CASE INFORMATION

Case ID:
Case Name: Daniel Peterson
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: A92 – Allergy/Allergic Reaction NOS

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 possible allergen exposure, symptom onset, and severity 2.2 Identifies potential triggers and differentiates between mild allergic reactions and anaphylaxis
3. Diagnosis, Decision-Making and Reasoning	3.1 Recognises clinical features of an allergic reaction and distinguishes from other conditions 3.2 Identifies red flags requiring urgent intervention (e.g., airway compromise, hypotension)
4. Clinical Management and Therapeutic Reasoning	4.1 Develops an evidence-based management plan, including antihistamines, corticosteroids, and adrenaline if required 4.2 Identifies when specialist referral for allergy testing is needed
5. Preventive and Population Health	5.1 Provides education on allergen avoidance and emergency management strategies
6. Professionalism	6.1 Demonstrates patient-centred care and acknowledges the impact of allergies on daily life
7. General Practice Systems and Regulatory Requirements	7.1 Ensures appropriate documentation and referral pathways for allergy management
8. Procedural Skills	8.1 Performs appropriate assessment, including airway examination and vital sign monitoring
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 anaphylaxis requiring adrenaline and hospitalisation

CASE FEATURES

Young man presenting with a generalised allergic reaction after eating at a restaurant.
Reports skin rash, facial swelling, and mild throat discomfort.
No history of known allergies but has had mild reactions to shellfish in the past.
Uncertain if this was an anaphylactic reaction and is anxious about future episodes.
Needs assessment of the severity of the reaction and guidance on allergy management.
Requires education on allergen avoidance, potential need for an adrenaline autoinjector, and specialist referral for allergy testing.

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

Daniel Peterson, a 34-year-old software engineer, presents to the clinic after experiencing an allergic reaction last night. He was eating seafood at a restaurant when he developed a rash on his arms and chest, mild facial swelling, and throat discomfort. He felt panicked but did not experience difficulty breathing, wheezing, or dizziness.

The symptoms gradually resolved over a few hours after he took an over-the-counter antihistamine.

PATIENT RECORD SUMMARY

Patient Details

Name: Daniel Peterson
Age: 34
Gender: Male
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

Possible seafood allergy (reaction to prawns last night, mild symptoms in the past)

Medications

Took an antihistamine (cetirizine) after the reaction, which improved symptoms

Past History

No history of asthma, eczema, or other atopic conditions
No previous anaphylaxis or severe allergic reactions

Social History

Works as a software engineer, no occupational exposure to allergens

Family History

No known family history of food allergies or anaphylaxis

Smoking

Non-smoker

Alcohol

Drinks socially (1–2 beers on weekends)

Vaccination and Preventative Activities

Up to date with routine 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.

ROLE-PLAYER SCRIPT

Opening Line

“Doctor, I had a scary reaction to something I ate last night. My face swelled up a little, and my throat felt weird. Do you think I have a serious allergy?”

General Information

You are Daniel Peterson, a 34-year-old software engineer. You have never had a severe allergic reaction before, but last night, while eating at a seafood restaurant, you developed a rash, mild facial swelling, and throat discomfort.

The reaction happened about 30 minutes after eating a meal that included prawns, fish, and some other seafood dishes. You started feeling itchy, then noticed a red rash on your chest and arms, and your face felt a little puffy. You also felt a strange tightness in your throat, but you could still breathe normally and didn’t have wheezing or chest pain.

Specific Information

(Reveal only when asked)

Background Information

You took an antihistamine (cetirizine) that you had at home, and after about an hour, the symptoms started improving. By this morning, you feel almost back to normal, but you’re worried about whether this could happen again and if it might be worse next time.

You have never been formally diagnosed with food allergies, but you recall mild itching once after eating prawns a few years ago, though it wasn’t serious enough to see a doctor.

Now, you are concerned about whether this was an anaphylactic reaction and whether you need to carry an EpiPen. You also want to know if you need to completely avoid seafood or just certain types and whether you should get allergy testing.

Symptoms During the Reaction

Rash: Itchy, red rash on chest and arms, lasting a few hours.
Swelling: Slight puffiness of the face, but no severe lip or tongue swelling.
Throat symptoms: Felt tight but not painful, and you did not have trouble breathing or swallowing.
Breathing: No wheezing, coughing, or shortness of breath.
Blood pressure: No dizziness, fainting, or confusion.
Gastrointestinal symptoms: No vomiting, nausea, or diarrhoea.

Medical and Family History

No history of asthma, eczema, or hay fever.
No past hospitalisations for allergic reactions.
No family history of anaphylaxis or severe allergies.

Diet and Lifestyle

You eat a varied diet and occasionally have seafood.
You don’t have any known medication allergies.
You live alone and sometimes eat out at restaurants.

Concerns and Expectations

You are worried about whether this could happen again and be more severe.
You want to know if you should completely avoid seafood or just certain types.
You are concerned about whether this was anaphylaxis and whether you need an EpiPen.
You want to know if allergy testing is necessary.

Emotional Cues & Body Language

You appear mildly anxious when discussing the reaction.
You lean forward slightly when asking if you should carry an EpiPen.
You seem relieved if the doctor explains the difference between mild allergic reactions and anaphylaxis.
If the doctor dismisses your concerns, you push for more tests or a referral to an allergy specialist.

Questions for the Candidate (Ask Naturally During the Consultation)

“Do you think this was an anaphylactic reaction?”
“Could my next reaction be worse? Could I stop breathing?”
“Do I need an EpiPen?”
“Should I avoid all seafood, or just prawns?”
“Do I need allergy testing?”
“Is there any way to reduce my risk of having another reaction?”

