CCE-CE-030

Case ID: CCE-2025-001
Case Name: Liam Thompson
Age: 3 years
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: R74 (Acute upper respiratory infection), A77 (Fever), R80 (Cough)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Engages effectively with parents and caregivers
1.2 Elicits concerns and expectations of parents
1.4 Provides clear and reassuring information
2. Clinical Information Gathering and Interpretation2.1 Takes a thorough paediatric history
2.2 Identifies red flags for serious illness
3. Diagnosis, Decision-Making and Reasoning3.2 Recognises common viral presentations
3.6 Differentiates viral from bacterial infections
4. Clinical Management and Therapeutic Reasoning4.1 Provides symptomatic management
4.5 Educates parents on symptom relief and warning signs
5. Preventive and Population Health5.1 Reinforces hand hygiene and vaccination recommendations
6. Professionalism6.2 Manages parental concerns with empathy and professionalism
7. General Practice Systems and Regulatory Requirements7.4 Provides appropriate documentation and follow-up advice
9. Managing Uncertainty9.2 Reassures parents while providing safety-netting strategies
10. Identifying and Managing the Patient with Significant Illness10.1 Recognises signs of serious paediatric illness requiring escalation

CASE FEATURES

  • Safety-netting and follow-up: When to return for reassessment
  • Common paediatric viral illness: Fever, cough, rhinorrhoea, mild wheezing
  • Parental anxiety: Concerns about severity and need for antibiotics
  • Paediatric red flags: Screening for dehydration, respiratory distress, and bacterial superinfection
  • Preventive health discussion: Hygiene measures, vaccination, and when to seek further care

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face-to-face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

  1. Take an appropriate history
  2. Explain your assessment, including a differential diagnosis
  3. Provide appropriate management advice
  4. Address parental concerns

SCENARIO

Liam Thompson, a 3-year-old boy, presents with his mother, Emma, who is concerned about his fever and cough for the past three days. Liam has been irritable, has had a decreased appetite, and is waking up frequently at night. His temperature at home has been around 38.5°C. He has a runny nose and mild wheezing but no difficulty breathing. Emma is worried he may need antibiotics.

The practice nurse has taken Liam’s observations:

  • Temperature: 38.3°C
  • Heart rate: 120 bpm
  • Respiratory rate: 26/min
  • Oxygen saturation: 98% on room air

PATIENT RECORD SUMMARY

Patient Details

Name: Liam Thompson
Age: 3 years
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • No known allergies

Medications

  • Nil regular medications

Past History

  • No significant medical history

Social History

  • Attends daycare 3 days per week
  • Lives with both parents and a 6-year-old sister

Family History

  • No family history of asthma or significant respiratory illness

Smoking

  • No household smoking exposure

Alcohol

  • Not applicable

Vaccination and Preventative Activities

  • Fully immunised per schedule, including influenza vaccine last season

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

Opening Line

“I’m really worried about Liam, Doctor. He’s had a fever and this awful cough for days. Does he need antibiotics?”

General Information

(Provide this freely when the candidate asks open-ended questions like “Can you tell me more about what’s been happening?”)

  • Liam has been unwell for the past three days. It started with a runny nose and mild cough, but yesterday his fever spiked to 38.5°C.
  • He has been more clingy than usual, wanting to be carried all the time.
  • He coughs more at night and when lying down.
  • He has been waking up frequently at night due to coughing fits.

Specific Information

(Only provide this when the candidate asks specific targeted questions.)

Symptoms and Severity

  • Liam’s fever responds to paracetamol, but it comes back after a few hours.
  • His runny nose started clear but has become slightly thicker in the last day.
  • The cough is wet but not barking.
  • When he runs, he seems a little out of breath but recovers quickly.
  • He has had no wheeze at rest, but Emma noticed a slight whistling sound when he was active earlier today.
  • His appetite has decreased, and he is only eating small amounts of soft foods.
  • He is drinking some water, but not as much as usual.
  • No vomiting or diarrhoea.
  • No complaints of ear pain or pulling at his ears.
  • No rash or unusual skin changes.

