mesothelioma and advanced disease. Candidates were required to not only manage the patient, but consider the needs of the patient’s wife as his carer and provide strategies to assist her in her role. The final question required candidates to address the medication strategies to manage the patient’s pain, and provide different drug classes that would be appropriate and a relevant drug from that class.

The most common errors for this case were not providing relevant and appropriate strategies for supporting the patient’s wife, and focusing on just the patient’s symptoms and presentation. For the final question, some candidates provided drugs from the same class, or inappropriate examples that are not part of palliative care management or related to managing his pain, but rather other symptoms he might develop due to his diagnosis.

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KFP 2023.2 

Case 1

This case focused on a woman, aged 64 years, with facial shingles complicated by herpes zoster ophthalmicus. Candidates were provided with a clinical photograph and patient information. They were asked to first describe immediate management and then appropriate pharmacological management of postherpetic neuralgia.

 The case evolved, and candidates needed to manage a situation in which the patient’s daughter was seeking information on her mother’s medical records and capacity to consent.

In this case, candidates who scored well were able to identify that immediate management included urgent referral to ophthalmology and could accurately describe medication classes and medication examples to manage post-herpetic neuralgia. Incorrect answers for the final question indicated that some candidates had poor understanding of the difference between capacity assessment, enduring power of attorney and advanced health directive. Candidates needed to demonstrate their understanding of the limits of confidentiality to perform well.

Case 2

This case focused on an Aboriginal man, aged 29 years, presenting two months after a finger injury.

Candidates were required to describe examination findings that would determine the diagnosis of the injury.

They were then asked to describe ways to encourage Aboriginal and Torres Strait Islander men to access primary healthcare.

Candidates performed poorly on the first question, demonstrating poor knowledge of finger examination and difficulty describing findings. Some candidates gave inappropriate answers that assumed a history of chronic health conditions. In the KFP exam, candidates should avoid making presumptions about history not given in the stem.

Candidates who did well in the second question gave a broad range of specific strategies to encourage Aboriginal and Torres Strait Islander men to access healthcare. Non-specific answers such as ‘regular health checks’, ‘follow-up’ and ‘provide prescriptions under Closing the Gap PBS program’ did not score.

Case 3

Candidates were presented with a man, aged 73 years, with memory difficulties and behavioural changes.

Appropriate differential diagnoses needed to be identified, including dementia, mood disorders and common organic causes, with rational initial investigations directed towards these. The case progressed to the patient being in a residential aged care facility and requiring non-pharmacological management of behavioural and psychological symptoms of dementia.

Candidates performed well on the first and second questions. Common errors in the third question included providing pharmacological management, such as deprescribing or changes to medication. In the KFP exam, it is important to read the questions carefully to ensure candidates are answering what is being asked.

Case 4

This case focused on the investigation and immediate management of a woman, aged 25 years, presenting with pyelonephritis in her second trimester of pregnancy. Candidates needed to identify that this case was in a rural setting and appropriate management included fluid resuscitation, commencement of appropriate pharmacological management and transfer to a tertiary medical centre. Subsequently, candidates were required to identify the most appropriate pharmacological prophylaxis of recurrent urinary tract infections in pregnancy.

Common errors in the case related to misinterpreting the severity of the patient’s illness. Some candidates subsequently gave incorrect treatment and did not recognise the need for transfer to a tertiary hospital. There were also some examples of overcoding, such as ‘insert intravenous cannula then give intravenous fluids’.

The KFP exam is designed to assess whether candidates can apply their knowledge and skills to an individual patient scenario, tailoring their investigations and management, and ensuring all information is considered. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 5

This case presented a man, aged 66 years, with poorly controlled insulin-dependent type 2 diabetes and a complex medical history including receiving palliative care for metastatic cancer.

Candidates were required to articulate non-pharmacological strategies to improve his diabetic control, including optimisation of insulin administration. The case then changed focus to non-pharmacological and pharmacological management of anxiety in the context of end-of-life care.

The most common issues in this case related to not identifying that the patient was undergoing palliative treatment for a malignancy. Some answers featured generic advice or management that would diminish quality of life. Although some referrals were appropriate, candidates should remember to be specific about the reasons for referring and avoid non-specific answers such as ‘GP management plan’, which do not demonstrate understanding of appropriate clinical care.

Case 6

Candidates were presented with a girl, aged 15 years, with moderate to severe facial acne exacerbated by occupational factors and current medication. A clinical photograph was included with relevant patient information. Appropriate pharmacological management was requested, and candidates needed to consider the patient’s medical history which contraindicated use of the combined oral contraceptive pill.

Candidates should ensure they read the clinical information provided carefully and answer in the context of the patient presentation.

The case evolved to the patient disclosing online bullying, with candidates required to provide management advice. Candidates who provided specific actionable advice and avoided generalisations or platitudes performed well in this question.

Case 7

This case focused on a woman, aged 49 years, presenting to a rural emergency department with symptoms and signs indicative of infective endocarditis. Candidates were required to identify this rare but important diagnosis, arrange appropriate initial investigations and give immediate pharmacological management.

Candidates performed well on the first and second questions, but struggled with the third question on immediate pharmacological management. Common errors included non-pharmacological management, such as intravenous cannulation or monitoring of vital signs. Some candidates did not treat acute infective endocarditis as a priority but focused on the treatment of potential long-term complications.

From 2023.2 onwards there will be no drug doses required within the KFP, although candidates may still be required to provide route of administration or frequency of administration.

Case 8

Candidates were presented with a man, aged 18 years, with a sore throat and associated symptoms that had not responded to oral antibiotics. Further examination and clinical photograph findings were indicative of Epstein–Barr virus infection. After making the diagnosis, candidates were required to investigate and commence appropriate pharmacological management, including cessation of antibiotics.

Although the case was generally answered well, candidates should remember that cessation of medication can be just as important for patient management as prescribing new treatment and is considered pharmacological management.

Case 9

Candidates were presented with a man, aged 79 years, with progressively worsening hearing loss and associated bilateral pulsatile tinnitus. Candidates were required to identify that appropriate investigation included angiography and imaging of the brain and temporal bones. Further information revealed all investigations to be normal and a specific diagnosis was required. Candidates were then required to provide advice to the patient’s family on how to improve communication with him in the context of his hearing loss.

Candidates performed well in the first two questions. Candidates who did well in the third question provided practical advice about how to support patients with hearing loss.

A common error in the final question was candidates providing more answers than were requested, referred to as ‘overcoding’. In the KFP exam it is important to only provide the number of answers requested, demonstrating rationalisation of responses. Using ‘and’, ‘or’ and ‘/’ within an answer can be signs of overcoding. To be fair to all candidates in the KFP, each additional answer attracts a 0.25% penalty from the candidate’s overall score.

Case 10

Candidates were presented with an Aboriginal girl, aged 12 months, living in a remote Northern Territory region. The child’s immunisation record was shown, and candidates needed to identify which routine immunisations were required, including those that had been missed in the past. Appropriate immunisations included meningococcal B immunisation, and candidates needed to describe specific advice on giving prophylactic paracetamol for the immunisation. This question was done poorly, with many candidates not recognising that regular paracetamol is advised with meningococcal B immunisation even in the absence of a fever.

The case then focused on the reasons for a higher burden of vaccine-preventable diseases in Aboriginal and Torres Strait Islander people. Common errors in this question were giving non-specific answers or generic answers on the social determinants of health that did not apply to the specific question being asked.

Case 11

Candidates were presented with a man, aged 61 years, with an enlarging pigmented skin lesion consistent with lentigo maligna. Candidates were required to identify the diagnosis and arrange appropriate urgent excisional biopsy. The most common errors were giving a less specific diagnosis and not specifying the urgency required for management.

