CASE INFORMATION

Case ID: IV-001
Case Name: Michael Thompson
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: A77 (Viral disease, other), A78 (Parasitic disease, other)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates appropriately in a culturally and linguistically sensitive manner. 1.2 Elicits relevant history, including travel, exposures, and risk factors. 1.4 Provides clear explanations and management advice.
2. Clinical Information Gathering and Interpretation	2.1 Obtains a comprehensive travel history, including destinations, timing, and exposures. 2.2 Recognises symptoms suggestive of vector-borne illness.
3. Diagnosis, Decision-Making and Reasoning	3.1 Forms an appropriate differential diagnosis, considering common and serious conditions. 3.2 Orders appropriate investigations based on clinical suspicion.
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a safe and effective management plan, including symptomatic relief and referral if needed. 4.2 Recognises and manages potential complications.
5. Preventive and Population Health	5.1 Provides education on vector-borne disease prevention.
6. Professionalism	6.1 Demonstrates professional and ethical management of a potentially infectious disease.
7. General Practice Systems and Regulatory Requirements	7.1 Recognises the need for notification to public health authorities if required.
9. Managing Uncertainty	9.1 Appropriately considers possible causes in the absence of a clear diagnosis.
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises red flags for severe vector-borne diseases requiring escalation.

CASE FEATURES

Public health implications: possibility of a notifiable disease.
A 34-year-old male presenting with fever, headache, and body aches after returning from Indonesia.
Possible exposure to mosquito-borne diseases such as Dengue, Malaria, or Chikungunya.
Unclear onset and progression of symptoms.
Potential red flags: persistent fever, dehydration, altered mental state.

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.

Perform the following tasks:

Take an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

Michael Thompson, a 34-year-old teacher, presents with fever, fatigue, and muscle aches. He recently returned from Bali, Indonesia, where he spent two weeks on holiday. He reports feeling generally unwell for the past five days.

Michael is worried about Dengue fever but is unsure whether his symptoms match. He mentions having multiple mosquito bites while overseas but did not take malaria prophylaxis.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Thompson
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies (NKDA)

Medications

Nil regular medications

Past History

No significant medical history

Social History

Works as a high school teacher.

Family History

No family history of tropical diseases.

Smoking and Alcohol

Non-smoker
Occasional alcohol consumption

Vaccination and Preventative Activities

Up to date with routine vaccinations but no travel vaccines taken.

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.

ROLE-PLAYER SCRIPT

Opening Line

“Hi Doctor, I’ve been feeling awful since I got back from Bali, and I’m really worried I might have Dengue fever.”

General Information

(To be freely provided when asked open-ended questions)

You recently returned from a two-week holiday in Bali, Indonesia with your partner and some friends.
You felt completely fine during the trip but started feeling unwell about five days ago, two days after returning home.
You noticed multiple mosquito bites on your legs and arms but didn’t think much of it at the time.
You did not take malaria prophylaxis or get any travel vaccinations before going.
You stayed at a mix of hotels and Airbnbs and spent a lot of time outdoors, including visiting rice fields and hiking near waterfalls.
You drank bottled water while in Bali but ate street food a few times.

Specific Information

(Only revealed if directly asked by the candidate)

Symptoms

Main Complaints:

Fever that started five days ago, initially mild but now reaching 38.5°C.
Severe headache, mainly behind the eyes.
Muscle aches and joint pain, mostly in the legs and lower back.
Fatigue and exhaustion, feeling wiped out all day.
Mild nausea, but no vomiting.
Mild loss of appetite.
No diarrhoea, cough, or sore throat.
No skin rash, no bleeding, no bruising.
No chills or night sweats.

Red Flags (If the doctor asks about severe symptoms):

No vomiting blood or passing black stools.
No shortness of breath or chest pain.
No seizures, confusion, or dizziness.
No severe abdominal pain.

Concerns & Emotional Cues

Concerned about Dengue fever: You read about it online and saw reports of cases in Bali. You know someone who had it before and said it was horrible.
Worried about Malaria: You realise you didn’t take malaria tablets and wonder if this could be it.
Anxious about spreading illness to your family: You live with your partner and two-year-old child, and you’re worried they might get sick too.
Frustrated about missing work: You are a high school teacher, and you have already called in sick for two days. You don’t want to miss more days but feel too unwell to go back yet.
Wondering if you need to go to the hospital: You feel awful but aren’t sure if it’s serious enough for hospital admission.

Questions for the Candidate

“Do I need to be tested for Dengue?”
“Could this be Malaria? I didn’t take any tablets.”
“Can I pass this on to my family?”
“Do I need to go to the hospital?”
“How long is this going to last?”

Emotional Cues and Body Language

Appears tired and sluggish, leaning slightly forward with low energy.
Frequently rubs forehead and temples due to the headache.
Occasionally shifts uncomfortably due to muscle and joint pain.
Speaks with a slightly strained voice, indicating fatigue and mild frustration.
Looks worried when discussing family exposure and missing work.
Slightly relieved if reassured that symptoms will improve with time.

