EXAMINER ONLY INFORMATION

QUESTIONS

Q1. Take a focused history and explain your working diagnosis.

• Prompt: Explore symptom onset, progression, severity, and red flags.
• Prompt: Address patient’s expectations regarding treatment and timeframes.

Q2. Outline the key examination findings and explain their significance.

• Prompt: Highlight the absence of red flags and signs pointing towards a viral aetiology.
• Prompt: Explain reasoning behind not needing antibiotics or further investigations.

Q3. Develop a management plan addressing symptomatic relief and patient concerns.

• Prompt: Recommend analgesia (paracetamol/NSAIDs), hydration, rest, nasal saline sprays.
• Prompt: Discuss natural history (most viral infections resolve within 7–10 days).
• Prompt: Provide safety-netting advice (return if worsening symptoms like dyspnoea or fever >38.5°C).

Q4. Educate the patient on the risks of unnecessary antibiotic use.

• Prompt: Explain antibiotic resistance, potential side effects, and why antibiotics won’t help viral infections.
• Prompt: Reassure about recovery expectations with conservative measures.

Q5. Discuss preventive strategies to reduce the spread of respiratory infections.

• Prompt: Emphasise hand hygiene, mask use if symptomatic, covering coughs/sneezes, and staying home if unwell.
• Prompt: Encourage up-to-date influenza and COVID-19 vaccinations.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: Take a focused history and explain your working diagnosis.

The competent candidate should:

• Establish rapport and demonstrate empathy towards Peter’s concerns about his health and work commitments.
• Elicit a comprehensive history of presenting symptoms: duration (6 days), nature (dry cough, sore throat, nasal congestion), severity, associated features (fever, fatigue), and the absence of red flags (dyspnoea, chest pain, haemoptysis).
• Explore Peter’s ideas, concerns, and expectations, particularly regarding his belief that antibiotics will hasten recovery.
• Review past medical history, medication use, allergies, smoking status, and immunisation status.
• Conclude with a working diagnosis of a viral upper respiratory tract infection (URTI) based on the typical presentation and lack of bacterial infection signs.
• Explain that most viral URTIs are self-limiting and resolve within 7-10 days.

Q2: Outline the key examination findings and explain their significance.

The competent candidate should:

• Report normal vital signs: Temp 37.8°C, RR 16, HR 80, SpO2 98%.
• Discuss ENT findings: mild throat erythema without exudates, clear nasal discharge, and slightly enlarged, non-tender cervical lymph nodes.
• Emphasise chest findings: clear breath sounds, no wheeze or crepitations, no signs of pneumonia or lower respiratory infection.
• Conclude that these findings support a non-complicated viral URTI, and there is no indication for antibiotics or further investigations.

Q3: Develop a management plan addressing symptomatic relief and patient concerns.

The competent candidate should:

• Provide a clear explanation of the diagnosis and expected course of illness.
• Recommend symptomatic treatment: paracetamol or ibuprofen for fever and pain, saline nasal sprays, hydration, rest, and warm fluids.
• Address Peter’s concern about returning to work: advise rest until symptoms improve to prevent transmission.
• Discuss safety-netting: advise return if fever persists >38.5°C, dyspnoea, chest pain, or deterioration occurs.
• Reassure about recovery and highlight the self-limiting nature of the illness.

Q4: Educate the patient on the risks of unnecessary antibiotic use.

The competent candidate should:

• Explain antibiotic resistance, including the broader community impact.
• Discuss side effects of unnecessary antibiotics: gastrointestinal upset, allergic reactions, and potential antibiotic-associated diarrhoea.
• Clarify that antibiotics do not shorten recovery in viral infections.
• Emphasise trust and shared decision-making in avoiding inappropriate antibiotic use.

Q5: Discuss preventive strategies to reduce the spread of respiratory infections.

The competent candidate should:

• Encourage hand hygiene, coughing into the elbow, and use of tissues.
• Advise staying home while symptomatic to reduce transmission.
• Recommend mask-wearing in crowded spaces if symptoms persist.
• Confirm that Peter is up to date with influenza and COVID-19 vaccinations and encourage annual reviews.

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SUMMARY OF A COMPETENT ANSWER

• Clear history-taking focusing on symptoms, duration, and red flags.
• Thorough examination findings supporting a viral URTI diagnosis.
• Evidence-based management plan: symptomatic relief, patient education, and safety-netting.
• Antibiotic stewardship: educating on risks of inappropriate antibiotic use.
• Infection prevention strategies discussed and reinforced.

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PITFALLS

• Failing to address the patient’s concerns about work impact and expectations.
• Inappropriate prescribing of antibiotics without clear bacterial infection evidence.
• Omitting safety-netting advice, risking delayed recognition of complications.
• Not providing preventive health education, including vaccination and hygiene practices.

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REFERENCES

• RACGP Red Book (9th edition)
• Therapeutic Guidelines on Antibiotic
• Australian Commission on Safety and Quality in Health Care

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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 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 Performs structured history and examination of respiratory symptoms.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates viral from bacterial infections and identifies serious illness.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops evidence-based treatment plans.
4.2 Educates patient on antibiotic stewardship.

5. Preventive and Population Health

5.1 Provides advice on preventing the spread of infection (e.g., hand hygiene, mask-wearing).

6. Professionalism

6.1 Demonstrates ethical prescribing practices.

7. General Practice Systems and Regulatory Requirements

7.1 Complies with antibiotic prescribing guidelines and documentation.

9. Managing Uncertainty

9.1 Explains natural progression of illness and provides safety-netting advice.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises red flags requiring urgent care (e.g., pneumonia, sepsis).

Competency at Fellowship Level

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