Response to Advice Given by the Candidate

If the candidate explains the difference between mild allergic reactions and anaphylaxis, you feel relieved but still ask about the risk of future reactions.
If they recommend avoiding seafood, you ask if cross-contamination is a risk.
If they suggest carrying an EpiPen, you ask how and when to use it.
If they recommend allergy testing, you ask how accurate it is and if it’s necessary.
If the doctor does not give clear advice, you push for more tests or a specialist referral.

Final Thought

If the candidate explains allergic reactions clearly, reassures you, and provides a structured management plan, you feel confident in managing your allergy and avoiding triggers. If they are vague, dismissive, or fail to address your concerns about anaphylaxis and prevention, you remain anxious and push for more investigations or an EpiPen prescription.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take a focused history, including potential allergen exposure, symptom onset, and severity.

The competent candidate should:

Clarify the timeline and onset of symptoms:
- Time of reaction after eating (30 minutes).
- Symptoms present (rash, mild facial swelling, throat discomfort).
- Duration and resolution of symptoms (gradual improvement with antihistamine).
Identify potential triggers:
- Seafood as a possible allergen (prawns, fish, other dishes eaten at the restaurant).
- Previous mild reactions to prawns.
Differentiate between a mild allergic reaction and anaphylaxis:
- Mild reaction: Rash, swelling, and throat discomfort without respiratory distress or hypotension.
- Anaphylaxis: Wheezing, difficulty breathing, dizziness, fainting, or severe swelling (not present in this case).
Assess past medical and family history:
- No history of asthma, eczema, or anaphylaxis.
- No family history of severe allergies.
Explore patient concerns and expectations:
- Fear of more severe reactions in the future.
- Uncertainty about the need for an EpiPen.
- Interest in allergy testing and dietary restrictions.

Task 2: Identify key clinical features and assess whether this was an anaphylactic reaction requiring adrenaline.

The competent candidate should:

Recognise features suggestive of an allergic reaction:
- Generalised urticaria and mild swelling without airway compromise.
- No wheezing, difficulty breathing, dizziness, or hypotension.
Distinguish mild allergic reactions from anaphylaxis:
- Mild reaction: Rash, facial swelling, mild throat discomfort (this case).
- Anaphylaxis (requires adrenaline): Severe throat swelling, stridor, respiratory distress, hypotension.
Assess risk of future severe reactions:
- Previous mild reactions indicate sensitisation.
- The presence of mild throat symptoms suggests increased future risk.
Determine need for further investigation:
- Referral for skin prick or specific IgE testing to confirm seafood allergy.

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

The competent candidate should:

Explain the diagnosis clearly:
- Likely mild allergic reaction to seafood, possibly prawns.
- Symptoms were not consistent with anaphylaxis.
Reassure but advise caution:
- Risk of a future severe reaction remains.
- Avoidance of suspected allergens is recommended until formal testing.
Discuss emergency management:
- Use of antihistamines for mild reactions.
- When to seek urgent medical attention (difficulty breathing, dizziness, severe swelling).
Discuss next steps:
- Allergy testing referral to confirm diagnosis.
- Consideration of an adrenaline autoinjector (EpiPen) based on specialist advice.

Task 4: Develop a safe, evidence-based management plan, including allergen avoidance, medications, and potential referral for allergy testing.

The competent candidate should:

Allergen avoidance:
- Avoid all seafood until testing is completed.
- Check ingredient lists when eating out.
Emergency action plan:
- Carry antihistamines (e.g., cetirizine) for mild reactions.
- Seek urgent care if experiencing breathing difficulty or severe swelling.
Consideration for an EpiPen:
- Recommended if future reactions could be more severe.
- Educate on when and how to use an EpiPen if prescribed.
Referral to an allergist:
- Skin prick or specific IgE testing to confirm allergy.
Follow-up:
- Review results of allergy testing and adjust management plan accordingly.

SUMMARY OF A COMPETENT ANSWER

Takes a detailed history, identifying allergen exposure, symptom onset, and severity.
Differentiates between a mild allergic reaction and anaphylaxis, ensuring no red flags were missed.
Explains the diagnosis clearly, reassuring the patient while discussing risks.
Develops a structured management plan, including allergen avoidance, antihistamines, and emergency action strategies.
Refers for allergy testing to confirm the diagnosis and assess future risk.

PITFALLS

Failing to assess airway symptoms properly, leading to missed anaphylaxis.
Not recognising the risk of a more severe future reaction, leading to inadequate management.
Overlooking the need for allergy testing, delaying diagnosis and appropriate allergen avoidance.
Not discussing the role of an EpiPen, missing an opportunity for preventive care.
Lack of clear patient education, leaving the patient unsure about allergen avoidance and emergency actions.

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 potential allergen exposure and symptom severity.

3. Diagnosis, Decision-Making and Reasoning

3.1 Recognises clinical features of an allergic reaction and distinguishes from anaphylaxis.

4. Clinical Management and Therapeutic Reasoning

4.1 Develops an evidence-based management plan, including antihistamines, corticosteroids, and adrenaline if required.

5. Preventive and Population Health

5.1 Provides education on allergen avoidance and emergency management strategies.

6. Professionalism

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

7. General Practice Systems and Regulatory Requirements

7.1 Ensures appropriate documentation and referral pathways for allergy management.

8. Procedural Skills

8.1 Performs appropriate assessment, including airway examination and vital sign monitoring.

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 anaphylaxis requiring adrenaline and hospitalisation.

Competency at Fellowship Level

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