Key Responses to Expect from the Doctor

History-taking:
- The doctor should ask about travel history, mosquito bites, and potential exposures.
- They should rule out other tropical diseases and assess severe symptoms that may require hospitalisation.
Diagnostic Plan:
- The doctor should explain the possible causes, including Dengue, Malaria, or Chikungunya.
- They should recommend blood tests, including FBC (platelets), LFTs, and Dengue/Malaria screening.
Management and Advice:
- The doctor should discuss supportive care: hydration, rest, paracetamol (but NOT NSAIDs if Dengue is suspected).
- They should advise on red flags for severe illness, such as bleeding, worsening fever, or confusion.
Preventive Advice:
- The doctor should educate on mosquito bite prevention for future travel.

Closing Statements

If the doctor explains things well and provides a clear plan, you feel more reassured but still tired.
If the doctor downplays your concerns, you may insist on testing and ask, “Are you sure I don’t need anything else?”
If the doctor suggests hospitalisation, you might hesitate at first, but agree if symptoms worsen.
Before leaving, you ask, “So just to confirm, what exactly should I watch out for?”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient regarding their symptoms and travel history.

The competent candidate should:

Establish travel history including destinations, duration, accommodations, and activities.
Ask about mosquito exposure and whether insect repellent or protective measures were used.
Inquire about pre-travel vaccinations and malaria prophylaxis.
Explore timeline of symptoms (fever, headache, muscle pain, nausea, rash, etc.).
Ask about red flag symptoms (bleeding, persistent vomiting, confusion, severe dehydration).
Assess for other potential causes of fever in travellers, including foodborne illnesses or other infections.
Explore impact on daily activities, including work and home responsibilities.

Task 2: Explain your differential diagnosis to the patient and justify your reasoning.

The competent candidate should:

Explain that Dengue fever is the most likely based on travel history, fever, headache, muscle pain, and onset after returning.
Discuss Malaria as a possibility, especially with fever and no prophylaxis.
Consider Chikungunya or other viral infections due to joint pain and travel to an endemic area.
Explain less likely diagnoses such as foodborne illnesses (e.g., Salmonella, Typhoid) or COVID-19.
Justify testing based on symptom severity, risk factors, and need for confirmation.

Task 3: Outline your management plan, including investigations, treatment, and safety-netting.

The competent candidate should:

Investigations: Request FBC, LFTs, Dengue NS1 antigen, Dengue IgM/IgG, Malaria thick and thin films, and CRP.
Treatment:
- Supportive care: Ensure adequate hydration, rest, and analgesia (paracetamol, NOT NSAIDs if Dengue is suspected).
- Symptom relief: Manage fever and pain with paracetamol, encourage small frequent meals if nausea is present.
Safety-netting and follow-up:
- Educate on red flags: worsening fever, bleeding gums, persistent vomiting, severe abdominal pain, confusion.
- Arrange urgent review if symptoms deteriorate.
- Advise strict avoidance of NSAIDs (e.g., ibuprofen, aspirin) due to risk of bleeding.

Task 4: Provide advice on preventing mosquito-borne diseases for future travel.

The competent candidate should:

Emphasise mosquito bite prevention:
- Use DEET-based repellents and wear long-sleeved clothing.
- Sleep under mosquito nets in endemic areas.
- Stay in air-conditioned or screened accommodations.
Discuss travel vaccinations (e.g., Yellow Fever if applicable).
Advise on malaria prophylaxis for high-risk areas in the future.
Encourage a pre-travel GP consultation for vaccinations and tailored health advice.

SUMMARY OF A COMPETENT ANSWER

Thorough travel history including exposures, accommodations, and preventive measures.
Comprehensive symptom assessment, covering timeline, severity, and red flags.
Clear differential diagnosis, prioritising Dengue fever, Malaria, and other travel-related infections.
Structured management plan, including investigations, supportive care, and safety-netting.
Preventive advice on mosquito avoidance and pre-travel health measures.

PITFALLS

Failing to consider other tropical illnesses (e.g., Malaria, Chikungunya, Zika virus).
Over-reliance on self-diagnosis instead of appropriate testing.
Not advising against NSAID use when Dengue fever is suspected.
Not explaining red flag symptoms that require urgent medical review.
Missing an opportunity for travel health education and future risk reduction.

REFERENCES

MARKING

Each competency area is assessed on a 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 Gathers and interprets information relevant to the presentation, considering epidemiology and red flag symptoms.

3. Diagnosis, Decision-Making and Reasoning

3.2 Prioritises Dengue fever as the most likely diagnosis while considering differentials such as Malaria and Chikungunya.

4. Clinical Management and Therapeutic Reasoning

4.3 Develops a clear investigation and management plan, including testing, supportive treatment, and follow-up advice.

5. Preventive and Population Health

5.1 Provides future travel health advice, including mosquito prevention and vaccinations.

6. Professionalism

6.3 Demonstrates duty of care by safety-netting and addressing patient concerns.

9. Managing Uncertainty

9.1 Recognises the need for diagnostic testing to confirm the underlying illness.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies red flags that may require escalation (e.g., severe Dengue).

Competency at Fellowship Level

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