CASE INFORMATION

Case ID: CCE-SUM-01
Case Name: Matthew Wilson
Age: 27
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: R80 – Influenza

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to gather relevant information about symptoms and concerns 1.2 Provides clear and empathetic explanations regarding the diagnosis and management plan
2. Clinical Information Gathering and Interpretation	2.1 Takes a thorough history, including symptom onset, severity, and risk factors 2.2 Identifies complications of influenza requiring further intervention (e.g., pneumonia, dehydration)
3. Diagnosis, Decision-Making and Reasoning	3.1 Recognises clinical features of influenza and differentiates from other respiratory infections 3.2 Identifies red flags requiring urgent referral (e.g., respiratory distress, sepsis)
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan, including symptom control and antiviral therapy where indicated 4.2 Identifies when hospital referral is required for high-risk patients
5. Preventive and Population Health	5.1 Provides education on influenza vaccination and infection prevention measures
6. Professionalism	6.1 Demonstrates patient-centred care and acknowledges the impact of illness on daily life
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate documentation and public health notifications if required
8. Procedural Skills	8.1 Performs relevant physical examination if indicated (e.g., respiratory assessment)
9. Managing Uncertainty	9.1 Recognises when symptoms require further observation or specialist input
10. Identifying and Managing the Patient with Significant Illness	10.1 Identifies cases requiring urgent intervention, such as severe dehydration or respiratory failure

CASE FEATURES

Young male presenting with high fever, cough, sore throat, myalgia, and fatigue for 3 days.
No history of chronic disease but has asthma, making him at higher risk of complications.
Mild shortness of breath, raising concerns about worsening respiratory status.
Concerned about when he can return to work and whether medication can speed up recovery.
Needs education on self-care, symptom management, and red flag signs.
Requires advice on influenza vaccination and risk reduction for future infections.

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

SCENARIO

Matthew Wilson, a 27-year-old warehouse worker, presents with fever, cough, sore throat, body aches, and fatigue for the past 3 days. He feels exhausted and unable to work, and his symptoms seem to be worsening.

He has a history of asthma, which is usually well controlled with salbutamol (Ventolin) as needed. Over the past 24 hours, he has noticed some shortness of breath and has used his inhaler more frequently than usual.

PATIENT RECORD SUMMARY

Patient Details

Name: Matthew Wilson
Age: 27
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Nil known

Medications

Salbutamol (Ventolin) inhaler as needed for asthma

Past History

Asthma – usually well controlled
No history of pneumonia, hospital admissions, or chronic illness

Social History

Works in a warehouse, physically demanding job

Family History

No significant family history of respiratory disease or immunodeficiency

Smoking

Non-smoker

Alcohol

Drinks socially (1-2 beers on weekends)

Vaccination and Preventative Activities

Up to date with routine vaccinations, but did not receive the flu vaccine this year

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.

ROLE-PLAYER SCRIPT

Opening Line

“Doctor, I’ve been feeling awful for the past few days. I’ve got a fever, a bad cough, and I’m aching all over. Do you think it’s the flu?”

General Information

You are Matthew Wilson, a 27-year-old warehouse worker. Over the past three days, you have developed fever, chills, body aches, a sore throat, and a dry cough. You feel completely exhausted, much worse than when you usually get a cold.

Your symptoms started suddenly with a high fever and body aches, and by the second day, you had a sore throat, cough, and a tight feeling in your chest. You feel worn out and too unwell to work, which is a problem because your job is physically demanding.

Specific Information

(Reveal only when asked)

Background Information

You have asthma, which is normally well controlled with Ventolin. However, in the last 24 hours, you have felt a little short of breath, especially when walking or talking a lot. You’ve been using your inhaler more frequently than usual, but you haven’t had a full asthma attack.

You haven’t had vomiting or diarrhoea, and you don’t have a runny nose like you usually do when you get a cold. You don’t have chest pain, palpitations, or confusion, but you feel really weak and tired.

You didn’t get the flu vaccine this year, mainly because you were too busy and didn’t think it was necessary. Now, you’re wondering if that was a mistake.

Respiratory Symptoms

The cough is dry and persistent but not producing green or bloody phlegm.
You feel some tightness in your chest, but there’s no severe wheezing.
You haven’t had major breathing difficulty, but you do feel more breathless than usual.
You don’t have ear pain or sinus congestion.

Fever and Fatigue

Your fever started suddenly and has been high (over 38.5°C) for the first two days.
You have been sweating at night, but not shaking or feeling confused.
You feel extremely tired and weak, much more than with a normal cold.

Concerns and Expectations

You’re worried about how long you will be off work, as you can’t afford to miss too many days.
You want to know if there’s medication that will help you recover faster.
You’re concerned about your asthma getting worse, as you’ve needed your Ventolin more often.
You’re wondering if the flu vaccine would have prevented this and whether you should get it in the future.

Emotional Cues & Body Language

You look exhausted and slightly breathless when talking.
You rub your forehead or throat occasionally, showing discomfort.
You lean forward slightly when asking if there’s medication that will help you recover faster.
If the doctor explains things well and reassures you, you nod and seem relieved.
If the doctor doesn’t give clear guidance, you push for more answers, asking about tests, medications, or returning to work.

Questions for the Candidate (Ask Naturally During the Consultation)

“Do I definitely have the flu, or could it be something else?”
“Is there anything I can take to make this go away faster?”
“How long will I be off work?”
“Should I be worried about my breathing getting worse?”
“Would the flu vaccine have stopped this?”
“How can I stop this from happening again next year?”