The case then changed focus to a breakdown in the therapeutic relationship with the patient. Candidates who gave a broad range of specific management actions did well in this question.

The KFP exam is designed to assess across all curriculum domains, including medico-legal situations.

Candidates should ensure they incorporate topics from all core and contextual curriculum units in their exam preparation.

Case 12

This case focused on a man, aged 71 years, presenting with ascites secondary to alcoholic liver disease with cirrhosis. Candidates were provided with a clinical photograph demonstrating the ascites. The questions in this case required candidates to provide appropriate pharmacological and non-pharmacological management and identify investigations appropriate to monitor cirrhosis.

A common error was candidates giving non-specific advice rather than management specific to the patient scenario. Although some of these answers related to candidates making an incorrect diagnosis, others stemmed from misreading the patient history. For example, some candidates recommended ceasing smoking when the case information stated the patient was an ex-smoker.

Candidates should ensure that they read all information in the KFP exam carefully. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 13

Candidates were presented with a woman, aged 59 years, with chronic paronychia of the finger and onychomycosis of the toenails. Candidates were provided with her past medical history, including relevant occupational history, and a clinical photograph of the nails. The questions required candidates to identify appropriate pharmacological management for the finger, describe specific non-pharmacological advice for this condition, and then give appropriate pharmacological management of toenail onychomycosis.

A common error in the first question was misdiagnosing the finger symptoms as onychomycosis and prescribing antifungal treatment.

The most common issue with candidates’ answers to the nonpharmacological management question was giving generic lifestyle advice instead of specific advice to improve chronic paronychia.

In the KFP exam, generic management and non-specific answers are not awarded marks and candidates should remember to tailor their management to the specific patient scenario.

Case 14

Candidates were presented with a man, aged 37 years, with incidentally diagnosed hypertension. Candidates were required to select appropriate initial investigations and initial management options, taking into account the patient’s young age. Candidates who considered secondary causes of hypertension and understood firstline antihypertensive therapy did well.

The case then evolved, with the man returning with sudden painless unilateral visual loss. A clinical photograph of fundoscopy appearances was provided. Candidates were required to recognise that the underlying risk factors, presenting symptoms and examination findings were consistent with a diagnosis of retinal artery occlusion.

Case 15

Candidates were presented with a man, aged 68 years, who had been in a recent motor vehicle accident and had risk factors and symptoms of obstructive sleep apnoea. The man had a commercial driver’s licence.

Candidates were required to describe further history features that would confirm the diagnosis, refer for a polysomnogram and provide appropriate non-pharmacological management advice while awaiting investigation results.

Candidates who described a broad range of relevant history did well in the first question. A common error was listing the different components of sleep apnoea assessment questionnaires without considering other aspects of history.

When providing non-pharmacological management advice, candidates did well if they gave specific advice about driving restrictions while considering lifestyle changes and sleep hygiene advice. These answers demonstrated a duty of care towards both the patient and other road users. 

Case 16

This case focused on a woman, aged 81 years, in a residential aged care facility who presented with symptoms and signs of digoxin toxicity. Candidates were required to make the diagnosis based on presenting information, including significant medication changes. Candidates were then required to arrange investigations to confirm the diagnosis.

Some candidates gave diagnoses not based on key features in the case. For example, there were no features of malignancy in the stem, but some candidates gave answers such as pancreatic or colorectal cancer and metastatic cancer. As for other cases, candidates should ensure all clinical information is considered and avoid assuming information.

When answering the investigations question, a common error was giving a scattergun approach and selecting investigations that would not confirm the most likely diagnosis. In the KFP exam it is important to read investigation questions carefully because answers may be quite different for ‘initial investigations’
versus ‘diagnostic investigations’.

Case 17

In this case, candidates were required diagnose and commence oral pharmacological management for a woman, aged 43 years, presenting with heavy menstrual bleeding. A common error in the diagnosis question was candidates answering with the symptom of ‘menorrhagia’ instead of the diagnostic term of
‘dysfunctional uterine bleeding’. In the management question, common errors related to candidates not considering contraindications to medications.

The case evolved with the patient presenting following a sexual assault by a health practitioner. Common errors related to not reading the question properly; the question specifically requested immediate management ‘other than performing physical examination and investigations’, yet some candidates provided lists of investigations or examinations they would perform. Some candidates also gave long-term management and follow-up of the patient.

Only a small proportion of candidates recognised that this scenario required mandatory notification of the health practitioner to Ahpra. It is important that candidates are familiar with requirements of mandatory reporting, both for success in the KFP exam and for working unsupervised as a Fellowed GP.

Case 18

This case focused on a woman, aged 51 years, presenting with an ST-elevation myocardial infarction.

Candidates were presented with clinical information, including an electrocardiogram, and were required to identify the specific diagnosis, provide immediate management and later give non-pharmacological management for secondary cardiovascular prevention.

The main errors for candidates not scoring well in this case were not being specific for the diagnosis, giving non-specific management and not demonstrating knowledge of current clinical guidelines.

Case 19

This case focused on the assessment of a woman, aged 45 years, presenting with symptoms of gastrooesophageal reflux. Candidates were required to take further history, identify appropriate initial investigations, provide appropriate preparation advice for a urea breath test and identify the specific components of combination pharmacological therapy for Helicobacter pylori infection.

Most candidates performed well in this case. Common errors in the first question related to giving either vague answers or answers not relevant to the presentation. In providing preparation advice for a urea breath test, some candidates gave incorrect or non-specific advice, which resulted in fewer marks. 

Case 20

This case focused on a pregnant woman, aged 27 years, presenting after a holiday to north-western Australia with symptoms and signs of Ross River virus infection. The clinical information included serological test results that excluded several other viral illnesses.

Candidates were required to identify the diagnosis, commence appropriate medication and advise the patient on long-term expectations following the illness.

Common errors related to candidates misdiagnosing the initial presentation, which influenced their subsequent answers. It is important that candidates are aware of common zoonotic infections endemic to Australia and incorporate travel medicine into their exam preparations.

Case 21

Candidates were presented with a man, aged 25 years, attending a rural emergency department with symptoms and signs of a spontaneous pneumothorax. A chest X-ray image was included. Candidates were required to provide the diagnosis, describe initial management and give advice on flying.

Although the diagnosis was correctly identified by most candidates, the most common errors in management related to non-specific answers, for example answering ‘analgesia’ instead of ‘paracetamol’.

Some candidates also misinterpreted the severity and gave management answers not indicated, such as
‘needle thoracocentesis’.

In the final question, candidates who performed well identified it was unsafe to fly with a current pneumothorax, advised travel should be deferred until after pneumothorax resolution and declined to certify the patient as fit to fly.

Case 22

Candidates were presented with a boy, aged 13 years, with symptoms and signs highly suggestive of a slipped upper femoral epiphysis. Candidates were required to provide the diagnosis, provide immediate management and identify potential complications.

Although the diagnosis was correctly identified by most candidates, common errors relating to the management question included providing general first aid advice rather than specific management, referring to allied health providers not required in acute management or answering with long-term management actions. Some candidates provided dangerous management, such as manipulation of the hip or advice to weight bear.

In KFP questions that focus on the management of musculoskeletal presentations, candidates will often respond with ‘rest, ice, compression and elevation’. These answers are either impractical or incorrect given the context and are not awarded marks. They do not demonstrate to the examiner any understanding of the presentation and, when written on one line, will result in overcoding.

Case 23

This case focused on a man, aged 44 years, presenting with specific delusions and paranoia. Candidates were required to identify the differential diagnoses, take further history, provide non-pharmacological management including appropriate psychiatric referral and arrange monitoring investigations after the man is commenced on appropriate medication.

