CASE INFORMATION

Case ID: BSC-004
Case Name: Emily Carter
Age: 27 years
Gender: Female
Indigenous Status: Non-Indigenous
Year: 2025
ICPC-2 Codes: F72 – Blepharitis/Stye/Chalazion

COMPETENCY OUTCOMES

Competency Domain	Competency Element
1. Communication and Consultation Skills	1.1 Engages the patient to understand concerns, ideas, and expectations 1.2 Provides clear explanations tailored to the patient’s level of health literacy 1.4 Uses effective consultation techniques, including active listening and empathy
2. Clinical Information Gathering and Interpretation	2.1 Takes a focused history to explore symptom onset, progression, and risk factors 2.2 Selects appropriate investigations based on clinical presentation
3. Diagnosis, Decision-Making and Reasoning	3.1 Develops a differential diagnosis for eyelid swelling and irritation 3.2 Identifies potential red flags indicating serious underlying conditions
4. Clinical Management and Therapeutic Reasoning	4.1 Develops a safe and effective management plan 4.2 Provides advice on pharmacological and non-pharmacological management
5. Preventive and Population Health	5.1 Discusses eyelid hygiene and prevention strategies to reduce recurrence
6. Professionalism	6.1 Maintains patient confidentiality and demonstrates ethical practice
7. General Practice Systems and Regulatory Requirements	7.1 Documents accurately and ensures appropriate follow-up
9. Managing Uncertainty	9.1 Provides reassurance and safety-netting when the diagnosis is unclear
10. Identifying and Managing the Patient with Significant Illness	10.1 Recognises features suggestive of orbital cellulitis or other serious ocular pathology requiring urgent intervention

CASE FEATURES

Adult female presenting with a red, swollen eyelid, concerned about infection or needing antibiotics.
Differentiating between blepharitis, stye (hordeolum), and chalazion through structured history-taking.
Addressing patient anxiety about cosmetic concerns, potential worsening, or need for surgical drainage.
Discussing conservative vs pharmacological management, based on severity and presence of secondary infection.
Providing patient education on eyelid hygiene and recurrence prevention.

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

Emily Carter, a 27-year-old office worker, presents with a swollen, red lump on her right upper eyelid that started three days ago. She describes it as tender and slightly itchy but denies significant pain or vision changes.

She initially thought it was a pimple, but it has gotten larger and more irritated. She is concerned about infection, spreading, and whether she needs antibiotics or drainage.

PATIENT RECORD SUMMARY

Patient Details

Name: Emily Carter
Age: 27
Gender: Female
Gender Assigned at Birth: Female
Indigenous Status: Non-Indigenous

Allergies and Adverse Reactions

No known drug allergies

Medications

Nil regular medications
Occasionally uses lubricating eye drops for dryness

Past History

No history of blepharitis, recurrent styes, or previous eye infections
No history of diabetes or immunosuppression

Social History

Works full-time in an office, using screens for long hours

Family History

No significant ocular conditions
No family history of rosacea or other skin conditions

Smoking

Non-smoker

Alcohol

Drinks socially, 3-4 standard drinks per week

Vaccination and Preventative Activities

Up to date with vaccinations, including influenza and COVID-19 booster

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 got this red lump on my eyelid, and it’s been getting worse over the past few days. Do I need antibiotics, or will it go away on its own?”

General Information

You are Emily Carter, a 27-year-old office worker.
You developed a small red lump on your right upper eyelid three days ago.
It started as a tiny, tender spot, but it has gradually grown larger and now feels slightly swollen and irritated.

Specific Information

(Reveal only when asked directly)

Background Information

You initially thought it was a pimple, but it hasn’t gone away and seems to be getting more noticeable.
The lump is not extremely painful, but it is tender when touched, and you sometimes feel a mild itching sensation.
You don’t have any eye discharge, pus, or crusting, but the area around the lump looks a bit red and inflamed.
No blurred vision, double vision, or difficulty opening the eye.

Lump Characteristics

The red lump is located on the upper eyelid, near the lash line.
It is round, firm, and tender, about the size of a small pea.
You haven’t noticed any pus coming out, but it feels slightly warm to touch.
There’s no significant swelling beyond the lump itself.

Risk Factors

You wear contact lenses daily and sometimes sleep in them overnight when you’re too tired to take them out.
You apply eye makeup daily (mascara, eyeliner, eyeshadow) but don’t always remove it properly before bed.
You spend long hours working on a computer, and your eyes sometimes feel dry and irritated by the end of the day.
You rub your eyes occasionally, especially when they feel itchy or tired.
You don’t have a history of chronic eye conditions or previous styes or chalazia.

Concerns and Expectations

You are worried that the lump is an infection and might spread to the rest of the eye.
You are unsure if you need antibiotics or if this will clear up on its own.
You are concerned about the cosmetic impact, as you work with clients and feel self-conscious about the appearance of your eye.
You want to know if this will leave a scar or cause permanent damage.
You are wondering if you should stop wearing contact lenses until it resolves.
You are keen to prevent this from happening again and want to know what you can do differently.

Red Flag Symptoms (Reveal only when asked directly)

No blurred vision, double vision, or difficulty keeping the eye open.
No significant swelling of the entire eyelid or face.
No fever, chills, or feeling generally unwell.
No severe eye pain or pain when moving the eye.
No history of trauma or insect bites near the area.