Response to Advice Given by the Candidate

If the candidate explains the flu clearly, you feel relieved but still ask about how long it will last.
If they recommend symptom management (fluids, rest, paracetamol), you ask if there’s anything stronger that will help.
If they mention antiviral medications, you ask if you need them and how effective they are.
If they discuss asthma worsening, you ask when you should seek help for breathing problems.
If they recommend the flu vaccine for next year, you ask if it’s really necessary and how well it works.
If the doctor doesn’t explain when to return to work, you ask how long you should stay home.

Final Thought

If the candidate explains the diagnosis well, reassures you, and gives a structured management plan, you feel more in control and ready to follow their advice. If they are vague, dismissive, or fail to address your concerns about work and recovery, you remain frustrated and unsure about what to do next.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history, including symptom onset, severity, and risk factors.

The competent candidate should:

Elicit symptom details, including:
- Onset and progression (sudden onset of fever, myalgia, sore throat, dry cough, fatigue).
- Severity of symptoms, particularly fever and respiratory difficulty.
- Impact on daily life, such as work absenteeism and energy levels.
Assess risk factors for complications:
- Asthma history (increased Ventolin use, breathlessness).
- Vaccination status (missed this year’s flu vaccine).
- Any underlying chronic conditions (e.g., diabetes, immunosuppression).
Screen for red flag symptoms:
- Severe shortness of breath, chest pain, altered consciousness (possible pneumonia, sepsis).
- Signs of dehydration (reduced urine output, dizziness).
Identify concerns and expectations:
- Wants to know if he has the flu and how long recovery will take.
- Asks if medication can speed up recovery.

Task 2: Identify key clinical features and assess for complications, such as pneumonia or exacerbation of asthma.

The competent candidate should:

Recognise classical features of influenza:
- Sudden onset of fever, myalgia, dry cough, fatigue, sore throat.
Differentiate from other respiratory infections:
- COVID-19 (loss of taste/smell, longer incubation period).
- Bacterial pneumonia (productive cough, focal chest findings).
- Acute asthma exacerbation (wheezing, increased respiratory effort).
Assess for influenza complications:
- Asthma exacerbation (increased inhaler use, breathlessness).
- Pneumonia (persistent fever >3 days, worsening cough, dyspnoea).
- Severe dehydration (fatigue, dizziness, reduced urine output).
Decide if further investigations are needed:
- Chest X-ray if suspected pneumonia.
- COVID-19 test if indicated by exposure history.

Task 3: Explain the likely diagnosis, management options, and need for follow-up.

The competent candidate should:

Explain the diagnosis in simple terms:
- Likely influenza, given symptoms and history.
- Usually self-limiting, lasting 5-7 days, but may worsen in asthma.
Outline treatment options:
- Symptom management:
  - Paracetamol for fever and aches.
  - Hydration and rest.
  - Steam inhalation or throat lozenges for sore throat.
- Asthma management:
  - Increase Ventolin use if needed.
  - Seek urgent care if severe shortness of breath develops.
- Antiviral therapy (oseltamivir):
  - Most effective within 48 hours of symptom onset.
  - Consider for high-risk patients (e.g., asthma, pregnancy, elderly).
Discuss follow-up and red flag symptoms:
- Return if worsening shortness of breath, persistent fever, or chest pain.

Task 4: Develop a safe, evidence-based management plan, including symptom relief, antiviral therapy if indicated, and preventive measures.

The competent candidate should:

Provide supportive care advice:
- Encourage fluids and rest.
- Use paracetamol/ibuprofen for fever and body aches.
- Steam inhalation and honey for sore throat relief.
Optimise asthma control:
- Increase reliever inhaler (Ventolin) use as needed.
- Seek emergency care if breathing worsens.
Consider antiviral therapy (oseltamivir 75 mg BD for 5 days) if indicated:
- Recommended for high-risk groups (asthma, immunosuppressed, elderly, pregnant women).
Educate on prevention and vaccination:
- Influenza vaccine annually to reduce severity and risk.
- Hand hygiene, coughing etiquette, and avoiding close contact with others.
Plan follow-up:
- Review in 48 hours if worsening symptoms.

SUMMARY OF A COMPETENT ANSWER

Takes a thorough history, assessing symptom onset, severity, and risk factors.
Differentiates influenza from other respiratory illnesses and assesses for complications.
Explains the diagnosis clearly, reassuring the patient while discussing treatment.
Provides an individualised management plan, including symptom relief, asthma control, and preventive strategies.
Ensures appropriate follow-up to monitor for complications.

PITFALLS

Failing to recognise asthma as a risk factor, leading to delayed escalation of care.
Overlooking red flag symptoms, such as severe shortness of breath or persistent fever.
Not considering antivirals for high-risk patients, missing an opportunity for early intervention.
Neglecting preventive advice, such as influenza vaccination and infection control measures.
Lack of follow-up planning, delaying recognition of secondary infections or deterioration.

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 sociocultural context.
1.2 Engages the patient to gather information about their symptoms, ideas, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Takes a thorough history, including symptom onset, severity, and risk factors.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises clinical features of influenza and differentiates from other respiratory infections.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, including symptom control and antiviral therapy where indicated.

5. Preventive and Population Health

5.1 Provides education on influenza vaccination and infection prevention measures.

6. Professionalism

6.1 Demonstrates patient-centred care and acknowledges the impact of illness on daily life.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and public health notifications if required.

8. Procedural Skills

8.1 Performs relevant physical examination if indicated (e.g., respiratory assessment).

9. Managing Uncertainty

9.1 Recognises when symptoms require further observation or specialist input.

10. Identifying and Managing the Patient with Significant Illness

10.1 Identifies cases requiring urgent intervention, such as severe dehydration or respiratory failure.

Competency at Fellowship Level

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