Common errors in this case were repeating information already given, giving non-specific answers (eg
‘family history’ instead of ‘family history of schizophrenia’) or arranging inappropriate management, such as scheduling the patient under the Mental Health Act.

Case 24

This case focused on an Aboriginal man, aged 66 years, presenting with symptoms and signs of a diabetic Charcot foot. Candidates were provided with both a clinical photograph and X-ray image to assist in making the diagnosis. Candidates were required to identify the diagnosis, provide immediate management, provide ongoing diabetic foot care advice and identify barriers that may have prevented the man accessing medical treatment in the past.

Many candidates appeared to have poor knowledge of diabetic Charcot foot diagnosis and management. A common error in the third question included giving overall diabetes management advice rather than specific foot care. The fourth question was generally done well, although non-specific answers such as ‘cultural barriers’ without further information did not score.

Case 25

Candidates were presented with a woman, aged 42 years, with vertigo symptoms. Candidates needed to provide red flag examination findings they would seek and determine the most likely diagnosis. A common error in the first question was failing to read the question and providing history questions rather than examination findings. A good answer considered information already given, described specific cerebellar signs and signs of a cerebrovascular accident.

In the second question, many candidates appeared to misunderstand the presenting history and absence of red flags, and therefore made the wrong diagnosis.

The final question in this case required candidates to manage a situation in which the patient’s employer disputes the validity of a medical certificate, providing two immediate management actions. Although most candidates recognised the need to maintain patient confidentiality in this situation, some candidates effectively repeated this in their second answer. In the KFP exam, candidates should consider a broad range of appropriate management actions to ensure they gain the most marks.

Case 26

Candidates were presented with a woman, aged 35 years, who has cystic fibrosis and requires annual investigations. Candidates were required to identify appropriate monitoring investigations and give specific non-pharmacological advice on reducing the risk of acquiring an infection from the workplace.

Candidates did poorly on the second question. Common errors were providing non-specific advice, providing pharmacological management, or providing advice that would not specifically reduce the risk of acquiring an infection at work.

The case evolved, with the patient’s sister presenting for preconception review and genetic carrier screening.

Candidates were required to provide pre-test counselling. Common errors included non-specific answers or referring onto another health practitioner to provide the pre-test counselling.

Several candidates did not complete this final case. Candidates should remember that all cases in the KFP are equally weighted and careful time management is important to ensure the most marks are gained.

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2024.1

Case 1

This case focused on an Aboriginal infant, aged 2½ months, presenting with a non-specific febrile illness and a normal physical examination. Candidates were required to identify the most likely differential diagnoses and select appropriate initial investigations. Common errors included giving diagnoses that did not fit with the clinical scenario, such as bronchiolitis or otitis media. Some candidates incorrectly answered that a likely diagnosis was acute rheumatic fever, whereas this was unlikely in the clinical context of the case.

The case then introduced the infant’s older adolescent sister, who presented for an Aboriginal and Torres Strait Islander children’s preventative health assessment. Candidates were required to identify relevant history to complete the assessment. Common errors included asking extensive family history or asking about symptoms of conditions that were not relevant. Candidates who did well provided specific aspects of history that recognised the greater health disadvantages Aboriginal and Torres Strait Islander people experience, while also demonstrating knowledge of common adolescent health issues.

Case 2

This case focused on a woman, aged 31 years, presenting with cyclical symptoms indicative of endometriosis. Candidates were required to identify relevant history and refer for an appropriate initial investigation. Candidates performed poorly on the first question. A common error was misinterpreting the clinical information and asking history more relevant to other diagnoses, such as sexually transmitted infections. Some candidates asked history already provided in the case material or asked questions that would not support the diagnosis. In the KFP exam, it is important that candidates read the question carefully and give a broad range of specific answers that are relevant to the clinical scenario.

The case then progressed to the patient returning several months after being commenced on opioid analgesia by another practitioner. Candidates were required to describe appropriate non-pharmacological actions to assist in deciding whether to continue opioid therapy, such as checking state-based dispensing history systems. Again, this question was poorly answered, with frequent incorrect responses listing lifestyle changes rather than processes that would assist in the decision-making process of opioid prescribing.

The KFP exam is designed to assess all domains of general practice, including non-clinical systems that ensure appropriate patient care. Candidates should ensure they consider the core and contextual curriculum units in their exam preparation and include these topics in their study plan.

Case 3

Candidates were presented with a woman, aged 60 years, returning for results of investigations highly suggestive of metabolic-associated fatty liver disease. Following identification of the specific diagnosis, candidates needed to identify appropriate subsequent investigations and describe non-pharmacological management advice.

Although most candidates correctly identified the underlying diagnosis, many struggled to articulate specific management advice. For example, some candidates recommended a ‘healthy diet’ rather than specific dietary or activity advice to enable weight loss. In the KFP, candidates should remember to be specific in their answers, in the same way they would give specific advice to patients in general practice.

Case 4

This case contained four questions and focused on a woman, aged 52 years, who initially presents with foot pain and then returns several months later with heel pain. In the first two questions, candidates were required to identify the most likely diagnosis of Morton’s neuroma and describe appropriate management. In the latter two questions, candidates were required to identify the most likely diagnosis of Achilles tendinopathy and describe appropriate non-pharmacological management.

In the two diagnosis questions, more candidates correctly identified the diagnosis of Morton’s neuroma than Achilles tendinopathy. A common error in diagnosing Achilles tendinopathy was misinterpreting the clinical information as plantar fasciitis, or providing a diagnosis of calcaneal apophysitis, which is a paediatric diagnosis and not relevant to the patient scenario.

In the management questions, common errors included providing insufficient detail about reasons for referral, or duplicating answers by giving similar responses in slightly different ways. Although some referrals were appropriate, candidates should remember to be specific about the reasons for referring and avoid nonspecific answers that do not demonstrate understanding of appropriate clinical care.

Case 5

This case presented a man, aged 48 years, with symptoms of depression in the context of being an emergency services worker. Candidates were required to articulate additional history to clarify the diagnosis and identify appropriate first-line medication for depression. A common error in the first question was not to include answers of anhedonia and suicidal ideation, or to include similar variations on answers rather than  a broad range of mental health history. The majority of candidates correctly identified first-line medications for depression.

The patient later returned acutely suicidal and candidates needed to give appropriate management. Many candidates struggled with this question. Errors here included misreading the question and recommending involuntary treatment when the patient was clearly willing to receive treatment voluntarily. Some candidates also did not recognise the severity of the patient’s presentation and referred for outpatient treatment rather than urgent psychiatric review. The KFP exam is designed to assess whether candidates can apply their knowledge and skills to an individual patient scenario, tailoring management and ensuring all information is considered. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 6

Candidates received a telephone consultation with the mother of a girl, aged 5 years, with respiratory symptoms. The case was set in a rural location, and candidates needed to identify history features necessitating face-to-face review, then examination findings necessitating transfer to hospital. Common errors included not taking the patient’s age into account and providing answers appropriate for the assessment of infants rather than a child aged 5 years. Some candidates also provided similar answers on different lines, missing the opportunity to demonstrate their breadth of knowledge and gain maximum marks.

The case evolved to reveal that the patient’s parents were separated, and her father was requesting a copy  of his daughter’s medical record. Candidates performed poorly on this question, with many stating incorrectly that they would refuse to provide the medical records.

Medico-legal and ethical dilemmas are frequently tested in the KFP exam, and candidates should familiarise themselves with common scenarios that may be encountered in general practice. The RACGP provides multiple resources to assist GPs with these issues.

