CASE INFORMATION

Case ID: FLU-2025-07
Case Name: Jessica Martin
Age: 36
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: R80 (Influenza)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively with the patient to assess flu symptoms 1.3 Explains the natural course of influenza and management options clearly 1.5 Uses shared decision-making regarding symptomatic treatment or antiviral therapy
2. Clinical Information Gathering and Interpretation	2.1 Conducts a thorough history and examination to assess severity 2.3 Identifies risk factors for influenza complications (e.g., pregnancy, comorbidities)
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates influenza from other respiratory illnesses (e.g., COVID-19, bacterial pneumonia) 3.4 Recognises when additional investigations or hospital referral are needed
4. Clinical Management and Therapeutic Reasoning	4.2 Provides evidence-based symptomatic treatment and advice 4.5 Discusses indications for antiviral therapy (e.g., high-risk patients)
5. Preventive and Population Health	5.1 Promotes influenza vaccination 5.3 Provides public health advice on infection control and reducing transmission
6. Professionalism	6.1 Provides reassurance while addressing the patient’s concerns
7. General Practice Systems and Regulatory Requirements	7.1 Documents clinical findings and management plan clearly 7.2 Ensures appropriate public health notifications if required
9. Managing Uncertainty	9.1 Addresses patient concerns regarding influenza severity and recovery
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises when influenza is complicated by secondary bacterial infection or exacerbation of chronic disease

CASE FEATURES

Young female presenting with fever, fatigue, myalgia, and cough for three days.
Recent contact with a co-worker who had influenza.
No significant past medical history but works in childcare and is concerned about spreading the illness.
Unsure if she should take antivirals or just symptomatic treatment.
Needs education on influenza vaccination and preventing transmission.

INSTRUCTIONS

Review the following patient record summary and scenario.
Your examiner will ask you a series of questions based on this information.

You have 15 minutes to complete this case.

The time for each question will be managed by the examiner.
The time allocation for each question is roughly as follows:

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: Jessica Martin
Age: 36
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Occasionally takes paracetamol for headaches

Past History

No significant medical conditions

Social History

Works in childcare, frequently exposed to respiratory illnesses
Lives with her partner and two young children
Non-smoker, occasional alcohol consumption

Family History

No significant family history of respiratory or chronic illnesses

Smoking

Non-smoker

Alcohol

Drinks 1–2 standard drinks per week

Vaccination and Preventative Activities

Has not had the annual influenza vaccine
Up to date with other immunisations

SCENARIO

Jessica Martin, a 36-year-old childcare worker, presents with fever, fatigue, muscle aches, sore throat, and a dry cough for the past three days. She reports that a co-worker tested positive for influenza last week.

She is worried about how long she will be unwell and whether she needs antiviral medication. She has not had her influenza vaccination this year and is concerned about spreading the illness to children in her care and her own family.

On examination, she appears mildly unwell but alert. Her vital signs are stable, and her chest is clear.

She seeks advice on management, symptom relief, and return-to-work guidance.

EXAMINATION FINDINGS

General Appearance: Mildly unwell, no respiratory distress
Vital Signs:

Temperature: 38.2°C
Heart Rate: 88 bpm
Blood Pressure: 118/76 mmHg
Respiratory Rate: 16 breaths per minute
Oxygen Saturation: 98% on room air

Respiratory Examination:

No crackles or wheeze
Normal air entry bilaterally

Other Findings:

Mild pharyngeal erythema
No cervical lymphadenopathy
No rash

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What aspects of history and examination are critical in assessing this patient’s influenza?

Prompt: How do you differentiate influenza from other viral and bacterial infections?
Prompt: What factors increase the risk of influenza complications?

Q2. Based on the findings, what is your differential diagnosis, and what is your working diagnosis?

Prompt: How do you distinguish influenza from COVID-19 or bacterial pneumonia?
Prompt: When would further investigations be warranted?

Q3. How would you manage Jessica’s influenza?

Prompt: What symptomatic treatments are recommended?
Prompt: When would you consider antiviral therapy?

Q4. How would you counsel Jessica on recovery, return to work, and preventing transmission?

Prompt: What advice would you give on isolation and infection control?
Prompt: How do you address concerns about her risk of spreading influenza at work?

Q5. What preventive strategies would you discuss for future influenza seasons?

Prompt: What is the role of influenza vaccination?
Prompt: How can high-risk individuals be protected from severe illness?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What aspects of history and examination are critical in assessing this patient’s influenza?

A structured history and focused examination are essential to confirm the diagnosis of influenza, assess severity, and rule out complications.

1. History

Onset and progression: Influenza symptoms typically develop suddenly (e.g., fever, fatigue, myalgia, cough).
Exposure history: Recent contact with a confirmed case is relevant.
Risk factors for complications:
- Pregnancy, asthma, COPD, diabetes, immunosuppression, cardiovascular disease.
- Occupational exposure (e.g., working in childcare, healthcare).
Vaccination history: Has she had the annual influenza vaccine?
Symptoms suggesting complications:
- Pneumonia: Productive cough, pleuritic chest pain, dyspnoea.
- Sinusitis or otitis media: Facial pain, ear pain.
- Exacerbation of chronic conditions (e.g., worsening asthma, COPD).
Impact on daily life: Work, childcare, or caregiving responsibilities.

2. Examination

General appearance: Assess for signs of respiratory distress or dehydration.
Vital signs:
- Fever (often >38°C), tachycardia, normal/mildly elevated BP.
- Respiratory rate and oxygen saturation (rule out hypoxia).
Respiratory exam:
- Auscultation: Clear lungs support viral infection; crackles may suggest bacterial pneumonia.
- Percussion: Dullness suggests consolidation (bacterial infection).
ENT exam: Pharyngeal erythema common in viral infections.
Lymph nodes: Cervical lymphadenopathy may be present.
Neurological signs: Consider complications like influenza-associated encephalitis in severe cases.

This structured assessment confirms the diagnosis, excludes complications, and ensures appropriate management.

SUMMARY OF A COMPETENT ANSWER

Elicits symptom onset, exposure history, and vaccination status.
Identifies risk factors for severe influenza, including chronic disease and pregnancy.
Assesses for complications such as pneumonia or exacerbation of chronic illness.
Performs a focused examination, including respiratory and systemic signs.

PITFALLS

Failing to assess for complications, leading to missed pneumonia or bacterial superinfection.
Not considering influenza differentials, such as COVID-19, RSV, or bacterial infections.
Overlooking risk factors for severe disease, especially in vulnerable populations.
Not taking a vaccination history, missing an opportunity for preventive discussion.

REFERENCES

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

2. Clinical Information Gathering and Interpretation

2.1 Conducts a thorough history and examination to assess severity.
2.3 Identifies risk factors for influenza complications.

Competency at Fellowship Level

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