CCE-CBD-063

Examiner Only Information

Questions

Q1. How would you explain Michael’s diagnosis and management plan?

• Prompt: How do you explain cellulitis in simple terms?
• Prompt: What are the key points of his management?

Q2. What factors put Michael at higher risk of complications, and how would you address them?

• Prompt: How does diabetes impact wound healing and infection risk?
• Prompt: What preventive measures should he take?

Q3. What is the appropriate antibiotic choice for Michael, and how would you prescribe it?

• Prompt: What first-line antibiotic would you choose?
• Prompt: When should he seek urgent review or hospital admission?

Q4. What preventive measures should Michael follow to reduce the risk of recurrence?

• Prompt: What wound care strategies would you advise?
• Prompt: Should he receive a tetanus booster?

Q5. When would you consider referral to a hospital or specialist?

• Prompt: What are red flags that would indicate the need for IV antibiotics or surgical intervention?
• Prompt: When would you involve an infectious diseases specialist?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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Q1: How would you explain Michael’s diagnosis and management plan?

The competent candidate should:

• Explain the diagnosis in simple terms:
  • “You have cellulitis, which is a bacterial skin infection that occurs when bacteria enter through a break in the skin. In your case, the cut on your shin has become infected.”
  • “Cellulitis causes redness, swelling, warmth, and pain, and can spread if untreated.”
• Discuss the management plan:
  • Oral antibiotics (e.g., flucloxacillin or cephalexin) for 5-7 days.
  • Pain relief with paracetamol or ibuprofen.
  • Elevation of the leg to reduce swelling.
  • Daily wound care and dressing changes.
• Provide follow-up instructions:
  • “If symptoms worsen, the redness spreads rapidly, or you develop a high fever, seek urgent medical attention.”

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Q2: What factors put Michael at higher risk of complications, and how would you address them?

The competent candidate should:

• Identify risk factors:
  • Diabetes (impairs immune response and wound healing).
  • Smoking (reduces circulation and slows healing).
  • Delayed wound care (infection risk increases with time).
• Address risk factors:
  • Optimise diabetes management (monitor blood sugar levels, lifestyle advice).
  • Encourage smoking cessation (support with NRT, Quitline referral).
  • Reinforce wound care and hygiene to prevent future infections.

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Q3: What is the appropriate antibiotic choice for Michael, and how would you prescribe it?

The competent candidate should:

• First-line antibiotic therapy:
  • Flucloxacillin 500 mg QID for 5-7 days (covers Staphylococcus aureus and Streptococcus pyogenes).
  • Cephalexin 500 mg QID (if mild penicillin allergy).
• When to escalate care:
  • If worsening symptoms within 48 hours, switch to IV antibiotics.
  • If signs of sepsis (fever >38.5°C, tachycardia, confusion), refer to hospital.

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Q4: What preventive measures should Michael follow to reduce the risk of recurrence?

The competent candidate should:

• Wound care and hygiene:
  • Clean wounds immediately and apply antiseptic.
  • Keep the area dry and covered if needed.
• Tetanus vaccination:
  • Given last booster >10 years ago, administer tetanus booster today.
• Lifestyle modifications:
  • Diabetes control and smoking cessation to improve skin healing.

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Q5: When would you consider referral to a hospital or specialist?

The competent candidate should:

• Hospital referral if:
  • Rapidly spreading infection or signs of systemic illness (hypotension, confusion, high fever).
  • Necrotising fasciitis suspected (severe pain, crepitus, skin discolouration).
• Specialist referral if:
  • Recurrent cellulitis (consider vascular or lymphatic insufficiency).
  • Chronic wounds or poor healing (consider diabetes educator, wound care nurse).

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SUMMARY OF A COMPETENT ANSWER

• Explains cellulitis and its management clearly.
• Recognises risk factors (diabetes, smoking) and addresses them appropriately.
• Prescribes appropriate antibiotics based on Australian guidelines.
• Provides preventive advice on wound care, hygiene, and tetanus vaccination.
• Identifies red flags requiring escalation to hospital or specialist care.

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PITFALLS

• Failing to recognise high-risk factors (e.g., diabetes).
• Prescribing inappropriate antibiotics (e.g., not covering Staphylococcus aureus).
• Delaying hospital referral when systemic infection is present.
• Not educating on wound care and infection prevention.

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REFERENCES

• RACGP Guidelines on Skin and Soft Tissue Infections
• National Institutes of Health on Cellulitis Management
• Australian Immunisation Handbook on Tetanus Prevention

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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 cellulitis, treatment, and red flags.

2. Clinical Information Gathering and Interpretation

2.1 Identifies risk factors contributing to infection.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates cellulitis from more serious infections.

4. Clinical Management and Therapeutic Reasoning

4.1 Prescribes correct antibiotic and advises on wound care.

5. Preventive and Population Health

5.2 Provides tetanus vaccination and wound care education.

6. Professionalism

6.3 Addresses patient concerns and expectations.

7. General Practice Systems and Regulatory Requirements

7.2 Ensures appropriate antibiotic prescribing and follow-up.

9. Managing Uncertainty

9.1 Recognises when further assessment or escalation is needed.

10. Identifying and Managing the Patient with Significant Illness

10.3 Detects systemic infection requiring hospital care.

Competency at Fellowship Level

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