CCE-CE-072 - GP Exams

CASE INFORMATION

Case ID: CCE-RESP-032
Case Name: Sarah Thompson
Age: 38
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: R81 – Respiratory Infection, 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 the diagnosis and management
2. Clinical Information Gathering and Interpretation	2.1 Takes a structured history, including symptom onset, duration, severity, and associated features 2.2 Identifies red flags for serious respiratory infections (e.g., pneumonia, COVID-19, pertussis)
3. Diagnosis, Decision-Making and Reasoning	3.1 Differentiates between upper and lower respiratory tract infections 3.2 Identifies when further investigations (e.g., chest X-ray, blood tests, swabs) or escalation of care is required
4. Clinical Management and Therapeutic Reasoning	4.1 Provides an evidence-based treatment plan, including symptom management and antibiotics if indicated 4.2 Educates the patient on recovery time, complications, and when to seek further care
5. Preventive and Population Health	5.1 Identifies risk factors for severe respiratory infections (e.g., smoking, asthma, immunosuppression) 5.2 Advises on vaccination and 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 for unresolved infections
8. Procedural Skills	8.1 Orders and interprets relevant investigations (e.g., sputum culture, viral swabs, CXR)
9. Managing Uncertainty	9.1 Recognises when to observe, prescribe, or escalate treatment
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies serious bacterial respiratory infections requiring urgent intervention

CASE FEATURES

Need for appropriate assessment, management, and safety-netting
Subacute cough, persistent for three weeks, initially mild but now worsening
Intermittent fevers and fatigue, but no severe dyspnoea or haemoptysis
Past history of asthma, with mild wheezing noted
Concerns about whether antibiotics are needed and how long symptoms will last

INSTRUCTIONS

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

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

A patient record summary is provided for your information.

Perform the following tasks:

Take an appropriate history.
Outline the differential diagnosis and key investigations required.
Address the patient’s concerns.
Develop a safe and patient-centred management plan.

SCENARIO

Sarah Thompson, a 38-year-old teacher, presents with a persistent cough for three weeks.

Her symptoms include:

Started as a mild cold, now a lingering productive cough with yellowish sputum.
Intermittent fevers but no chills or night sweats.
Occasional shortness of breath but no severe wheezing or chest pain.
Fatigue, affecting daily activities and work.

PATIENT RECORD SUMMARY

Patient Details

Name: Sarah Thompson
Age: 38
Gender: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Salbutamol inhaler (as needed, occasional use for mild asthma)

Past History

Mild asthma, triggered by colds and exercise
No previous hospitalisations or pneumonia

Social History

Primary school teacher, exposed to frequent respiratory infections
Non-smoker, drinks alcohol occasionally

Family History

Mother has COPD (ex-smoker)
No known history of lung cancer or tuberculosis

Vaccination and Preventative Activities

Up to date with influenza and COVID-19 vaccines

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’ve had this cough for three weeks now, and it just won’t go away.”

General Information

Sarah Thompson is a 38-year-old primary school teacher who presents with a persistent cough for three weeks.

Started as a mild cold with a runny nose and sore throat, which improved after a few days.
However, the cough has lingered, getting worse at night and after activity.
Cough is sometimes dry but often produces yellowish phlegm.

Specific Information

(To be revealed only when asked)

Background Information

No blood in sputum.
Occasional shortness of breath, but no severe wheezing.
Intermittent mild fevers but no chills, night sweats, or significant weight loss.
Fatigue is the most frustrating symptom, making it difficult to get through a full workday.

Her main concerns are:

“I’ve never had a cough last this long. Should I be worried?”
“Do I need antibiotics to clear this up?”
“Could this be pneumonia?”
“How much longer will this last?”
“Can I go back to work, or should I rest more?”

Cough Characteristics and Associated Symptoms

(Sarah will provide these details when asked about her symptoms.)

Cough began mild but has persisted beyond the initial cold.
Coughing fits are worse at night and when talking for long periods.
Triggers include cold air, exercise, and lying down.
Brings up yellowish mucus, but no foul smell or blood.
Occasional mild wheezing, but no severe chest tightness.
No significant difficulty breathing, just gets winded faster than usual.

Previous Treatments and Self-Care

(Sarah will share these details if asked what she has tried so far.)

Tried over-the-counter cough syrup but found it didn’t help much.
Drinks warm tea and honey, which soothes the cough temporarily.
Uses lozenges to relieve throat irritation.
Hasn’t been using her salbutamol inhaler much, but when she does, it helps slightly.
Took paracetamol for the fever, which helped.
Has been resting and drinking plenty of fluids but feels exhausted.

Impact on Work and Daily Life

(Sarah will mention this if asked how the illness is affecting her.)

Works as a teacher and struggles to get through the day without feeling drained.
Cough disrupts her classes, making teaching difficult.
Has taken two sick days but is worried about taking more time off.
Doesn’t want to risk infecting students but also doesn’t want to stay home unnecessarily.
Family is healthy—husband and kids have not been sick.

Past Medical and Family History

(Sarah will provide this information when asked about her medical background.)

Mild asthma since childhood, but well-controlled.
Only uses her salbutamol inhaler occasionally for exercise-induced symptoms.
No history of pneumonia or lung infections.
No history of tuberculosis, travel to high-risk areas, or exposure to sick contacts.
Mother has COPD from previous smoking.

Concerns About Recovery and Next Steps

(Sarah will ask about how to manage her symptoms and when she should be concerned.)

“Is there anything I can do to speed up my recovery?”
“Should I stay home from work longer, or is it okay to go back?”
“How will I know if this turns into something more serious?”
“Do I need a chest X-ray or other tests?”

Emotional Cues

Sarah is frustrated by how long the cough is lasting and is concerned about whether it is something serious.

Mild anxiety about pneumonia or another serious lung infection.
Concerned about her students and whether she should stay home longer.
Wants a clear answer on whether she needs antibiotics or if this will resolve on its own.
Feels tired and overwhelmed but not in distress.
If the doctor dismisses her concerns, she may insist on antibiotics or ask for further testing.

Questions for the Candidate

Sarah may ask some or all of the following:

“Do I need antibiotics for this cough?”
“Could this be pneumonia?”
“How long will it take for me to get better?”
“What should I do if this doesn’t improve?”
“Can I still go to work, or do I need more rest?”
“Should I be using my inhaler more?”

Expected Reactions Based on Candidate Performance

If the candidate provides a clear explanation and structured plan:

Sarah will feel reassured and willing to follow the recommended management.
She may say: “Okay, I’ll monitor my symptoms and take it easy for a few more days.”

If the candidate is vague or dismissive:

Sarah may insist on antibiotics even if not indicated.
She may feel unsure about when to seek further medical review.
She may say: “So, there’s nothing I can do except wait?”

Key Takeaways for the Candidate

Take a structured history, assessing cough duration, risk factors, and red flags.
Differentiate between viral and bacterial infections, considering pneumonia, pertussis, post-viral cough, and asthma exacerbation.
Provide clear management advice, including symptomatic relief, inhaler use, and safety-netting for worsening symptoms.
Educate on expected recovery time, self-care, and warning signs requiring further review.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including onset, progression, associated symptoms, past respiratory history, and red flags for serious illness.

The competent candidate should:

Obtain a structured respiratory history, including:
- Onset and duration (started as a mild cold, cough persisted for three weeks).
- Symptoms (productive cough with yellow sputum, mild intermittent fevers, no haemoptysis).
- Impact on daily life (fatigue affecting work, difficulty teaching due to cough).
- Past medical history (mild asthma, occasional salbutamol use).
- Family history (mother with COPD).
- Social history (schoolteacher, frequent exposure to infections, no recent sick contacts).
Screen for red flags, including:
- Severe breathlessness, pleuritic chest pain, haemoptysis, weight loss, or night sweats.
- History of recent travel, tuberculosis exposure, or immunosuppression.
Assess risk factors for complications, such as asthma exacerbation, pneumonia, or pertussis.

Task 2: Conduct a risk assessment for complications or underlying conditions and determine whether further investigations are required.

The competent candidate should:

Differentiate between common causes of a prolonged cough:
- Post-viral cough (most likely in this case).
- Asthma exacerbation (wheezing, cough worse at night).
- Pertussis (persistent, paroxysmal cough, post-tussive vomiting).
- Bacterial infection (persistent fever, worsening symptoms, consolidation on auscultation).
Determine if investigations are needed:
- No immediate need for CXR unless there are red flags (e.g., persistent fever, significant dyspnoea, haemoptysis).
- Consider nasopharyngeal swab if pertussis is suspected (due to exposure risk to students).
- Consider spirometry if concern about asthma flare-up.

Task 3: Provide a diagnosis and discuss an initial management plan, including symptomatic treatment, antibiotics if indicated, and when to escalate care.

The competent candidate should:

Explain that the most likely diagnosis is a post-viral cough, possibly with mild asthma exacerbation.
Reassure that symptoms should gradually improve but may take a few more weeks.
Prescribe symptom relief measures:
- Salbutamol inhaler if symptoms suggest mild asthma involvement.
- Honey, steam inhalation, and hydration for cough relief.
- Paracetamol or ibuprofen for fever and fatigue.
Discuss antibiotic use:
- Not recommended unless signs of bacterial pneumonia or pertussis.
- If pertussis suspected, consider a macrolide (e.g., azithromycin) to reduce transmission.
Recommend rest and gradual return to work:
- Avoid excessive voice strain.
- Monitor for worsening symptoms.

Task 4: Educate the patient on expected recovery time, self-care, and warning signs requiring urgent review.

The competent candidate should:

Explain that post-viral coughs can last up to 6-8 weeks but should gradually improve.
Advise on symptom monitoring:
- Return for review if fever persists beyond 48 hours, cough worsens, or new symptoms develop.
- Seek urgent care if experiencing breathlessness, chest pain, or coughing up blood.
Provide preventive advice:
- Stay hydrated, avoid irritants, and use steam inhalation for relief.
- Consider flu vaccination and pertussis booster if not up to date.

SUMMARY OF A COMPETENT ANSWER

Takes a structured history, identifying onset, progression, and red flags.
Differentiates between post-viral cough, asthma, pertussis, and pneumonia.
Recommends symptomatic management and avoids unnecessary antibiotics unless indicated.
Provides clear safety-netting advice on when to seek medical review.
Educates on expected recovery time and preventive strategies.

PITFALLS

Failing to assess for red flags, such as persistent fever, haemoptysis, or night sweats.
Overprescribing antibiotics, leading to unnecessary use and resistance.
Not recognising asthma involvement, potentially missing an opportunity for optimisation of inhaler use.
Failing to provide clear safety-netting, leading to delayed diagnosis if symptoms worsen.
Not considering pertussis in a schoolteacher with a prolonged cough, missing an opportunity for early detection and public health notification.

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 symptom onset, duration, severity, and associated features.
2.2 Identifies red flags for serious respiratory infections (e.g., pneumonia, COVID-19, pertussis).

3. Diagnosis, Decision-Making and Reasoning

3.1 Differentiates between upper and lower respiratory tract infections.
3.2 Identifies when further investigations (e.g., chest X-ray, blood tests, swabs) or escalation of care is required.

4. Clinical Management and Therapeutic Reasoning

4.1 Provides an evidence-based treatment plan, including symptom management and antibiotics if indicated.
4.2 Educates the patient on recovery time, complications, and when to seek further care.

5. Preventive and Population Health

5.1 Identifies risk factors for severe respiratory infections (e.g., smoking, asthma, immunosuppression).
5.2 Advises on vaccination and 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 for unresolved infections.

8. Procedural Skills

8.1 Orders and interprets relevant investigations (e.g., sputum culture, viral swabs, CXR).

9. Managing Uncertainty

9.1 Recognises when to observe, prescribe, or escalate treatment.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies serious bacterial respiratory infections requiring urgent intervention.

Competency at Fellowship Level

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