CCE-CE-085

CASE INFORMATION

Case ID: CCE-2025-002
Case Name: Michael Thompson
Age: 45
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: U99 (Chronic Kidney Disease), U94 (Polycystic Kidney Disease)

COMPETENCY OUTCOMES

Competency DomainCompetency Element
1. Communication and Consultation Skills1.1 Engages the patient to understand their ideas, concerns, and expectations.
1.3 Explains the diagnosis and management plan in a patient-centred manner.
1.5 Communicates risk effectively and facilitates behaviour change.
2. Clinical Information Gathering and Interpretation2.1 Takes a thorough history of symptoms, risk factors, and family history.
2.2 Interprets relevant laboratory and imaging findings.
3. Diagnosis, Decision-Making and Reasoning3.1 Recognises chronic kidney disease (CKD) and identifies polycystic kidney disease (PKD) as the likely underlying cause.
3.2 Assesses disease progression and potential complications.
4. Clinical Management and Therapeutic Reasoning4.1 Develops a comprehensive management plan, including lifestyle modifications, blood pressure control, and nephrology referral.
4.3 Addresses symptom management and potential complications such as hypertension and renal cyst complications.
5. Preventive and Population Health5.2 Provides education on CKD progression and risk reduction strategies.
6. Professionalism6.2 Maintains a compassionate and non-judgmental approach.
7. General Practice Systems and Regulatory Requirements7.1 Refers appropriately to nephrology and other specialists.
9. Managing Uncertainty9.1 Discusses prognosis and provides guidance on monitoring and follow-up.
10. Identifying and Managing the Patient with Significant Illness10.2 Recognises when CKD progression requires specialist intervention.

CASE FEATURES

  • Wants to understand prognosis and treatment options.
  • Middle-aged male presenting with hypertension and declining renal function.
  • History of family members with kidney disease.
  • Ultrasound confirmed polycystic kidney disease (PKD) as the underlying cause.
  • Elevated serum creatinine and reduced eGFR consistent with CKD stage 3.
  • Concerns about disease progression and need for future dialysis or transplant.

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:

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

SCENARIO

Michael Thompson, a 45-year-old man, presents to your general practice clinic after recent blood tests showed worsening kidney function. He was diagnosed with hypertension five years ago, and his latest eGFR is 45 mL/min/1.73m², indicating CKD stage 3. His serum creatinine is elevated at 165 µmol/L.

An ultrasound showed bilateral enlarged kidneys with multiple cysts, consistent with autosomal dominant polycystic kidney disease (ADPKD). He reports occasional flank pain and intermittent hematuria but no significant swelling or shortness of breath.

PATIENT RECORD SUMMARY

Patient Details

Name: Michael Thompson
Age: 45
Gender: Male
Gender Assigned at Birth: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

  • Nil known

Medications

  • Amlodipine 10mg daily (for hypertension)

Past History

  • Hypertension (diagnosed 5 years ago)

Social History

  • Works as a construction manager
  • Drinks alcohol socially (3-4 drinks per week)
  • No smoking history

Family History

  • Father had CKD due to polycystic kidney disease, required dialysis at 52
  • Mother has hypertension
  • No known history of diabetes

Smoking

  • Never smoked

Alcohol

  • 3-4 standard drinks per week

Vaccination and Preventative Activities

  • Up to date with routine immunisations

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.

Opening Line

“My doctor told me my kidney function is getting worse. Does this mean I’m going to need dialysis like my dad?”

General Information

You are Michael Thompson, a 45-year-old construction manager who has recently been told you have chronic kidney disease (CKD) after a routine blood test. You were diagnosed with high blood pressure five years ago, but you never really thought much about it other than taking your daily medication.

Specific Information

(To be revealed only when asked)

Background Information

Your father had kidney disease and was on dialysis in his early 50s. You remember how hard that was for him, and you’re now worried the same thing will happen to you. You don’t feel unwell, but in the last six months, you’ve had occasional pain in your flanks and noticed blood in your urine a couple of times. You’re here because you want to understand how serious this is, whether you’ll need dialysis, and what you can do to slow the disease down.