Case 7

This case focused on a man, aged 41 years, with a recent diagnosis of melanoma who is referred to an appropriate specialist. Candidates were required to identify that further surgical management of the melanoma was indicated and then provide appropriate patient education about ongoing care. A common error on the first question was being non-specific by describing local excision without specifying appropriate margin width. On the second question, some candidates gave advice on skin examination with inappropriately long intervals between checks, or overemphasised sun protection measures at the expense of providing advice on other skin cancer education.

The patient was subsequently lost to follow-up and later returned with metastatic disease. Candidates needed to discuss appropriate end-of-life care. In this question, some candidates provided more answers than requested, known as overcoding. In the KFP exam, it is important to only provide the number of answers requested, demonstrating rationalisation of responses. To be fair to all candidates in the KFP,  each additional answer attracts a 0.25% penalty from the candidate’s overall score.

Case 8

Candidates were presented with a woman, aged 55 years, with typical symptoms of a frozen shoulder. Candidates were required to identify the likely diagnosis, describe confirmatory examination findings and commence appropriate initial management.

Although the majority of candidates correctly identified the underlying diagnosis, common errors in the management question included giving general overview statements such as ‘rest’ or ‘avoid lifting’, rather than specific patient education, specific physiotherapy referrals or appropriate procedural interventions.

Case 9

Candidates were presented with a man, aged 48 years, with scalp itch and hair loss. A clinical image demonstrated a thickened red scalp rash with overlying silvery scale. Candidates were required to describe appropriate differential diagnoses, articulate initial pharmacological management of the most likely diagnosis of scalp psoriasis and describe appropriate non-pharmacological management advice.

Although most candidates correctly identified the most likely diagnosis, a common error was not recognising the appropriate formulation of topical therapy for the scalp would be a lotion or shampoo rather than a cream. It is important that candidates are aware of best practice guidelines for common conditions and apply their knowledge to specific patient scenarios.

Case 10

Candidates were presented with an Aboriginal woman, aged 69 years, recently discharged from hospital following a myocardial infarction. The patient had a complex medical history and was prescribed multiple medications requiring different times and modes of administration. Candidates were required to identify barriers to medication compliance and strategies to assist the patient to take her medications.

Although this case was generally done well, some candidates appeared to make assumptions about the patient based on her being an Aboriginal woman. Answers relating to socioeconomic status, education level and substance use did not relate to any key features in the scenario. Cultural safety is an integral and essential requirement for fellowship of the RACGP and exam candidates should expect to demonstrate  their competence in this.

Case 11

Candidates were presented with a man, aged 53 years, presenting with gout after making significant lifestyle changes. Candidates were required to identify factors that contributed to his development of gout, select an appropriate diagnostic investigation and arrange appropriate long-term pharmacological management.

Most candidates recognised the clinical picture of gout and appropriately investigated the patient. However, there was a high proportion of extra responses (overcoding) in the first question. Candidates should be careful of using words such as ‘and’, ‘or’ and ‘because’, or symbols such as ‘/’, ‘+/–’ and ‘( )’ in their answers. These will often lead to candidates providing more responses than asked for and obtaining an overcode penalty.

Most candidates managed the patient appropriately. Cessation of medications contributing to gout was  an important part of management and many candidates identified this in their answers.

Case 12

This case focused on a woman, aged 21 years, who was an elite athlete presenting with difficulty managing her menstrual periods. Candidates needed to describe appropriate pharmacological management strategies. Many candidates identified appropriate treatments, but some answered with ‘Implanon’ or ‘Kyleena intrauterine device’, which were not indicated in this scenario.

The patient then disclosed a history of anabolic steroid use, and candidates needed to identify potential adverse effects. The most common error in answering this question was listing adverse effects of corticosteroids rather than anabolic steroids, which led to significant errors in responses.

Finally, the patient disclosed multiple aspects of family medical history, including significant cardiac history. Candidates needed to identify that an electrocardiogram was an essential immediate investigation, particularly given her intensive sport participation. A number of candidates prioritised breast cancer screening or wrote vague answers. An essential aspect of this question was recognising that the patient was an elite athlete and her significant family cardiac history could be a risk factor for sudden cardiac death. Candidates should ensure that they read all information in the KFP exam carefully. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 13

Candidates were presented with a boy, aged 7 years, with abdominal pain and constipation. Candidates were provided with some aspects of history and needed to articulate additional history that would indicate a serious underlying cause of the patient’s symptoms. Candidates were then advised that there were no red-flag history features and needed to describe appropriate non-pharmacological management for the boy, which required management of his constipation.

Candidates who performed well considered the differential diagnoses and took into account significant negative features in the stem. A good management answer addressed the common paediatric condition of constipation with specific non-pharmacological strategies. Common errors included giving history features that had already been given in the clinical stem, and giving vague management answers, such as ‘educate’  or ‘reassure’. In the KFP exam, generic management and non-specific answers do not score.

Case 14

This case focussed on a man, aged 84 years, living in residential aged care. The man had some foul-smelling urine with a normal urine microscopy and positive culture, and candidates needed to identify that he had asymptomatic bacteriuria. They then needed to give appropriate education advice for nursing staff about the management of non-specific urinary symptoms. The most common error in this question was that the urine should be tested regularly, which is inappropriate advice in aged care settings, which can have a high rate of asymptomatic bacteriuria.

The case evolved to the man later developing a urinary tract infection, and candidates needed to describe appropriate pharmacological management. Although most candidates prescribed appropriate antibiotic treatment, a common error was not administering simple analgesia or prematurely ceasing sodium–glucose cotransporter 2 inhibitors.

Finally, candidates were given examination findings and a clinical image consistent with a subconjunctival haemorrhage, and needed to describe appropriate management advice. Most candidates performed well in this question, correctly identifying that no specific intervention was required.

Case 15

Candidates were presented with a man, aged 47 years, requesting a general check-up. Limited patient history was available, although some cardiovascular risks were identified. Candidates needed to describe what additional factors would increase the risk of the patient having cardiovascular disease. They needed to give appropriate lifestyle advice, and then commence pharmacological management to reduce the patient’s cardiovascular risk.

Common errors in the first question related to not reading the question properly. The question clearly asked for history other than physical symptoms, but many candidates gave answers such as ‘palpitations’, ‘chest pain’ or ‘breathlessness’. Some candidates also gave history already given in the stem, such as the patient’s alcohol intake or family history. Candidates should ensure they read the question carefully to be sure they are answering correctly and are not repeating information already given.

In general, the second and third questions were done well. Common errors related to being non-specific in lifestyle advice; for example, responding with ‘lose weight’ rather than giving a specific weight loss target. In the third question, drug class and specific medication were asked for. Some candidates gave incorrect examples, such as ‘ACE-inhibitor, for example candesartan’. Candidates should be careful to give correct examples in the KFP exam when these are asked for, otherwise they may render their answer incorrect or fail to gain maximum marks.

Case 16

This case initially focussed on a woman aged 22 years. The woman had a complex medical history including solid organ transplantation and presented requesting cervical cancer screening. Candidates needed to explain the rationale for changes to the cervical screening program in 2017. A common error in this question was describing the current cervical screening program rather than the rationale behind the changes. A small number of candidates answered that cervical screening was not required if sexual activity commenced after human papillomavirus immunisation. This was clearly incorrect and potentially dangerous because it would lead to underscreening.

Candidates were then required to identify factors in the patient’s history that supported her undergoing cervical screening and having a self-collected sample. A good answer needed to consider the patient’s wishes and notable details in her history, such as immunosuppression and early sexual debut. Her personal history of sexually transmitted infections and family history of cervical cancer were not correct reasons for undergoing self-obtained cervical screening.

The case then evolved to the woman’s partner, a transgender man aged 31 years, presenting with symptoms requiring an internal vaginal examination. Candidates were required to identify what specific approaches could reduce his discomfort with the examination. Common errors in the question centred around failing to consider the unique aspects of a genital examination for a transgender male patient, and instead giving generic advice about female genital examination.

