CCE-CBD-030.1

Examiner Only Information

Questions

Q1. How would you explain Emily’s condition and its expected course?

• Prompt: How do you reassure the patient that this is likely a viral illness?
• Prompt: What is the expected duration of symptoms?

Q2. What red flags or concerning features would prompt further investigation?

• Prompt: What signs would suggest a bacterial infection or complications?
• Prompt: When would you consider blood tests or imaging?

Q3. How would you manage Emily’s symptoms and concerns?

• Prompt: What symptomatic treatments would you recommend?
• Prompt: How would you address her concern about antibiotics?

Q4. What preventive measures should Emily follow to avoid spreading the infection?

• Prompt: What hygiene and isolation measures should she take?
• Prompt: When can she safely return to work?

Q5. When would you consider further review or specialist referral?

• Prompt: What clinical scenarios require escalation to hospital care?
• Prompt: When is a specialist review indicated?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Q1: How would you explain Emily’s condition and its expected course?

The competent candidate should:

• Explain the likely viral nature of the illness in simple terms:
  • “Your symptoms, including fever, fatigue, muscle aches, and sore throat, are most likely due to a viral infection such as influenza or another respiratory virus.”
  • “Viral infections typically resolve on their own without antibiotics.”
• Set expectations for symptom duration:
  • “Symptoms can last 7-10 days, with fatigue possibly persisting for longer.”
• Provide reassurance while addressing concerns:
  • “Your examination findings do not suggest a serious bacterial infection.”
  • “If symptoms worsen or new concerning signs develop, we will reassess.”

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Q2: What red flags or concerning features would prompt further investigation?

The competent candidate should:

• Signs of bacterial infection or complications:
  • Severe throat pain with exudates, difficulty swallowing (suggesting bacterial pharyngitis or quinsy).
  • Persistent high fever (>5 days) or worsening condition (suggesting secondary bacterial infection).
  • Shortness of breath, chest pain, confusion (suggesting pneumonia or severe respiratory infection).
• Indications for further tests:
  • FBC, CRP if bacterial infection suspected.
  • Throat swab if streptococcal pharyngitis suspected.
  • CXR if pneumonia suspected.

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Q3: How would you manage Emily’s symptoms and concerns?

The competent candidate should:

• Supportive care measures:
  • Paracetamol/ibuprofen for fever and pain relief.
  • Hydration and rest.
  • Saltwater gargles and lozenges for throat discomfort.
• Addressing concerns about antibiotics:
  • “Antibiotics are not needed for viral infections and can cause side effects without benefit.”
  • “We will monitor for bacterial complications, but at this stage, no antibiotics are required.”

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Q4: What preventive measures should Emily follow to avoid spreading the infection?

The competent candidate should:

• Infection control strategies:
  • Regular handwashing.
  • Avoiding close contact with vulnerable individuals.
  • Wearing a mask if coughing or sneezing.
• Return-to-work advice:
  • “You should avoid work until you have been fever-free for at least 24 hours and feel well enough to return.”

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Q5: When would you consider further review or specialist referral?

The competent candidate should:

• Urgent referral or hospitalisation if:
  • Severe respiratory distress or oxygen desaturation.
  • Signs of sepsis or severe bacterial infection.
• Specialist referral if:
  • Recurrent or prolonged viral symptoms needing immunology review.
  • Concern for post-viral complications (e.g., post-viral fatigue syndrome).

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SUMMARY OF A COMPETENT ANSWER

• Explains the viral nature of illness and expected course clearly.
• Identifies red flags that may indicate bacterial infection or complications.
• Provides symptomatic management and reassures the patient about antibiotics.
• Educates on infection control measures and return-to-work guidelines.
• Recognises when to escalate care or refer to a specialist.

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PITFALLS

• Overprescribing antibiotics without clear bacterial infection evidence.
• Failing to assess red flags that may indicate a more serious illness.
• Not providing clear advice on symptom duration and expected recovery.
• Inadequate guidance on infection control and return-to-work.

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REFERENCES

• RACGP Guidelines on Viral Illness Management
• National Prescribing Service (NPS) on Antibiotic Use
• National Institutes of Health on Viral Infections

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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 Clearly explains viral illness and symptom expectations.

2. Clinical Information Gathering and Interpretation

2.1 Identifies red flags requiring further assessment.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates viral from bacterial infections appropriately.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides symptomatic relief and avoids unnecessary antibiotics.

5. Preventive and Population Health

5.2 Advises on infection control and return-to-work recommendations.

6. Professionalism

6.3 Addresses patient concerns and expectations sensitively.

7. General Practice Systems and Regulatory Requirements

7.2 Ensures appropriate documentation of clinical findings and management plan.

9. Managing Uncertainty

9.1 Recognises when to escalate care or refer for specialist input.

10. Identifying and Managing the Patient with Significant Illness

10.3 Detects complications requiring further intervention.

Competency at Fellowship Level

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