You work full-time in construction, which is physically demanding. You’re concerned about how kidney disease might affect your ability to work, especially if you need dialysis in the future. You’re also worried about your family, especially your two children, because you read online that polycystic kidney disease (PKD) can be inherited.

Symptoms

  • You feel fine most of the time, and if the doctor hadn’t told you about your kidneys, you wouldn’t have known anything was wrong.
  • You’ve had occasional dull pain in your lower back/flanks, which comes and goes.
  • You’ve seen blood in your urine a couple of times in the last six months but didn’t think much of it.
  • No swelling in your legs, shortness of breath, or major changes in urination.

Emotional Concerns

  • You are worried about your future—your father had a difficult time with dialysis, and you don’t want to go through the same thing.
  • You feel frustrated because you weren’t told about CKD earlier. If you had known, you might have done things differently.
  • You don’t fully understand why your kidneys are failing and want to know what caused this.
  • You’re worried about your children—should they get tested for PKD?

Questions for the Candidate

You have several concerns and will ask these questions during the consultation:

  1. “Is there anything I can do to stop my kidneys from getting worse?”
    • You want practical advice, not just medical terms.
    • You feel like you didn’t get enough information from your last doctor.
  2. “Am I definitely going to need dialysis?”
    • This is your biggest fear, based on your father’s experience.
    • You want a realistic answer—how long do you have before dialysis is needed?
  3. “What treatment options are available?”
    • You want to know if medications can help or if there are any lifestyle changes you can make.
    • You have read about some newer treatments for PKD and wonder if they apply to you.
  4. “Should my children get tested for this?”
    • You want to know if PKD runs in families and whether your kids might inherit it.
    • If there’s a way to catch it early, you want to know.

Body Language and Emotional Cues

  • At the start of the consultation, you seem worried and slightly defensive.
  • When discussing your father’s dialysis, you look anxious and uncomfortable.
  • If the doctor explains things clearly and with empathy, you gradually become more engaged.
  • If the doctor brushes off your concerns, you become frustrated and resistant.
  • When talking about your children, you look concerned and protective.
  • If the doctor gives clear guidance on what you can do, you feel more in control and optimistic by the end.

Potential Triggers for More Emotion

  • If the doctor says something too bluntly about your future with CKD, you may respond with frustration or fear:
    • “So what you’re saying is there’s nothing I can do? I’m just going to end up on dialysis no matter what?”
  • If the doctor talks about family history and genetics, you may ask in a worried tone:
    • “Does this mean my kids are going to get this too? Should I get them tested now?”

Closing Thoughts

If the doctor provides clear, supportive answers and gives you a structured plan, you will respond positively and say something like:
“Alright, I get it now. I didn’t realise there were things I could do to slow this down. I’ll try to make some changes.”

If the doctor doesn’t answer your concerns well or makes you feel like nothing can be done, you may leave frustrated, saying:
“So, what’s the point then? It sounds like it’s just a waiting game until my kidneys fail.”

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history, including family history, risk factors, symptoms, and patient concerns.

The competent candidate should:

  • Use open-ended questions to explore the patient’s medical history, particularly symptoms of CKD, including fatigue, nocturia, haematuria, flank pain, oedema, and hypertension.
  • Assess family history, focusing on polycystic kidney disease (PKD) and its impact on relatives.
  • Clarify past medical conditions such as hypertension, infections, and medication use (e.g. NSAIDs, nephrotoxic drugs).
  • Address lifestyle factors (diet, alcohol, hydration, smoking) that may impact disease progression.
  • Explore the patient’s ideas, concerns, and expectations about CKD and its prognosis.
  • Use empathetic communication to acknowledge patient anxiety about potential dialysis and inheritance risks.

Task 2: Explain the diagnosis of CKD secondary to polycystic kidney disease (PKD) to the patient in a clear, empathetic manner.

The competent candidate should:

  • Confirm the diagnosis of CKD stage 3, explaining it means moderate kidney function decline (eGFR 45 mL/min).
  • Discuss how PKD causes CKD, explaining progressive cyst enlargement leads to kidney damage.
  • Reassure the patient that not all PKD cases require dialysis, and many can be managed with lifestyle changes and medications.
  • Address genetic aspects, explaining autosomal dominant inheritance and whether his children should be tested.
  • Use patient-friendly language, avoiding medical jargon, and check for understanding throughout.

Task 3: Discuss disease progression, complications, and lifestyle modifications to slow CKD progression.

The competent candidate should:

  • Explain potential complications, including hypertension, renal cyst rupture, infection, kidney stones, and cardiovascular disease.
  • Emphasise blood pressure control as key to slowing CKD progression, targeting <130/80 mmHg with medications such as ACE inhibitors or ARBs.
  • Discuss dietary modifications, including reducing sodium, protein control, and adequate hydration.
  • Advise avoiding nephrotoxic substances, such as NSAIDs, smoking, and excessive alcohol.
  • Encourage regular follow-up for monitoring kidney function, blood pressure, and complications.

Task 4: Outline a structured management plan, including medications, lifestyle changes, nephrology referral, and follow-up.

The competent candidate should:

  • Prescribe or optimise antihypertensive treatment (preferably ACE inhibitors or ARBs).
  • Provide referral to a nephrologist for disease-specific management and long-term planning.
  • Offer supportive management, including pain control (avoiding NSAIDs), treatment for urinary tract infections, and addressing anaemia if present.
  • Arrange regular monitoring of kidney function, blood pressure, and urine protein levels.
  • Discuss the role of newer therapies (e.g. tolvaptan, which may slow PKD progression in certain patients).
  • Reassure and provide resources such as Kidney Health Australia for further education and support.

SUMMARY OF A COMPETENT ANSWER

  • Thorough history-taking covering symptoms, family history, and risk factors.
  • Clear and empathetic explanation of CKD and its link to PKD, using simple, patient-friendly language.
  • Addresses patient concerns about dialysis, prognosis, and inheritance risks.
  • Emphasises lifestyle modifications (diet, hydration, avoiding nephrotoxins) to slow disease progression.
  • Provides a structured management plan, including blood pressure control, nephrology referral, and regular follow-up.
  • Incorporates shared decision-making, ensuring the patient understands their condition and participates in treatment choices.

PITFALLS

  • Failing to acknowledge patient concerns about dialysis and prognosis, leading to increased anxiety.
  • Using medical jargon without checking patient understanding.
  • Overloading the patient with information without prioritising key points.
  • Not discussing lifestyle modifications, missing an opportunity for disease progression control.
  • Failing to arrange nephrology referral, which is crucial for ongoing specialist input.
  • Ignoring the genetic implications, missing a chance to discuss family screening and inheritance patterns.

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.
1.3 Explains the diagnosis and management plan in a patient-centred manner.
1.5 Communicates risk effectively and facilitates behaviour change.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history of symptoms, risk factors, and family history.
2.2 Interprets relevant laboratory and imaging findings.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises chronic kidney disease (CKD) and identifies polycystic kidney disease (PKD) as the likely underlying cause.
3.2 Assesses disease progression and potential complications.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops a comprehensive management plan, including lifestyle modifications, blood pressure control, and nephrology referral.
4.3 Addresses symptom management and potential complications such as hypertension and renal cyst complications.

5. Preventive and Population Health

5.2 Provides education on CKD progression and risk reduction strategies.

6. Professionalism

6.2 Maintains a compassionate and non-judgmental approach.

7. General Practice Systems and Regulatory Requirements

7.1 Refers appropriately to nephrology and other specialists.

9. Managing Uncertainty

9.1 Discusses prognosis and provides guidance on monitoring and follow-up.

10. Identifying and Managing the Patient with Significant Illness

10.2 Recognises when CKD progression requires specialist intervention.

Competency at Fellowship Level

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