CCE-CBD-022

Examiner Only Information

Questions

Q1. What key features in Liam’s history and examination help confirm a diagnosis of viral gastroenteritis?

• Prompt: What factors suggest a viral cause rather than bacterial or parasitic?
• Prompt: What red flags would suggest a more serious illness?

Q2. What is the appropriate management plan for Liam’s gastroenteritis?

• Prompt: What are the first-line treatments for gastroenteritis?
• Prompt: How would you address his concerns about dehydration and antibiotics?

Q3. What advice would you give Liam on preventing the spread of gastroenteritis?

• Prompt: What hygiene measures can reduce transmission?
• Prompt: What workplace considerations should be discussed?

Q4. When would you consider further investigations or referral?

• Prompt: What stool or blood tests would be indicated?
• Prompt: When should Liam be referred to the hospital?

Q5. If Liam’s symptoms persisted for more than 2 weeks, how would you modify your management?

• Prompt: What are the common causes of persistent diarrhoea?
• Prompt: What further investigations should be considered?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What key features in Liam’s history and examination help confirm a diagnosis of viral gastroenteritis?

The competent candidate should:

• History suggestive of viral gastroenteritis:
  • Acute onset (2 days) of watery diarrhoea, nausea, vomiting, and abdominal cramps.
  • No blood or mucus in stools (suggesting a non-invasive pathogen).
  • Associated mild fever (38.1°C) but no severe systemic signs.
  • Recent exposure to an infected housemate (suggestive of viral transmission).
  • Possible foodborne illness from takeaway meal within the incubation period (24 hours).
• Examination findings supporting mild dehydration:
  • Mildly dry mucous membranes, postural drop in blood pressure.
  • Tired but alert, no signs of severe dehydration (no tachycardia or hypotension).
• Red flags to exclude:
  • No severe abdominal pain, bloody diarrhoea, neurological symptoms, or persistent vomiting.
  • No recent travel or immunosuppression that would increase risk of severe bacterial/parasitic infections.

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Q2: What is the appropriate management plan for Liam’s gastroenteritis?

The competent candidate should:

• Rehydration therapy:
  • Oral rehydration solution (ORS) is preferred over plain water to replace electrolytes.
  • Small, frequent sips to prevent worsening nausea.
  • IV fluids only if severe dehydration or persistent vomiting.
• Symptomatic relief:
  • Paracetamol for fever and pain.
  • Ondansetron wafer (if nausea is limiting oral intake).
  • Loperamide avoided unless essential (e.g., travel or work commitment), as it may prolong infection.
• Antibiotics are NOT required:
  • Likely viral aetiology.
  • Reserve for bacterial infections (e.g., Shigella, Campylobacter, severe traveller’s diarrhoea).
• Expected course:
  • Self-limiting within 3-7 days.
  • Red flags requiring review: worsening dehydration, persistent fever, bloody stools.

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Q3: What advice would you give Liam on preventing the spread of gastroenteritis?

The competent candidate should:

• Hand hygiene:
  • Frequent handwashing with soap and water (not just hand sanitiser).
  • Avoid sharing utensils, towels, or drinks.
• Workplace precautions:
  • Exclude from work (especially food handling roles) for at least 48 hours post-symptom resolution.
  • Notify employer if outbreak suspected.
• Food safety:
  • Avoid preparing food for others while symptomatic.
  • Ensure proper food storage and reheating practices.

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Q4: When would you consider further investigations or referral?

The competent candidate should:

• Stool culture and microscopy if:
  • Persistent symptoms (>7 days), immunosuppression, or recent travel.
  • Bloody diarrhoea (concern for bacterial dysentery).
  • High fever (>38.5°C) or signs of systemic illness.
• Blood tests (FBC, U&E) if:
  • Severe dehydration or concern for electrolyte imbalance.
• Hospital referral if:
  • Severe dehydration (hypotension, tachycardia, confusion).
  • Persistent vomiting preventing oral hydration.

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Q5: If Liam’s symptoms persisted for more than 2 weeks, how would you modify your management?

The competent candidate should:

• Common causes of persistent diarrhoea:
  • Post-infectious irritable bowel syndrome (PI-IBS).
  • Parasitic infections (Giardia, Cryptosporidium) – consider stool microscopy and antigen testing.
  • Lactose intolerance or small intestinal bacterial overgrowth (SIBO) post-infection.
  • Inflammatory bowel disease (Crohn’s, ulcerative colitis) if bloody diarrhoea.
• Investigations for persistent symptoms:
  • Stool culture, ova and parasites, faecal calprotectin (if IBD suspected).
  • Coeliac serology if gluten sensitivity suspected.
• Management strategies:
  • Low-FODMAP diet trial if post-infectious IBS suspected.
  • Probiotics for gut microbiome recovery.

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SUMMARY OF A COMPETENT ANSWER

• Identifies viral gastroenteritis based on acute onset, exposure history, and absence of red flags.
• Provides hydration-focused management while avoiding unnecessary antibiotics.
• Educates on hygiene and workplace precautions to prevent transmission.
• Recognises when investigations or hospital referral are required.
• Considers differential diagnoses for persistent diarrhoea and plans appropriate testing.

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PITFALLS

• Overprescribing antibiotics without clear bacterial features.
• Not addressing dehydration adequately or missing red flag symptoms.
• Failing to give public health advice on hygiene and work exclusion.
• Not considering stool tests in prolonged or severe cases.

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REFERENCES

• RACGP Clinical Guidelines on Gastroenteritis Management
• National Institutes of Health on Gastroenteritis and Diarrhoea
• Australian Government Department of Health on Foodborne Illness Guidelines

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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 Engages the patient in a supportive discussion about symptoms and management.

2. Clinical Information Gathering and Interpretation

2.1 Differentiates viral vs bacterial gastroenteritis based on history and examination.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises self-limiting viral illness and avoids unnecessary investigations.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides appropriate rehydration therapy and symptomatic treatment.

5. Preventive and Population Health

5.2 Educates on hygiene and work exclusion to prevent outbreaks.

6. Professionalism

6.3 Provides patient-centred care while addressing concerns about dehydration and antibiotics.

7. General Practice Systems and Regulatory Requirements

7.2 Recognises notifiable conditions and public health responsibilities.

9. Managing Uncertainty

9.1 Determines when stool testing or specialist referral is required.

10. Identifying and Managing the Patient with Significant Illness

10.3 Recognises red flags requiring hospitalisation.

Competency at Fellowship Level

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