Case Information
- Case ID: AB-007
- Patient Name: Emily Roberts
- Age: 29
- Gender: Female
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: R78 – Acute Bronchitis/Bronchiolitis
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Establishing rapport, explaining the self-limiting nature of viral bronchitis, and addressing patient concerns about antibiotics |
| 2. Clinical Information Gathering and Interpretation | Taking a structured history to assess symptom severity and ruling out pneumonia or other complications |
| 3. Diagnosis, Decision-Making and Reasoning | Identifying acute bronchitis based on history and examination while differentiating from bacterial pneumonia and other respiratory conditions |
| 4. Clinical Management and Therapeutic Reasoning | Implementing evidence-based treatment, avoiding unnecessary antibiotics, and considering symptomatic relief |
| 5. Preventive and Population Health | Providing education on smoking cessation (if applicable), vaccination, and minimising transmission |
| 6. Professionalism | Managing patient expectations regarding antibiotics while maintaining shared decision-making |
| 7. General Practice Systems and Regulatory Requirements | Ensuring appropriate use of PBS-listed medications and adherence to antimicrobial stewardship guidelines |
| 9. Managing Uncertainty | Recognising red flag symptoms requiring escalation of care or further investigations |
| 10. Identifying and Managing the Patient with Significant Illness | Identifying patients at risk of complications, such as those with asthma or COPD |
Case Features
- Wants antibiotics as she is struggling to recover and has a busy work schedule.
- 29-year-old teacher presenting with a persistent cough for 10 days, initially associated with a sore throat and nasal congestion.
- No significant fever, but fatigue and occasional wheezing noted.
- Cough is worse at night and after exercise, producing clear or slightly yellow sputum.
- No breathlessness, haemoptysis, or pleuritic chest pain.
- No history of asthma, COPD, or recent travel.
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: Emily Roberts
- Age: 29
- Gender: Female
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- Nil regular medications
Past History
- No history of asthma, COPD, or immunosuppression
Social History
- Works as a teacher, frequent exposure to children with respiratory infections
- Non-smoker, occasional alcohol use
- No recent overseas travel
Family History
- No significant family history of respiratory disease
Vaccination and Preventive Activities
- Influenza vaccine: Up to date
- COVID-19 booster: Received
Scenario
Emily Roberts, a 29-year-old teacher, presents with a persistent cough lasting 10 days, following an initial sore throat, nasal congestion, and fatigue.
She is otherwise well, has no underlying respiratory conditions, and reports no significant fever, breathlessness, or chest pain. The cough is worse at night and after exertion and produces small amounts of clear or slightly yellow sputum.
Emily wants antibiotics because she is struggling to recover and is worried about missing work.
On examination:
- General appearance: Well, no respiratory distress
- Temperature: 37.3°C
- Respiratory rate: 16 breaths per minute
- Oxygen saturation: 98% on room air
- Chest examination:
- No crackles or focal findings
- Mild wheezing on forced expiration
- No signs of consolidation (no dullness to percussion, no bronchial breath sounds)
Diagnosis: Acute viral bronchitis, likely post-viral cough
Examiner Only Information
Questions
Q1. How would you confirm that this is acute bronchitis rather than pneumonia or another serious condition?
- Prompt: What features differentiate viral bronchitis from pneumonia?
- Prompt: When would you consider further investigations (e.g., chest X-ray)?
Q2. How would you counsel Emily on the role of antibiotics in acute bronchitis?
- Prompt: How do you explain the self-limiting nature of acute bronchitis?
- Prompt: What strategies can be used to reduce unnecessary antibiotic use?
Q3. What non-pharmacological and symptomatic management options would you recommend?
- Prompt: What measures can help relieve her symptoms?
- Prompt: When should she return for follow-up?
Q4. How would you address Emily’s concerns about needing to return to work?
- Prompt: What advice can you give on symptom duration and recovery?
- Prompt: When should she consider staying home to prevent transmission?
Q5. What preventive strategies would you discuss for future respiratory infections?
- Prompt: How can she reduce her risk of recurrent infections?
- Prompt: What role does vaccination play in preventing bronchitis?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1. How would you confirm that this is acute bronchitis rather than pneumonia or another serious condition?
The competent candidate should:
- Take a structured history to assess symptom progression and rule out serious infections:
- Acute bronchitis: Persistent cough lasting >5 days, typically following an upper respiratory tract infection.
- Pneumonia: Presence of fever >38°C, pleuritic chest pain, dyspnoea, rigors, or productive cough with purulent sputum.
- Influenza: Sudden onset of fever, myalgia, fatigue, typically more systemic symptoms.
- Perform a focused examination, looking for red flags:
- Normal respiratory rate, oxygen saturation, and lung auscultation findings support bronchitis.
- Crackles, bronchial breath sounds, or signs of consolidation suggest pneumonia.
- Assess risk factors for complications:
- Immunosuppression, smoking, COPD, heart failure, or recent hospitalisation.
- Consider further investigations only if:
- Symptoms persist beyond 3-4 weeks.
- Tachypnoea, hypoxia, or focal chest findings are present.
- There is concern for bacterial pneumonia (CXR indicated).
SUMMARY OF A COMPETENT ANSWER
- History supports viral bronchitis (persistent cough, no systemic illness).
- Examination findings are normal (no signs of pneumonia or respiratory distress).
- No need for imaging unless red flags are present.
- Risk factors assessed for complications or alternative diagnoses.
PITFALLS
- Failing to assess for pneumonia red flags, such as dyspnoea or pleuritic chest pain.
- Over-reliance on clinical judgement without considering red flag symptoms requiring further workup.
- Requesting unnecessary investigations, such as a chest X-ray, without indication.
- Missing underlying conditions such as asthma or COPD.
REFERENCES
- RACGP Guidelines for Acute Cough in Adults
- National Institutes of Health on Respiratory Infections
- Australian Prescriber on Acute Bronchitis Management
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.
1.3 Engages the patient to discuss concerns about their symptoms and expectations.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured and hypothesis-driven history.
2.3 Conducts an appropriate respiratory examination.
3. Diagnosis, Decision-Making and Reasoning
3.1 Differentiates acute bronchitis from pneumonia and other serious conditions.
3.5 Uses clinical reasoning to determine the need for further investigations.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD