CCE-CE-065.1 - GP Exams

CASE INFORMATION

Case ID: CCE-ENDO-025
Case Name: Mark Johnson
Age: 50
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: T99 – Endocrine/Metabolic/Nutritional Disease, Other

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Establishes rapport and engages the patient 1.2 Explores the patient’s concerns, ideas, and expectations 1.3 Provides clear and structured explanations about diagnosis, prognosis, and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a structured history, including risk factors, symptom progression, and family history 2.2 Identifies key clinical features and relevant investigations for metabolic disorders
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between different metabolic and endocrine disorders 3.2 Identifies when further investigations or specialist referral is required
4. Clinical Management and Therapeutic Reasoning	4.1 Provides an evidence-based management plan, including lifestyle and pharmacological interventions 4.2 Educates the patient on chronic disease management and prevention of complications
5. Preventive and Population Health	5.1 Identifies lifestyle and dietary risk factors contributing to metabolic disease 5.2 Advises on long-term prevention strategies
6. Professionalism	6.1 Demonstrates empathy and a patient-centred approach
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate documentation and follow-up of metabolic disorder management
8. Procedural Skills	8.1 Orders and interprets relevant investigations (e.g., blood tests for metabolic function)
9. Managing Uncertainty	9.1 Recognises when symptoms require urgent intervention versus ongoing monitoring
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies severe metabolic disorders requiring escalation of treatment

CASE FEATURES

Needs education on lifestyle changes and long-term risk reduction
Recent weight gain, fatigue, and muscle cramps
Concerns about possible metabolic syndrome or thyroid dysfunction
History of poor diet and sedentary lifestyle

INSTRUCTIONS

You have 15 minutes to complete the tasks for this case.

You should treat this consultation as if it is face to face.

You are not required to perform an examination.

A patient record summary is provided for your information.

Perform the following tasks:

Take an appropriate history, including risk factors, symptom progression, and lifestyle factors.
Differentiate between potential metabolic and endocrine conditions, identifying any red flags requiring urgent management.
Provide a diagnosis and discuss an initial management plan, including lifestyle and pharmacological interventions if needed.
Educate the patient on diet, exercise, and the importance of long-term monitoring and follow-up.

SCENARIO

Mark Johnson, a 50-year-old accountant, presents with recent weight gain, fatigue, and muscle cramps over the past six months. He is concerned about his metabolism slowing down and wonders if he has a thyroid problem or another metabolic condition.

He has noticed:

Gradual weight gain of 7 kg despite no major dietary changes.
Persistent fatigue, even after a full night’s sleep.
Muscle cramps and occasional tingling in his hands and feet.
Dry skin and mild hair thinning.

His main concerns are:

“Is this my thyroid? My mum had thyroid problems.”
“Why am I gaining weight even though I don’t eat that much?”
“Do I need medication, or can I fix this with lifestyle changes?”
“Could this be something serious?”

PATIENT RECORD SUMMARY

Patient Details

Name: Mark Johnson
Age: 50
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Nil regular medications

Past History

Hypertension (diagnosed three years ago, well controlled with diet)
Mild dyslipidaemia (borderline cholesterol levels, not on medication)

Social History

Sedentary lifestyle, works long hours at a desk.
Diet high in processed foods, often eats takeout due to work schedule.
Drinks 2–3 beers on weekends, no smoking.
Married with two children, busy family life.

Family History

Mother had hypothyroidism.
Father had type 2 diabetes.

Vaccination and Preventative Activities

Last blood tests two years ago (no significant abnormalities at the time).
Up to date with vaccinations.

ROLE PLAYER INSTRUCTIONS

Just like a consultation with a doctor, the candidate will ask you a series of questions.
The OPENING LINE is always to be said exactly as written. This is the only part of the script
which will be the same for all candidates. Where the candidate goes after the opening line is
up to them.

The remainder of the information is to be given based on the questions asked by the
candidate.

The information in the following script are core pieces of information. The core pieces of
information will not necessarily follow the order in the script but should be given when cued
by the candidate’s question.

GENERAL INFORMATION can be given relatively freely. After the opening line, most
candidates will ask an open question like “Can you tell me more about that?” You can provide
the GENERAL INFORMATION in response to that sort of question.

SPECIFIC INFORMATION should only be given when the candidate asks a relevant question.
Candidates don’t need to ask for all the information in the SPECIFIC INFORMATION section,
but all the relevant information is given there should they want to.

Each line or dot point in the SPECIFIC INFORMATION section is an appropriate chunk of
information which can be provided to the candidate when asked a relevant question.

Do not give extra information than asked.

Do not provide details which are not given in the information chunks (i.e.: do not elaborate
or ad-lib).

If the candidate asks a question that is not given in the script, the best way to respond is with
a generic response indicating there is no problem. For example:

Candidate: “How many hours do you sleep?”
Response: “I’m sleeping fine.” / “I don’t have any concerns about my sleep.”

The case may have specific QUESTIONS to ask the candidate. You can start asking the
QUESTIONS if the candidate asks about your ideas or concerns or questions.

Ask the other questions in a conversational way. You do not need to ask all the questions. The
aim should be to ask most of the questions but without interrupting the candidate.

The Patient Record Summary is also included. This is not part of the script but is included for
your general information.

If you need help in understanding any of the medical information in the script, ask the College
examiner who will be with you, and they can help to explain the terms or the conditions.

SCRIPT FOR ROLE-PLAYER

Opening Line

“Doctor, I feel like my metabolism has slowed down. I’ve gained weight, I’m always tired, and my muscles cramp up a lot. Do you think I have a thyroid problem?”

General Information

Mark Johnson is a 50-year-old accountant who has been experiencing weight gain, fatigue, and muscle cramps for the past six months.

Gained about 7 kg despite no major dietary changes.
Feels tired all the time, even after a full night’s sleep.
Experiencing muscle cramps, particularly in his legs, and occasional tingling in his hands and feet.
Noticed his skin has become drier, especially in winter.
Feels his hair is thinning slightly, but no bald patches.

His main concerns are:

“Is this my thyroid? My mum had thyroid problems.”
“Why am I gaining weight even though I don’t eat that much?”
“Do I need medication, or can I fix this with lifestyle changes?”
“Could this be something serious?”

Specific Information (To be revealed only when asked)

Weight Gain and Diet

Weight gain has been gradual over six months.
Eats out for lunch most days, often sandwiches, fast food, or pre-made meals.
Evening meals are home-cooked but portion sizes may be too large.
Has a sweet tooth but doesn’t eat desserts daily.
Drinks alcohol on weekends (2–3 beers).

Exercise and Activity Levels

Sedentary job, sits at a desk most of the day.
Tries to walk occasionally but not consistently active.
Feels too tired most days to exercise.

Medical and Family History

No diagnosed thyroid disease but mother had hypothyroidism.
Father had type 2 diabetes and Mark is worried he may be at risk.
Has hypertension and mild dyslipidaemia but not on medication.
No previous history of anaemia, vitamin deficiencies, or kidney disease.
No recent infections except a mild cold last month.

Symptoms in More Detail

Fatigue has worsened over time, particularly in the afternoon.
No brain fog or memory issues but feels a bit sluggish mentally.
No cold intolerance, constipation, or significant hair loss.
No palpitations, tremors, or sweating.
No joint pain, stiffness, or changes in bowel habits.

Concerns About Diagnosis and Management

Worried about metabolic syndrome or prediabetes.
Concerned that he may need lifelong medication.
Asks if supplements could help.
Wants to know what blood tests should be done.

Emotional Cues

Mark is concerned but open to lifestyle changes.

Frustrated by weight gain: “I don’t eat that much, so why am I still gaining weight?”
Worried about underlying conditions: “I feel tired all the time. Could this be something serious?”
Seeking reassurance: “Can I fix this without needing lifelong medication?”

If the candidate provides a structured explanation and management plan, Mark will be reassured and open to making changes.

If the candidate is dismissive or vague, Mark may become more anxious and push for unnecessary medications or investigations.

Questions for the Candidate

Mark will ask some of the following questions, especially if the doctor does not address them directly:

“Is this my thyroid?”
“Do I need blood tests?”
“How can I lose weight if my metabolism is slow?”
“Could this be prediabetes?”
“What happens if I don’t make any changes?”
“Do I need to see a specialist?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

Mark will feel reassured and motivated to improve his lifestyle.
He may say, “Okay, I’ll try exercising more and changing my diet.”

If the candidate is vague or dismissive:

Mark may insist on unnecessary testing or medications.
He may say, “So, you don’t think this is serious?”

Key Takeaways for the Candidate

Take a structured metabolic history, identifying risk factors and symptoms.
Differentiate between thyroid dysfunction, metabolic syndrome, and other causes.
Provide an evidence-based management plan, including lifestyle and pharmacological interventions if needed.
Educate on long-term prevention and monitoring.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including risk factors, symptom progression, and lifestyle factors.

The competent candidate should:

Elicit a structured history, including:
- Onset and progression of symptoms (fatigue, weight gain, muscle cramps over six months).
- Dietary habits and exercise routine (sedentary lifestyle, processed food intake, frequent eating out).
- Risk factors for metabolic disorders (family history of diabetes and hypothyroidism).
- Presence of other metabolic symptoms (hair thinning, dry skin, tingling in extremities).
Identify red flags that require further investigation:
- Rapid weight gain, severe fatigue, significant hair loss, or neurological symptoms.
- Significant polyuria, polydipsia, or postural dizziness suggesting diabetes or adrenal insufficiency.

Task 2: Differentiate between potential metabolic and endocrine conditions, identifying any red flags requiring urgent management.

The competent candidate should:

Consider differential diagnoses:
- Hypothyroidism (weight gain, fatigue, dry skin, muscle cramps, family history).
- Metabolic syndrome (weight gain, hypertension, dyslipidaemia, prediabetes).
- Vitamin D or calcium deficiency (muscle cramps and tingling).
- Anaemia (B12 or iron deficiency) (fatigue and neurological symptoms).
Identify red flags requiring urgent referral:
- Severe unexplained weight loss (concern for malignancy, uncontrolled diabetes).
- Marked neurological deficits (concern for neuropathy, B12 deficiency, or stroke).

Task 3: Provide a diagnosis and discuss an initial management plan, including lifestyle and pharmacological interventions if needed.

The competent candidate should:

Explain likely diagnoses:
- Suspected metabolic syndrome with possible hypothyroidism or early diabetes.
- Possible nutritional deficiency (e.g., vitamin D, B12) contributing to symptoms.
Outline initial investigations:
- Fasting blood glucose, HbA1c, lipid profile to assess for diabetes and metabolic syndrome.
- TSH, free T4 to assess for hypothyroidism.
- Vitamin D, calcium, B12, and iron studies if deficiencies are suspected.
Discuss lifestyle modifications:
- Dietary changes (reduce processed foods, increase fibre, protein, and healthy fats).
- Exercise recommendations (gradual increase in activity levels, weight resistance training).
- Weight management strategies (portion control, avoiding late-night eating).

Task 4: Educate the patient on diet, exercise, and the importance of long-term monitoring and follow-up.

The competent candidate should:

Explain the role of lifestyle in metabolic health:
- Poor diet and inactivity contribute to weight gain and metabolic disorders.
- Exercise improves insulin sensitivity and metabolic rate.
Provide structured dietary advice:
- Increase whole foods, limit sugar and refined carbohydrates.
- Encourage home-cooked meals over processed food options.
Discuss follow-up and ongoing monitoring:
- Review blood test results in 2–4 weeks.
- Consider endocrine referral if thyroid dysfunction or diabetes is confirmed.
- Regular monitoring of weight, blood pressure, and metabolic parameters.

SUMMARY OF A COMPETENT ANSWER

Takes a structured metabolic history, identifying risk factors, symptoms, and lifestyle habits.
Considers metabolic syndrome, hypothyroidism, and nutritional deficiencies as differential diagnoses.
Orders appropriate investigations, including blood glucose, thyroid function, and vitamin levels.
Provides structured lifestyle modification advice, including dietary changes and exercise recommendations.
Ensures follow-up for blood test results and ongoing metabolic monitoring.

PITFALLS

Failing to assess for red flags, leading to missed serious conditions (e.g., undiagnosed diabetes or thyroid disease).
Over-reliance on medication without addressing lifestyle factors, missing opportunities for long-term prevention.
Not considering multiple possible causes of symptoms, leading to misdiagnosis (e.g., assuming weight gain is purely lifestyle-related without checking for hypothyroidism).
Not providing clear follow-up recommendations, leaving the patient uncertain about next steps.
Overprescribing unnecessary tests, increasing healthcare costs without clear clinical justification.

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

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.
1.3 Provides clear and structured explanations about diagnosis, prognosis, and management.

2. Clinical Information Gathering and Interpretation

2.1 Takes a structured history, including risk factors, symptom progression, and family history.
2.2 Identifies key clinical features and relevant investigations for metabolic disorders.

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between different metabolic and endocrine disorders.
3.2 Identifies when further investigations or specialist referral is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an evidence-based management plan, including lifestyle and pharmacological interventions.
4.2 Educates the patient on chronic disease management and prevention of complications.

5. Preventive and Population Health

5.1 Identifies lifestyle and dietary risk factors contributing to metabolic disease.
5.2 Advises on long-term prevention strategies.

6. Professionalism

6.1 Demonstrates empathy and a patient-centred approach.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and follow-up of metabolic disorder management.

8. Procedural Skills

8.1 Orders and interprets relevant investigations (e.g., blood tests for metabolic function).

9. Managing Uncertainty

9.1 Recognises when symptoms require urgent intervention versus ongoing monitoring.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies severe metabolic disorders requiring escalation of treatment.

Competency at Fellowship Level

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