Red Flag Symptoms (or lack thereof)

  • He has not been excessively drowsy or lethargic.
  • He is still passing urine at least three times a day.
  • He hasn’t had any convulsions or difficulty breathing.
  • No blue lips or noisy breathing.
  • No chest pain or pulling in of the ribs when breathing.

Daycare and Family Context

  • Liam attends daycare three days a week. Several kids there have been sick with similar symptoms.
  • Emma’s friend’s child, who goes to the same daycare, was given antibiotics for a “chest infection,” and she is wondering why Liam hasn’t been prescribed any.
  • Liam’s six-year-old sister has a mild cold, but she seems to be getting better on her own.

Emotional Cues

(Show these naturally during the conversation.)

  • Worried and anxious: Emma is afraid Liam’s illness will get worse overnight.
  • Frustrated: She has taken time off work and is exhausted from the frequent night wakings.
  • Skeptical: She questions why some kids get antibiotics and others don’t.
  • Seeking reassurance: She wants to know exactly when to worry and what she should do to help Liam recover.

(If the candidate reassures you well, show slight relief, but remain mildly concerned.)

Questions for the Candidate

(Ask these at natural points in the conversation, particularly if the candidate hasn’t yet addressed them.)

  1. “How do I know if this is just a virus and not something more serious?”
  2. “Why don’t you want to give antibiotics? Will he get worse without them?”
  3. “What can I do to help his cough and fever at home?”
  4. “What if his fever doesn’t go away in a couple of days?”
  5. “When should I bring him back, or go to the hospital?”
  6. “How do I stop him from getting sick all the time? He’s always picking things up from daycare!”

Expected Responses from the Candidate

(The role-player should respond positively if the candidate explains these well.)

  • Clear differentiation between viral and bacterial infections: If the candidate explains that most childhood viral infections resolve on their own and antibiotics won’t help, Emma should still be a little unsure but mostly accepting.
  • Safety-netting advice: If the candidate outlines red flags (e.g., struggling to breathe, dehydration, fever lasting more than five days, lethargy), Emma should look relieved and say something like, “That’s good to know. I’ll watch for those things.”
  • Symptomatic management: If the candidate explains how to use paracetamol for fever, saline spray for a blocked nose, and fluids for hydration, Emma should nod and say, “Okay, I can do that.”
  • Preventative measures: If the candidate talks about hand hygiene, good nutrition, flu vaccination, and rest, Emma should seem appreciative but may say, “It’s so hard to keep him from touching everything at daycare!”

Final Concern

(If the candidate has addressed everything well, show some remaining hesitation.)

“So, just to be sure… you really don’t think he needs antibiotics? I just don’t want to miss anything serious.”

(If the candidate reassures effectively, show visible relief and say something like, “Alright, I trust you, Doctor. I’ll keep a close eye on him and bring him back if needed.”)

THE COMPETENT CANDIDATE

Task 1: Take an appropriate history from the parent regarding Liam’s symptoms and relevant background.

The competent candidate should:

  • Use open-ended questions to encourage the parent to describe Liam’s symptoms in detail.
  • Elicit information on fever pattern, cough characteristics, nasal congestion, and appetite.
  • Clarify any red flag symptoms such as breathing difficulty, dehydration, lethargy, or reduced urine output.
  • Ask about response to medications, such as paracetamol or ibuprofen.
  • Explore the duration and progression of symptoms to differentiate viral from bacterial causes.
  • Identify daycare attendance and recent exposures to illness.
  • Check vaccination status to assess risk of vaccine-preventable infections.
  • Inquire about past medical history, allergies, and family history of asthma or atopy.
  • Address parental concerns, expectations, and ideas about management.

Task 2: Explain your assessment, including a differential diagnosis and key considerations.

The competent candidate should:

  • Clearly communicate that Liam’s symptoms are consistent with a viral upper respiratory tract infection (URTI), likely caused by rhinovirus, RSV, or influenza.
  • Explain that antibiotics are not required as there are no signs of bacterial infection (e.g., pneumonia, otitis media, or tonsillitis).
  • Provide a differential diagnosis, including:
    • Viral URTI (most likely) – fever, cough, rhinorrhoea, mild wheezing.
    • Viral-induced wheeze – mild wheeze with activity but no significant respiratory distress.
    • Lower respiratory tract infection (pneumonia/bronchiolitis) – less likely given normal oxygen saturation, no increased work of breathing.
    • Bacterial superinfection (e.g., otitis media, sinusitis) – consider if symptoms worsen or persist beyond 10 days.
  • Reassure the parent that most viral infections resolve in 7–10 days but emphasise red flag symptoms requiring review.
    • Red flags include breathing difficulty, dehydration, lethargy, or reduced urine output.
    • Parental concern is also a valid red flag so should not be dismissed lightly

Task 3: Provide appropriate management advice, including symptomatic treatment and red flag symptoms.

