CASE INFORMATION

Case ID: INFECT-2025-11
Case Name: Ahmed Khan
Age: 32
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A78 (Infectious Disease NOS)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages effectively with the patient to assess infectious symptoms 1.3 Explains possible causes, transmission, and management in clear terms 1.5 Uses shared decision-making regarding investigations and treatment
2. Clinical Information Gathering and Interpretation	2.1 Conducts a structured history to identify risk factors and potential sources of infection 2.3 Recognises systemic signs of infection and assesses severity
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between bacterial, viral, and other infectious causes 3.5 Recognises when hospital admission or specialist referral is needed
4. Clinical Management and Therapeutic Reasoning	4.2 Provides appropriate initial management and treatment 4.5 Discusses antimicrobial stewardship and judicious antibiotic use
5. Preventive and Population Health	5.1 Provides advice on infection prevention and control 5.3 Identifies the need for contact tracing or public health notification if applicable
6. Professionalism	6.1 Provides reassurance while addressing patient concerns
7. General Practice Systems and Regulatory Requirements	7.1 Documents clinical findings and ensures appropriate follow-up 7.2 Completes public health notifications if indicated
9. Managing Uncertainty	9.1 Addresses diagnostic uncertainty with a structured approach to differentials and testing
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises sepsis or other life-threatening infections requiring urgent care

CASE FEATURES

Young male presenting with fever, fatigue, and generalised myalgia for five days.
Recently returned from Bali, concerned about dengue fever or other tropical infections.
No localising symptoms such as cough, sore throat, or urinary issues.
Concerned about potential serious infection vs. self-limiting viral illness.
Needs assessment for red flags and advice on testing, treatment, and follow-up.

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: Ahmed Khan
Age: 32
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Nil regular medications

Past History

No chronic illnesses
Fully vaccinated, including recent travel vaccinations

Social History

Works as a civil engineer, returned from Bali five days ago
No known sick contacts or food poisoning
No unprotected sexual contacts or recreational drug use

Family History

No known family history of autoimmune or infectious diseases

Smoking

Non-smoker

Alcohol

Drinks socially on weekends

Vaccination and Preventative Activities

Up to date with vaccinations, including COVID-19 and hepatitis A/B

SCENARIO

Ahmed Khan, a 32-year-old civil engineer, presents with a five-day history of fever, fatigue, headache, and muscle aches. He has recently returned from Bali and is concerned about dengue fever or another tropical infection.

He has had no respiratory symptoms (cough, sore throat, shortness of breath), no gastrointestinal symptoms (vomiting, diarrhoea, abdominal pain), and no urinary symptoms.

He has been taking paracetamol with some relief but remains lethargic and febrile. He is concerned about whether he needs further testing or hospital admission.

On examination, Ahmed appears mildly unwell but not in distress. His temperature is 38.5°C, and there is no rash, jaundice, or lymphadenopathy. His cardiovascular and respiratory exams are normal, and his abdomen is non-tender.

He seeks advice on whether testing is needed, possible diagnoses, and what symptoms should prompt urgent review.

EXAMINATION FINDINGS

General Appearance: Mildly unwell but alert
Vital Signs:

Temperature: 38.5°C
Heart Rate: 88 bpm
Blood Pressure: 110/70 mmHg
Respiratory Rate: 16 breaths per minute
Oxygen Saturation: 98% on room air

Examination Findings:

No pharyngeal erythema or exudates
No cervical lymphadenopathy
Chest clear, no crackles or wheeze
Abdomen soft, non-tender, no hepatosplenomegaly
No rash, no petechiae, no jaundice

EXAMINER ONLY INFORMATION

QUESTIONS

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

Prompt: How do you assess severity and risk factors for serious infection?
Prompt: What key travel-related infections should be considered?

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

Prompt: How do you differentiate between viral vs. bacterial infections in this case?
Prompt: What features would suggest dengue fever, typhoid, or other tropical diseases?

Q3. What investigations would you order to confirm the diagnosis or rule out serious infection?

Prompt: What initial blood tests would be appropriate?
Prompt: When would hospital admission be necessary?

Q4. How would you counsel Ahmed about his illness and expected course?

Prompt: How do you explain possible diagnoses and prognosis?
Prompt: What red flag symptoms would warrant urgent medical review?

Q5. What follow-up plan would you implement?

Prompt: When should he return for review?
Prompt: When would specialist referral or notification to public health authorities be required?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

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

A structured history and focused examination are essential to determine the cause, severity, and potential risks of Ahmed’s febrile illness, particularly given his recent travel.

1. History

Symptom onset and progression:
- When did the fever start? Has it been persistent, intermittent, or worsening?
- Any associated headache, myalgia, rash, or joint pain?
Travel history and exposures:
- Location: Travel to endemic areas (e.g., dengue, typhoid, malaria)?
- Activities: Mosquito bites, contaminated water/food, animal exposure?
- Vaccination status: Hepatitis A/B, typhoid, yellow fever?
Red flag symptoms:
- Severe headache, confusion, photophobia (meningitis/encephalitis).
- Persistent vomiting, severe diarrhoea, dehydration (gastroenteritis).
- Petechial rash, easy bruising, bleeding (dengue, meningococcaemia).
- Jaundice, dark urine, right upper quadrant pain (hepatitis).
Personal and social factors:
- Chronic illnesses (diabetes, immunosuppression) affecting susceptibility?
- Recent sick contacts, unprotected sex, high-risk activities?

2. Examination

General appearance: Well vs. toxic? Signs of dehydration?
Vital signs: Hypotension, tachycardia, fever pattern.
Neurological: Meningism, altered consciousness.
Skin: Rash, jaundice, bruising.
Respiratory & cardiac: Tachypnoea, crackles, murmurs.
Abdominal: Hepatosplenomegaly, tenderness.

This structured approach helps to differentiate self-limiting from serious infections requiring urgent intervention.

SUMMARY OF A COMPETENT ANSWER

Elicits symptom onset, progression, and risk factors (travel, exposures).
Screens for red flags (rash, bleeding, neurological symptoms, hypotension).
Performs a targeted examination for signs of systemic infection.
Identifies when urgent investigations or referral are needed.

PITFALLS

Failing to ask about travel exposures, insect bites, or vaccination history.
Not considering tropical infections (dengue, typhoid, malaria).
Overlooking red flag symptoms indicating severe disease.
Relying on empirical antibiotics without appropriate investigations.

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 structured history to identify risk factors and potential sources of infection.
2.3 Recognises systemic signs of infection and assesses severity.

Competency at Fellowship Level

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