Case 17

In this case, candidates were required to identify causative factors contributing towards impaired renal function in a man, aged 58 years. The man had a significant past medical history of type 2 diabetes and non-steroidal anti-inflammatory drug use, in addition to other comorbidities and medication use. Candidates needed to arrange appropriate investigations, which included confirming impaired renal function and microalbuminuria. Candidates then needed to make appropriate changes to the patient’s medications.

Candidates performed well in this case. In the investigations question, some candidates selected tests that had been recently performed and did not need repeating. In selection questions, candidates should ensure they prioritise their investigations and select rationally from the list. In the KFP exam, it is important to read investigation questions carefully because answers may be quite different for ‘initial’, ‘additional’ or ‘diagnostic’ investigations.

Case 18

This case focused on a man, aged 47 years, presenting with chronic rhinosinusitis using long-term nasal decongestants and sedating antihistamines. Candidates were required to describe initial pharmacological management and then select appropriate investigations when the patient’s symptoms did not improve. Candidates performed well in these questions, with most recognising that the nasal decongestants required cessation.

The patient then presented requesting assistance with smoking cessation. Candidates needed to consider both best practice guidelines and the significant medical history of monoamine oxidase inhibitor use when deciding which pharmacological management to prescribe. Although most candidates performed well in this question, a small proportion prescribed bupropion, which was contraindicated in this scenario. It is important that candidates consider medication interactions and contraindications when answering pharmacological management questions in the KFP exam.

Case 19

This case focused on a girl, aged 16 years, presenting with symptoms and examination findings typical of Turner syndrome. Candidates needed to interpret relevant clinical information to make the diagnosis, including parental height and weight, and a growth chart. After making the diagnosis, candidates were required to arrange appropriate initial investigations. A common error in the diagnosis question was candidates describing the condition without giving a specific diagnosis; for example, answering ‘delayed puberty’ or ‘primary amenorrhoea’. The investigation question was generally done well, although many candidates did not recognise that a karyotype was an important investigation in this scenario.

The case evolved to the patient presenting on her own and candidates needed to articulate appropriate advice regarding confidentiality of adolescent consultations. Although this question was answered well overall, common errors included providing answers that did not relate directly to confidentiality or stating that assessment of Gillick competence was needed. It was made clear from the clinical stem that the patient met Gillick competence; therefore, this answer did not gain marks.

Case 20

This case focused on a man, aged 69 years, with poorly controlled hypertension in the context of a complex medical history. The case was set in a rural location. Candidates were required to arrange appropriate initial investigations and pharmacological management of the patient. Common errors in the management question related to not reading the patient’s medication history correctly or giving non-pharmacological answers that did not answer the question.

The case evolved to the patient presenting to the local hospital emergency department with hypertensive urgency. Clinical information included normal blood tests, electrocardiogram and chest X-ray. Candidates were required to describe appropriate immediate management, which included medication to reduce the patient’s blood pressure and appropriate patient monitoring. This question was answered poorly. Common errors related to diagnostic errors, giving non-specific advice and not demonstrating knowledge of current clinical guidelines.

Case 21

In this case candidates receive a telephone call from a nurse about a woman, aged 86 years, residing in an aged care facility. Clinical information included past medical history, medications, symptoms, basic examination findings and recent blood test results. Candidates were required to identify that the patient was experiencing hypoglycaemia secondary to sulfonylurea use and required urgent management of this important situation. Errors in this question related to candidates not recognising that the most likely diagnosis was hypoglycaemia. This subsequently affected their management advice in the second question, with many failing to demonstrate the required knowledge. Vague answers were also common and often not accompanied by medical management that would resolve the situation.

The case evolved to the patient later presenting with long-term cognitive impairment requiring appropriate initial investigation. Common errors in this question related to not recognising that some investigations had already been recently performed, and selecting tests not indicated by current guidelines.

Case 22

Candidates were presented with a woman, aged 36 years, with symptoms highly suggestive of irritable bowel syndrome. Candidates were required to provide the diagnosis, arrange initial investigations and commence appropriate pharmacological management when conservative measures failed to improve  her symptoms.

Although the diagnosis was correctly identified by most candidates, a common error in the second question was selecting investigations that were less relevant in a patient with several years of symptoms. In the third question, common errors related to not reading the question and giving answers that did not address the patient scenario.

Case 23

This case focused on a woman, aged 70 years, presenting with painless macroscopic haematuria. Clinical information included key features of smoking history and occupational chemical exposure, and urine microscopy and culture results. Candidates were required to identify the most likely differential diagnoses and arrange appropriate investigations. Common errors related to giving answers unrelated to the key features in the stem (eg ‘renal abscess’ or ‘ovarian cancer’) or giving non-specific answers.

The case then evolved to the patient presenting with features of a chalazion, with two clinical images shown. Candidates needed to describe appropriate management of this common ophthalmic condition. Although most candidates answered this well, some responded with the diagnosis rather than management strategies. As for other cases, it is important for candidates to read question instructions carefully to ensure they are answering appropriately.

Case 24

This case focused on a man, aged 65 years, presenting with symptoms and signs of chronic obstructive pulmonary disease. Candidates were provided with spirometry results to assist in making the diagnosis. Candidates were required to provide non-pharmacological management advice and describe additional conditions the patient was at increased risk of. In the management question, common errors included candidates giving generic lifestyle advice relating to alcohol intake and weight management. In this case,  the patient drank a minimal amount of alcohol and was not significantly overweight, therefore these answers were not appropriate and did not score. Candidates should be mindful to tailor their management advice and avoid generic answers that are irrelevant to the scenario.

The patient then presented for immunisations and candidates needed to list specific immunisations  that were appropriate for his age and medical condition. This question was generally answered well,  but common errors related to giving less-specific answers, such as ‘influenza immunisation’ rather than  an age-appropriate immunisation.

Case 25

Candidates were presented with a woman, aged 23 years, with classical symptoms of migraine with aura in the context of considering pregnancy in the near future. Candidates needed to describe additional symptoms that would indicate a serious underlying cause of headache. Candidates struggled with this question. Common errors included asking for symptoms already given in the stem, asking examination findings rather than history or asking for history that would not indicate an underlying serious pathology. In the KFP exam, it is important for candidates to read the questions carefully to ensure they are answering what is being asked.

Candidates then needed to describe appropriate prophylactic medication for the patient. Common errors included giving acute migraine treatment rather than migraine prophylaxis, or giving medications that would not be suitable in pregnancy.

The context then changed to the patient requesting long-term effective contraception. Candidates needed to identify appropriate contraceptives in this situation. This question was generally done well, with candidates recognising that migraine with aura is a contraindication to combined hormonal contraception.

Case 26

Candidates were presented with a man, aged 19 years, with symptoms typical of social anxiety disorder.

Candidates were required to identify psychological management strategies specific to this condition. Common errors included answering with therapies not indicated for social anxiety or giving non-specific answers, such as ‘refer to psychologist’.

The second question required candidates to describe why the patient was not eligible for support from the National Disability Insurance Scheme (NDIS). Candidates performed poorly on this question. A common error was giving answers relevant for Centrelink disability support rather than the NDIS. To perform well, candidates needed to demonstrate understanding that permanent disability is an NDIS eligibility requirement.

In the third question, candidates needed to prescribe medication for the management of ongoing performance anxiety. Most candidates correctly answered with propranolol.

Finally, the case evolved to the patient presenting with a plantar wart; candidates needed to describe an appropriate evidence-based pharmacological treatment of this common condition. Errors related to choosing a non-pharmacological treatment, which did not answer the question.

Some candidates did not complete this final case. Candidates should remember that all cases in the KFP  are equally weighted and careful time management is important to ensure the most marks are gained.

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2024.2

Case 1

This case focused on a woman, aged 32 years, presenting with fatigue. Clinical information included her family history, examination findings and abnormal thyroid function tests. Candidates were required to identify the most likely diagnosis and give specific advice about pharmacological management. The majority of candidates did well in the first question, giving the specific diagnosis of Hashimoto’s disease. Candidates who performed well in the second question correctly reasoned that the pharmacological management was to prescribe thyroxine and gave specific advice about the medication, including common interactions, storage and need for monitoring.

The case then progressed to the patient planning pregnancy. Candidates were required to identify appropriate investigations in this scenario. In general, candidates performed well, recognising that appropriate investigations included monitoring of thyroid function and routine preconception tests.

Case 2

Candidates were presented with a man, aged 73 years, with lower back pain. They were required to describe red-flag history features that would increase concern about his pain. Common errors included giving non-specific answers, such as ‘neurological symptoms’, providing history already given in the stem or giving examination or investigation answers. Many candidates gave more answers than requested, known as ‘overcoding’. In the KFP exam, it is important to only provide the number of answers requested, demonstrating rationalisation of responses. To be fair to all candidates in the KFP, each additional answer attracts a 0.25% penalty from the candidate’s overall score.

The case then evolved to the patient returning with dual X-ray absorptiometry results indicative of secondary osteoporosis. Candidates were required to select appropriate further investigations and give nonpharmacological management advice. In general, candidates performed well on these questions, although a common error was giving generic non-pharmacological advice on healthy diet and exercise. Candidates who gave specific answers on appropriate dietary calcium intake and weight-bearing exercise did well in the final question. In the KFP, candidates should remember to be specific in their answers, in the same way they would give specific advice to patients in general practice.

Case 3

This case focused on an Aboriginal woman, aged 27 years, at 12 weeks gestation in her first pregnancy. The case was set in a rural location and included specific information on the patient’s wishes for her pregnancy and delivery. Candidates were required to articulate appropriate ways to engage the patient in antenatal care. This question was done poorly by many candidates. Common errors included providing answers around medical management that did not acknowledge cultural aspects or demonstrate patient engagement and shared decision making. Some candidates appeared to make assumptions about the patient based on her Aboriginal status. A good answer acknowledged cultural safety, gave appropriate answers relevant to a firsttime mother and made no judgements on the patient.

The case then evolved to the patient returning postpartum with her infant son for a six-week check. Candidates were given examination findings that included information on the infant’s weight faltering and were required to articulate relevant history in this situation. Some candidates gave incorrect answers on breastfeeding or focused on irrelevant history, such as parental height. A good answer considered both medical and psychosocial factors that could affect infant weight gain, in the specific cultural context of  the question.

Case 4

This case presented a man, aged 18 years, with a fever and sore throat. Candidates were required to give examination findings that would indicate a need for hospital admission. Common errors included reiterating information already given in the stem, giving answers that would not indicate a need for inpatient admission or giving answers relevant to infants but not adult patients.

The case then evolved to the patient re-presenting with ongoing symptoms and a new rash. Candidates were given a clinical image that was consistent with a scarlet fever rash. Candidates were required to describe the most appropriate medication management, including the route of administration. The most common errors were misinterpreting the clinical information and prescribing incorrect medication, or not giving the route of administration. In the KFP exam, candidates should ensure they read the question carefully to give all required information.

In the third question, candidates were required to manage a patient complaint. Common errors included focusing on medical management rather than the complaint, neglecting to manage the complaint at a practice level or giving non-specific answers. Some candidates answered that they would involve their supervisor. It is important for candidates to remember the KFP exam is aimed at the point of Fellowship,  in which candidates are required to demonstrate their competency to practice unsupervised.

Case 5

This case presented a woman, aged 27 years, with optic neuritis. Candidates were provided with a patient history, preliminary examination findings and a clinical fundoscopy image. They were required to provide the most likely diagnosis, describe additional relevant examination findings, give the most appropriate management and identify the most appropriate investigation.

Candidates struggled with the first two questions. Common errors included misinterpreting the clinical information and providing an incorrect diagnosis, which led to describing incorrect examination findings.

Some candidates also articulated the examination they would perform, rather than the relevant finding.  For example, ‘pupillary light reflex’ rather than ‘presence of relative afferent pupillary defect’.

Although most candidates identified that urgent referral to a relevant specialist was appropriate, a common error in the investigations question was answering with blood tests or CT scans. These investigations were not appropriate in the context of the case. In the KFP exam, further clinical information is often given as the case progresses. Candidates should ensure they consider this progressive information when formulating their answers.

Case 6

Candidates were presented with a girl, aged 11 months, with respiratory symptoms consistent with bronchiolitis. She had a family history of atopy, and her immunisation history was given. Candidates were required to describe red-flag examination findings. Common errors related to not following directions in the question or identifying key features in the stem. Candidates were specifically instructed not to give findings relating to hydration status in their answers, but many candidates included these. Candidates should ensure they read the question carefully to be sure they are answering correctly and not giving unnecessary information.

Candidates were then advised there were no red-flag findings and asked to articulate appropriate management. The most common errors related to giving vague instructions, such as ‘safety netting’ or ‘encourage fluids’, without giving specific instructions for parents.

The case evolved to the girl returning, aged 3 years, with symptoms consistent with asthma. Candidates were required to describe appropriate pharmacological management. Many candidates answered with combination preventer therapy, which was not appropriate in the context of the case. Only a small proportion of candidates identified that influenza immunisation was indicated. In the KFP exam, it is important for candidates to consider relevant immunisations in their pharmacological management plans.

Case 7

Candidates were presented with a man, aged 68 years, with fatigue. He had a complex past medical history and was planned to undergo major elective surgery in the near future. Candidates were required to describe relevant differential diagnoses and select appropriate initial investigations. Although these questions were generally done well, some candidates attempted to expand on their diagnosis answers, which resulted in overcoding. In the KFP exam, it is important to give succinct relevant diagnoses that use the information given in the stem.

In the third question, candidates were provided with investigation results confirming iron deficiency anaemia. They were then required to describe appropriate management. Common errors included giving non-specific answers to ‘improve diet’, rather than specific advice to increase iron-rich foods. Another common error was failing to recognise that immediate correction of the patient’s iron deficiency was required via iron infusion, given his upcoming major surgery. The KFP exam is designed to assess whether candidates can apply their knowledge and skills to an individual patient scenario, tailoring management and ensuring all information is considered. Failing to do this when providing answers will significantly reduce the number of marks awarded.

Case 8

This case focused on a woman, aged 80 years, who presented with her daughter with concerns about worsening memory. Key features included a fluctuating course, visual hallucinations and bradycardia on examination. Candidates were required to describe the likely differential diagnoses, identify appropriate investigations and describe appropriate pharmacological management of bradycardia associated with electrocardiogram changes.

Common errors in the first question included giving answers not relevant to the case, less likely diagnoses (eg encephalopathy or meningitis) or assuming information that was not provided (eg giving cardiac diagnoses that had no supporting evidence in the stem). A good answer recognised that delirium, Lewy  body dementia and symptoms of Alzheimer’s or vascular dementia were the most likely diagnoses.

The investigations question was generally performed well by candidates. In the third question, many candidates did not recognise that the patient’s anticholinesterase medication was the most likely cause  of bradycardia with prolonged QT syndrome, and therefore scored poorly on this question.

Case 9

Candidates were presented with a woman, aged 27 years, requesting benzodiazepines. The first question focused on relevant history. Common errors included giving answers already provided in the stem or asking for multiple symptoms of depression rather than a broad range of relevant history.