The competent candidate should:

  • Advise symptomatic treatment including:
    • Paracetamol or ibuprofen for fever and discomfort.
    • Saline nasal spray and suction for nasal congestion.
    • Humidifier or steam inhalation to ease congestion.
    • Adequate hydration – small frequent sips of water or oral rehydration solution.
    • Rest and monitoring of symptoms at home.
  • Explain that antibiotics are ineffective against viral infections and may cause harm if overused.
  • Provide clear safety-netting advice, advising parents to return if:
    • Breathing becomes laboured, fast, or noisy.
    • Liam becomes lethargic or difficult to wake.
    • He refuses fluids or has reduced urine output.
    • Fever persists beyond five days.
  • Offer written information or a fact sheet on viral infections and fever management.

Task 4: Address parental concerns, including the role of antibiotics and when to seek further medical care.

The competent candidate should:

  • Acknowledge the parent’s anxiety and provide empathetic reassurance.
  • Explain why antibiotics are not needed, using simple language:
    • “Liam’s symptoms are most likely due to a viral infection, which will get better on its own.”
    • “Antibiotics don’t work against viruses and can cause side effects.”
  • Validate the parent’s concerns and provide evidence-based guidance.
  • Reinforce when to seek further medical attention (e.g., breathing difficulty, dehydration, persistent fever).
  • Address daycare concerns, explaining that viral infections are common and offering preventive advice (e.g., hand hygiene, flu vaccination).

SUMMARY OF A COMPETENT ANSWER

  • Takes a structured paediatric history, focusing on symptoms, red flags, and parental concerns.
  • Differentiates viral from bacterial infections, explaining the rationale clearly.
  • Provides patient-centred management, including symptom relief and safety-netting.
  • Uses clear and reassuring language, addressing parental concerns effectively.
  • Emphasises preventive strategies, such as vaccination and hygiene.

PITFALLS

  • Failure to address parental concerns – not acknowledging anxiety or explaining why antibiotics aren’t needed.
  • Incomplete history-taking – missing red flags like dehydration or respiratory distress.
  • Poor safety-netting advice – not clearly stating when to return or seek emergency care.
  • Overuse of medical jargon – using complex terms instead of simple explanations.
  • Inadequate management plan – not providing specific advice on symptom relief.

REFERENCES

MARKING

Each competency area is on the following scale from 0 to 3.

☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated

1. Communication and Consultation Skills

☐ 1.1 Communication is appropriate to the person and the sociocultural context.
☐ 1.2 Engages the patient to gather information about their symptoms, ideas, concerns, expectations of healthcare and the full impact of their illness experience on their lives.
☐ 1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

☐ 2.1 Takes a thorough paediatric history.
☐ 2.2 Identifies red flags for serious illness.

3. Diagnosis, Decision-Making and Reasoning

☐ 3.2 Recognises common viral presentations.
☐ 3.6 Differentiates viral from bacterial infections.

4. Clinical Management and Therapeutic Reasoning

☐ 4.1 Provides symptomatic management.
☐ 4.5 Educates parents on symptom relief and warning signs.

5. Preventive and Population Health

☐ 5.1 Reinforces hand hygiene and vaccination recommendations.

6. Professionalism

☐ 6.2 Manages parental concerns with empathy and professionalism.

7. General Practice Systems and Regulatory Requirements

☐ 7.4 Provides appropriate documentation and follow-up advice.

9. Managing Uncertainty

☐ 9.2 Reassures parents while providing safety-netting strategies.

10. Identifying and Managing the Patient with Significant Illness

☐ 10.1 Recognises signs of serious paediatric illness requiring escalation.

Competency at Fellowship Level

☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD