CCE-CBD-205 - GP Exams

CASE INFORMATION

Case ID: BURNS-001
Case Name: Jackson Miller
Age: 3 years
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2024
ICPC-2 Codes: S18 (Burns and Corrosions)

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Communicates effectively with distressed caregivers 1.2 Uses age-appropriate language to engage with a young child 1.3 Provides clear and empathetic explanations of diagnosis and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a structured history to determine burn cause, severity, and risk factors 2.2 Conducts a thorough physical examination including burn depth assessment 2.3 Identifies red flags requiring escalation of care
3. Diagnosis, Decision-Making and Reasoning	3.1 Classifies burns based on depth, extent (Total Body Surface Area – TBSA), and location 3.2 Recognises indications for hospital referral 3.3 Identifies potential complications such as infection and dehydration
4. Clinical Management and Therapeutic Reasoning	4.1 Provides initial first aid and pain management 4.2 Formulates an appropriate wound care plan 4.3 Advises on follow-up and monitoring for complications
5. Preventive and Population Health	5.1 Provides burn prevention education to caregivers 5.2 Discusses household safety modifications
6. Professionalism	6.1 Demonstrates empathy and cultural sensitivity when communicating with caregivers
7. General Practice Systems and Regulatory Requirements	7.1 Ensures accurate documentation and appropriate referral if required
8. Procedural Skills	8.1 Demonstrates appropriate wound dressing techniques for minor burns
9. Managing Uncertainty	9.1 Recognises when escalation of care is required
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies burns that require emergency management

CASE FEATURES

Paediatric burn case requiring assessment, classification, and management.
Parental distress requiring empathetic communication.
Consideration of child safety and household risk factors.
Decision-making regarding referral based on burn severity.

CANDIDATE INFORMATION

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: Jackson Miller
Age: 3 years
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known allergies

Medications

None

Past History

No significant past medical history
Normal growth and development

Social History

Lives with both parents and an older sibling (5 years)
Mother is a stay-at-home parent; father works full-time
No history of family violence or neglect

Family History

No relevant family medical conditions

Smoking

No exposure to household smoking

Alcohol

No household concerns related to alcohol use

Vaccination and Preventative Activities

Up to date with routine childhood immunisations

SCENARIO

Jackson, a 3-year-old boy, presents with his distressed mother after sustaining a hot tea burn to his left forearm. His mother reports that he accidentally pulled a mug off the kitchen bench, spilling hot tea onto his arm. She immediately ran cool tap water over the burn for 5 minutes but was unsure how long was needed.

On examination, there is a partial-thickness burn (erythematous with blistering) covering approximately 4% of his Total Body Surface Area (TBSA). Jackson is crying and appears distressed, with mild pain upon touch but no signs of systemic illness.

Your role is to assess the severity of Jackson’s burn, manage his pain and wound, determine whether he requires hospital referral, and provide parental education on wound care and burn prevention.

EXAMINATION FINDINGS

General Appearance: Distressed but alert, responding appropriately to surroundings
Temperature: 36.8°C
Blood Pressure: Not routinely measured in a 3-year-old
Heart Rate: 110 bpm (within normal range for age)
Respiratory Rate: 22 breaths per minute (within normal range)
Oxygen Saturation: 98% on room air
Weight: 14 kg (50th percentile for age)
Burn Examination:

Location: Left forearm
Size: ~4% TBSA (Wallace rule of nines adjusted for paediatrics)
Depth: Partial thickness (blisters, erythema, pain on touch)
Surrounding tissue: No signs of infection or full-thickness involvement
Capillary Refill: Normal
Signs of dehydration: None

EXAMINER ONLY INFORMATION

QUESTIONS

Q1. What are the key components of assessing Jackson’s burn severity?

Prompt: What factors determine the severity of a burn?
Prompt: How do you classify burns based on depth and TBSA?

Q2. How would you manage Jackson’s burn in the general practice setting?

Prompt: What are the immediate first-aid steps?
Prompt: How would you manage pain and dress the wound?

Q3. What criteria would indicate the need for hospital referral in this case?

Prompt: Which burns require specialist management?
Prompt: Does Jackson’s burn meet any referral criteria?

Q4. How would you educate Jackson’s mother on home care and wound monitoring?

Prompt: What advice would you give on dressing changes and signs of infection?
Prompt: How would you counsel on pain relief and bathing?

Q5. What preventive advice would you provide to reduce the risk of future burns?

Prompt: What home modifications can reduce paediatric burn risk?
Prompt: What specific advice should parents follow regarding hot liquids?

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Q1: What are the key components of assessing Jackson’s burn severity?

A systematic approach is essential when assessing paediatric burns. The Australian & New Zealand Burn Association (ANZBA) guidelines provide an evidence-based framework.

1. History-Taking

Mechanism of injury: Hot tea spill, contact time, first aid provided.
Timing of burn: Determines evolution of symptoms.
Pain assessment: Guides burn depth classification.
Risk factors: Previous burns, developmental stage (accidental vs non-accidental injury).
Immunisation status: Particularly tetanus.

2. Examination Findings

Burn Depth:
- Superficial: Red, painful, no blisters.
- Superficial partial-thickness: Blisters, moist, painful.
- Deep partial-thickness: Pale, sluggish capillary refill, reduced sensation.
- Full-thickness: White/charred, leathery, no pain.
Total Body Surface Area (TBSA):
- Wallace Rule of Nines (adjusted for paediatrics).
- Palmar method (child’s palm ≈ 1% TBSA).
Location and Special Considerations:
- High-risk areas: Face, hands, feet, perineum, major joints.
- Circumferential burns: Risk of compartment syndrome.
Signs of Infection or Systemic Involvement: Fever, erythema, worsening pain.

Conclusion: Jackson has a superficial partial-thickness burn (blisters, pain) covering 4% TBSA on the forearm, requiring local wound care and close monitoring.

Q2: How would you manage Jackson’s burn in the general practice setting?

1. Immediate First Aid

Cool running water for at least 20 minutes (if within 3 hours of injury).
Avoid ice or greasy substances.

2. Pain Management

Paracetamol or ibuprofen for mild pain.
Consider oral opioids for moderate pain.

3. Wound Care

Debridement of ruptured blisters (intact blisters may be left intact).
Apply hydrogel or non-adherent dressing (e.g., Bactigras, Mepilex).
Secure with secondary dressing and avoid tight bandaging.

4. Infection Prevention

Tetanus booster if indicated.
Oral antibiotics not routinely required unless infection signs present.

5. Follow-up

Review in 48 hours to reassess healing and signs of infection.
Advise on signs requiring urgent review: Increased pain, swelling, fever.

Conclusion: Jackson’s burn can be managed conservatively in general practice with dressing, pain relief, and close monitoring.

Q3: What criteria would indicate the need for hospital referral in this case?

According to ANZBA referral guidelines, hospital referral is required for:

Burns >5% TBSA in children.
Full-thickness burns.
Burns to high-risk areas (face, hands, feet, perineum, major joints).
Inhalation injury (e.g., soot in nostrils, respiratory distress).
Circumferential burns (risk of compartment syndrome).
Non-accidental injury concerns.
Infection or inadequate healing at follow-up.

Conclusion: Jackson’s burn does not require referral based on size, depth, and location, but he requires monitoring for complications.

Q4: How would you educate Jackson’s mother on home care and wound monitoring?

1. Dressing and Care

Keep the dressing dry and intact.
Change dressings every 2–3 days or earlier if soiled.

2. Signs of Infection

Redness, swelling, increased pain, pus.
Fever or systemic symptoms.

3. Pain Management

Continue regular paracetamol or ibuprofen.
Avoid popping blisters.

4. Follow-up Plan

Review in 48 hours.
Escalate if signs of infection or delayed healing.

Conclusion: Clear wound care instructions, infection monitoring, and follow-up plans are crucial for optimal healing.

Q5: What preventive advice would you provide to reduce the risk of future burns?

1. Safe Kitchen Practices

Keep hot drinks out of reach.
Use child-proof locks on kitchen cupboards.
Avoid tablecloths that children can pull.

2. Bath Safety

Check water temperature (<50°C).
Use cold water first when filling a bath.

3. Emergency Response

If a burn occurs, apply cool running water for 20 minutes.
Do not use ice, butter, or creams.

Conclusion: Prevention strategies reduce the risk of future burns by modifying the home environment and teaching correct first aid.

SUMMARY OF A COMPETENT ANSWER

Systematic assessment of burn depth, TBSA, and risk factors.
Evidence-based management with cooling, dressing, and pain relief.
Appropriate hospital referral criteria based on ANZBA guidelines.
Clear, empathetic communication with parents about home care.
Strong emphasis on burn prevention strategies.

PITFALLS

Failing to cool the burn properly (running water for <20 minutes).
Overlooking infection signs or missing red flags.
Inappropriate dressing selection (e.g., dry gauze instead of non-adherent dressings).
Not considering non-accidental injury in a young child.
Failing to educate caregivers on prevention and first aid.

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

Competency at Fellowship Level

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