Candidates were then required to describe management to assist in benzodiazepine reduction. Many candidates did not recognise that rapid cessation was inappropriate in the scenario, and slow weaning or benzodiazepine substitution was required. Another common error was giving non-specific answers,  or prescribing medication that was not indicated (such as beta-blockers).

In the third question, candidates were asked to describe specific strategies to assist with the practice management of patients requesting drugs of dependence. A common error was giving Schedule 8 prescribing requirements that did not relate to practice policies. A good answer demonstrated understanding of how a practice policy would support all prescribers in the practice.

The KFP exam is designed to assess all domains of general practice, including organisational dimensions such as practice management systems that ensure appropriate patient care. Candidates should ensure they consider the core and contextual curriculum units in their exam preparation and include these topics in their study plan.

Case 10

This case focused on a man, aged 61 years, with type 2 diabetes and multiple cardiovascular risk factors who presented with a chronic foot wound. A clinical image of the wound was provided. Candidates were required to describe positive examination findings that identified contributing factors to the wound, give appropriate management and identify relevant investigations for the patient’s type 2 diabetes. The investigations question was generally done well, with most candidates recognising that both glycaemic monitoring and renal function testing were required.

As for other examination questions, a common error in the first question was describing the examination rather than the specific finding being sought, for example ‘peripheral pulses’ rather than ‘absence of pedal pulses’. In the KFP exam, candidates are often asked to describe relevant examination findings to demonstrate their competence in this aspect of clinical assessment.

In describing management, common errors included giving general management advice for diabetes and hypertension rather than specific management of the foot wound. A good answer included appropriate antibiotic therapy, specific pressure off-loading and appropriate allied health input.

Case 11

This case focussed on a girl, aged 8 years, who presented with her mother with concerns about school absences and a forearm injury. The information provided included several key features concerning for nonaccidental injury and candidates were provided with an X-ray image. Candidates were required to describe appropriate history, interpret the girl’s X-ray and give appropriate initial management.

A common error in the history question was focusing primarily on the physical injury without considering broader psychosocial aspects of the family’s situation. Some candidates also neglected to address important aspects of the case, such as how the injury occurred and what care had already been provided.

In describing management, several candidates gave vague answers rather than specifically stating they would involve child protection services or make a mandatory report. Some candidates also made assumptions about an alleged perpetrator. A good answer gave clear, succinct answers that acknowledged critical elements of the case that needed to be addressed urgently, and outlined specific management of a forearm fracture from suspected non-accidental injury.

Case 12

This case focused on a man, aged 58 years, with difficulty sleeping following the death of his wife. Candidates needed to describe the most likely differential diagnoses, give appropriate non-pharmacological management advice and then identify appropriate short-term medication options to assist with poor sleep.

Candidates performed poorly in the first question, with many misdiagnosing the patient with a mood disorder or post-traumatic stress disorder, which were not supported by the key features given. A good answer recognised that normal grief or a sleep disorder were the most likely diagnoses.

Candidates generally performed well in the second question, but several candidates provided additional answers and were given an overcoding penalty. Candidates should be careful of using words such as ‘and’, ‘or’ and ‘because’, or symbols such as ‘/’, ‘+/–’ and ‘( )’ in their answers. These will often lead to candidates providing more responses than asked for and obtaining an overcoding penalty.

Case 13

Candidates were presented with a man, aged 19 years, with type 1 diabetes and viral gastroenteritis. The case was set in a remote location without hospital services. Candidates were required to give the most likely diagnosis (which was generally done well), then give appropriate initial management advice. Many candidates appropriately answered with anti-emetics and oral rehydration; however, a common error was to not include specific advice about insulin management during a sick day. This was an important aspect of management and significantly impacted on the marks candidates received.

In the final question, candidates received a telephone call advising the man had worsening symptoms and was hypoglycaemic. They needed to give immediate management advice. Although the majority of candidates identified that glucagon was required, common errors included advising the patient to call an ambulance or present to hospital. In the remote case setting, this was not appropriate. In the KFP exam it is important to consider the specific case environment and tailor management to the location.

Case 14

This case focused on an Aboriginal boy, aged 18 months, presenting for routine immunisations. Candidates were provided with an immunisation record that showed he had missed immunisations indicated for Aboriginal and Torres Strait Islander children. Candidates needed to give the immunisations now due, articulate practice strategies to identify Aboriginal and Torres Strait Islander patients and describe how a general practice can provide culturally safe healthcare for Aboriginal and Torres Strait Islander patients.

Candidates generally performed well in the first question, correctly identifying appropriate scheduled immunisations. When delivering immunisation questions in the KFP exam, the RACGP ensures that answers are applicable to candidates in all states of Australia, because there can be some regional variation in immunisation schedules.

Candidates struggled in the second and third questions. Many candidates gave answers to the second question that focused on practice and patient incentives, which would not assist in identifying Aboriginal and Torres Strait Islander patients. In the third question, common errors included giving generalisations applicable to all patients and not specific to culturally safe healthcare. Common examples of these were ‘treat patients with respect’, ‘non-judgemental approach’ and ‘ensure confidentiality’. Some candidates gave answers that were vague and did not demonstrate why they were important. For example, ‘involve family’. A good answer needed to demonstrate how candidates were responsive to patient’s cultural needs or how they would provide a culturally safe space. Cultural safety is an integral and essential requirement for fellowship of the RACGP, and KFP exam candidates should expect to demonstrate their competence in this.

Case 15

Candidates were presented with a woman, aged 48 years, with localised ear symptoms and a rash after use of latex earplugs. A clinical image of the rash was provided. Candidates were required to describe the most likely diagnosis and give appropriate non-pharmacological management advice.

The majority of candidates identified that a contact dermatitis was the most likely diagnosis, but several did not specify that latex allergy was a contributing factor. This impacted on answers in the management question, with some candidates giving answers non-specific to latex allergy. Other common errors included giving similar answers on two separate lines; for example, ‘don’t get water in ears’ and ‘keep ears dry’. Candidates should ensure they give a broad range of answers in management questions that demonstrate their breadth of knowledge.

The case evolved to the woman’s employer calling to request information on her medical condition. Most candidates correctly identified that no information could be supplied due to patient confidentiality. Medicolegal and ethical challenges are frequently tested in the KFP exam, and candidates should familiarise themselves with common scenarios that may be encountered in general practice. The RACGP provides multiple resources to assist candidates in their study of these areas.

Case 16

This case focused on a boy, aged 14 years, presenting with groin pain and testicular tenderness. Limited history was given, and candidates had to describe additional history that was relevant to the presentation. They then needed to describe information required to allow the boy to give informed consent for a physical examination. Finally, candidates needed to identify physical examination findings consistent with the most important differential diagnosis.

In the first question, a common error was not reading the question and providing examination findings instead of history. Some candidates gave non-specific answers, such as ‘difficulty passing urine’, rather than specific features, such as ‘urinary frequency’ or ‘dysuria’. Other candidates focused on past medical history and family history rather than features of the presentation and relevant associated history.

The second question was generally answered well, but a common error was giving answers on how to assess for Gillick competence. The stem clearly stated that the boy was Gillick competent, so answers related to this did not score marks. Candidates should ensure they read all the information given in KFP exam questions to allow them to focus their answers.

The third question was answered well, with most candidates correctly identifying examination findings specific to testicular torsion.

Case 17

In this case, candidates were required to identify the causative medication contributing towards mild hyponatraemia and hypercalcaemia in a woman, aged 52 years. They then needed to describe the most likely differential diagnoses when the woman’s electrolyte changes did not resolve and select appropriate further investigations.

A significant proportion of candidates incorrectly gave sertraline as the most likely medication causing the electrolyte abnormalities. Candidates needed to recognise that the patient’s significant hypercalcaemia meant a thiazide diuretic was the most likely causative medication. Initial errors impacted on answers in the second question, with some candidates giving differential diagnoses that only addressed hyponatraemia. A good answer identified primary hyperparathyroidism and hypercalcaemia of malignancy as the most likely differential diagnoses, and directed investigations towards these in the third question.

Case 18

Candidates received a telephone consultation with a woman, aged 22 years, concerned about a pigmented skin lesion. They needed to describe relevant history of the skin lesion. Although this question was generally answered well, a common error was giving non-specific answers, such as ‘changing lesion’, rather than describing the specific change that was significant (eg the size, shape or colour of the lesion).

Candidates then received a clinical image of the pigmented lesion and needed to describe immediate management. The majority of candidates correctly identified that urgent excisional biopsy with appropriate margins was required for a lesion suspicious of melanoma.

Case 19

This case focused on a man, aged 52 years, presenting to a rural emergency department with an STelevation myocardial infarction. Candidates received relevant history, examination findings, troponin level and an electrocardiogram image. They were advised that it would be several hours before the patient could be transferred to a tertiary centre and needed to provide the immediate medications required.

There were several common errors in this question. Many candidates advised to give glyceryl trinitrate, which the stem clearly said had already been administered. Some candidates included actions that were not medications, such as ‘seek advice from cardiologist’ or ‘transfer to tertiary hospital’. Other candidates gave answers that were not based on current thrombolytic guidelines, such as ‘streptokinase’ rather than ‘alteplase’. Candidates who performed well clearly demonstrated their understanding of current guidelines for immediate management of acute coronary syndromes. It is important that candidates are aware of best practice guidelines for common and important conditions and can apply their knowledge to specific patient scenarios.

The case evolved to the man returning several weeks later. Candidates received relevant history, examination findings, blood test results, a chest X-ray image and an echocardiogram report. They were required to identify the patient had congestive heart failure with reduced ejection fraction and therefore describe appropriate pharmacological management. This question was generally answered better than the first one, but some candidates gave answers including beta-blockers, which are not appropriate in heart failure with clinical congestion.

Finally, candidates were required to describe strategies to assist the patient’s medication compliance.  This question was generally done well, with most candidates articulating a broad range of specific practical strategies.

Case 20

This case focused on a woman, aged 50 years, with worsening symptoms of gastro-oesophageal reflux. Candidates received limited history and needed to articulate additional history that would indicate a need  for immediate gastroscopy. They then needed to describe appropriate non-pharmacological management.

The first question was generally done well, with most candidates describing appropriate red-flag history features. A common error in the second question was giving answers around psychological management, which was not appropriate in the context of the case.

The case progressed to the woman requesting advice on reducing bowel cancer risk. She had a relevant family history of bowel cancer in a first-degree relative. Common errors related to not reading the question carefully. For example, the stem clearly stated advice for smoking and alcohol cessation had already been provided, yet some candidates included this in their answer. Other candidates gave non-specific answers, such as ‘exercise’ or ‘weight loss’. In the KFP exam, generic management and non-specific answers do not score.

Case 21

Candidates were presented with a man, aged 67 years, with a cough and shortness of breath on exertion. Clinical information included symptoms, past medical history, medications, smoking and occupational history, examination findings and spirometry results. Candidates were required to interpret the spirometry, provide appropriate differential diagnoses and identify relevant initial investigations.

In the first question, a common error was giving a diagnosis rather than a direct spirometry interpretation. In the second question, the most common error was misdiagnosing the patient with chronic obstructive pulmonary disease. Candidates should ensure they consider all key features when developing differential diagnoses; in this case, the patient’s occupational history, examination findings and restrictive lung defect made idiopathic pulmonary fibrosis and coal worker’s pneumoconiosis the most likely diagnoses.

In questions that provide a selection of investigations, candidates should ensure they prioritise their investigations and select rationally from the list. In the KFP exam, it is important to read investigation questions carefully because answers may be quite different for ‘initial’, ‘additional’ or ‘diagnostic’ investigations.

Case 22

Candidates were presented with a woman, aged 40 years, requesting weight loss advice. Clinical information included her use of the combined oral contraceptive pill, smoking status, family history and examination findings. Candidates were required to identify appropriate initial investigations and provide appropriate pharmacological management. The first question was generally done well. In the second question, several candidates did not identify the important feature of multiple risk factors for cardiovascular disease, which contraindicated use of the combined oral contraceptive pill. This led to candidates losing marks for that question. It is important that candidates consider medication contraindications when answering pharmacological management questions in the KFP exam.

In the third question, the patient requested a backdated referral to a surgical specialist. The majority of candidates appropriately answered that referrals cannot be backdated.

Case 23

This case contained four questions and focused on an infant, aged 4 months, presenting with a mild febrile illness and new heart murmur. In the first two questions, candidates were required to describe examination findings consistent with the most likely diagnosis and give appropriate management advice. Common errors in these questions were related to misdiagnosing the murmur as rheumatic heart disease or congenital heart disease. Candidates performed poorly in the management question, with many either overinvestigating or providing no follow-up at all for the infant. A good answer recognised that the most likely diagnosis was an innocent murmur that should be followed up after an appropriate time interval.

The case evolved to candidate’s receiving further history and a clinical image of a birthmark. They were required to give the most likely diagnosis and describe management options. A common error in the diagnosis question was to give a less specific diagnosis, for example ‘haemangioma’ rather than ‘infantile haemangioma’ or ‘strawberry naevus’. A good management answer included reassurance about the benign nature of the lesion and consideration of appropriate pharmacological management options.

Case 24

This case focused on a man, aged 70 years, presenting with symptoms and signs of polycythaemia. Candidates were provided with pathology results to assist in making the diagnosis. Candidates were required to describe relevant additional history and identify appropriate further investigations. The first question was answered poorly, with many candidates giving non-specific answers relating to alcohol intake, past medical history and family history. As for other questions, candidates should ensure they consider the key features of the case to rationalise their answers.

The patient then presented for immunisations. Candidates needed to list specific immunisations that were appropriate for his age. This question was generally answered well, but common errors related to giving less specific answers, such as ‘influenza immunisation’, rather than an age-appropriate high-dose influenza immunisation.

Case 25

Candidates were presented with a man, aged 61 years, with urinary symptoms strongly suggestive of acute prostatitis. Clinical information included a detailed medical history, examination findings and urinalysis results. Candidates were required to identify the most appropriate investigation and initiate medications to manage the presentation. The majority of candidates correctly identified that a urine microscopy and culture was an appropriate next investigation. Although most candidates correctly identified the first-line antibiotic therapy, several did not commence simple analgesia for the patient. In the KFP exam, it is important for candidates to be holistic in their management approach.

In the third question, the patient re-presented to discuss prostate cancer screening and candidates needed to provide appropriate advice. Common errors included giving vague answers, focusing on the risk of false negatives or giving incorrect information about the prostate-specific antigen test. A good answer demonstrated a systematic outline of options for prostate cancer screening, the limitations and possible outcomes of testing and an understanding of the current evidence for screening.

Case 26

Candidates were presented with a woman, aged 50 years, with symptoms typical of menopause. They were required to identify the diagnosis, give appropriate non-pharmacological management advice and give a specific medication to prescribe when her symptoms did not improve.

Common errors when giving non-pharmacological management advice included giving non-specific answers, such as ‘healthy diet’, ‘lose weight’ or ‘lifestyle change’. In the third question, many candidates did not prescribe appropriate menopausal hormonal therapy despite there being no contraindications, and therefore lost marks on this final question.

Some candidates did not complete this final case. Candidates should remember that all cases in the KFP are equally weighted and careful time management is important to ensure the most marks are gained.