Emotional Cues & Body Language

You appear mildly anxious but are trying to stay calm and logical.
You lean forward slightly, watching the doctor closely, expecting clear advice on what to do next.
If the doctor dismisses your concerns too quickly, you may frown slightly and ask, “Are you sure this isn’t something more serious?”
If the doctor recommends antibiotics without explanation, you may look hesitant and say, “But do I really need them? I don’t want to take antibiotics unless it’s necessary.”
If the doctor suggests waiting and watching, you might say, “How long should I wait before coming back? What if it doesn’t go away?”
If the doctor explains things well, you relax and nod along but may still ask, “So, what can I do to stop this from happening again?”

Questions for the Candidate

(Ask these naturally throughout the consultation.)

“Do I need antibiotics, or will this go away on its own?”
“Could this be something serious, like an eye infection?”
“How can I stop this from getting worse?”
“Will this leave a scar?”
“Can I still wear my contact lenses?”
“If this happens again, what should I do?”
“How do I know if it’s getting worse?”

Key Behaviours & Approach

You expect the doctor to take your concerns seriously and provide clear, evidence-based advice.
If the doctor fails to mention prevention, you will ask about how to avoid future occurrences.
If the doctor suggests antibiotics without explanation, you will question whether they are truly necessary.
If the doctor doesn’t address the cosmetic impact, you may say, “But will this go away completely, or will there be a lump left behind?”
If the doctor is vague about timeframes, you may ask, “How long should I expect this to last?”

Additional Context for the Role-Player

You trust doctors but prefer conservative treatment when possible.
You want to make informed decisions, so you ask for explanations rather than blindly accepting recommendations.
You are willing to follow medical advice, but you need reassurance that it is the best approach.
If the doctor suggests warm compresses, you may ask, “How often should I do that, and for how long?”
If the doctor recommends stopping contact lens use, you may respond, “Can I wear glasses instead, or should I avoid anything near my eye?”
You do not have any medical background, so you prefer simple, straightforward explanations without too much jargon.

THE COMPETENT CANDIDATE

The competent candidate should be able to:

Task 1: Take an appropriate history from the patient, considering possible causes of eyelid swelling.

The competent candidate should:

Use open-ended questions to allow the patient to describe the onset, progression, and characteristics of the lump.
Establish key features: location, size, tenderness, redness, discharge, and associated symptoms such as pain, vision changes, or eyelid dysfunction.
Assess for systemic symptoms (fever, malaise) that may indicate a more serious infection.
Explore risk factors:
- Contact lens use, particularly if worn overnight.
- Eyelid hygiene habits, including makeup removal and hand hygiene.
- Previous episodes of similar lesions, blepharitis, or eye infections.
- Occupational or environmental factors, such as prolonged screen use and dry eye symptoms.
Address the patient’s concerns about infection, treatment, and cosmetic impact.

Task 2: Formulate a differential diagnosis and explain it to the patient.

The competent candidate should:

Outline the most likely diagnoses based on history:
- Stye (hordeolum): Acute, tender lump at the lash line, often with redness and localised swelling.
- Chalazion: Painless or mildly tender lump due to blocked Meibomian gland, often persisting for weeks.
- Blepharitis: Chronic eyelid inflammation with redness, irritation, and crusting.
Consider less common but important differentials:
- Preseptal cellulitis: Painful swelling, redness, warmth, and possible systemic symptoms.
- Orbital cellulitis (red flag): Eyelid swelling with severe pain, fever, and vision changes—requires urgent referral.
Explain the natural course of the condition and reassure the patient about the benign nature of most cases.

Task 3: Address the patient’s concerns empathetically, including cosmetic impact and infection risk.

The competent candidate should:

Acknowledge the patient’s concerns about appearance, especially given her client-facing work.
Explain that most styes and chalazia resolve within weeks and rarely cause permanent scarring.
Provide realistic expectations for recovery time and when to seek further treatment.
Clarify that antibiotics are usually not needed unless signs of secondary infection appear.
Address contact lens safety and the importance of good eyelid hygiene to prevent recurrence.

Task 4: Develop an initial management plan, including treatment options, prevention, and follow-up.

The competent candidate should:

Recommend first-line conservative management:
- Warm compresses (10-15 minutes, 3-4 times a day) to promote drainage.
- Eyelid hygiene: Gentle cleansing with warm water or diluted baby shampoo.
- Avoid squeezing the lump, as this may worsen inflammation or infection.
- Discontinue contact lenses until symptoms improve.
Consider topical antibiotic ointment (e.g., chloramphenicol) if there are signs of secondary bacterial infection.
If the lump persists beyond 4-6 weeks or becomes large and obstructive, refer for minor surgical drainage.
Arrange follow-up in 1-2 weeks to assess progress, with earlier review if symptoms worsen or spread.
Educate the patient on preventing recurrence, including proper eyelid hygiene, makeup removal, and avoiding overnight contact lens use.

SUMMARY OF A COMPETENT ANSWER

Thorough history-taking to distinguish between a stye, chalazion, and other possible causes.
Structured differential diagnosis, explaining why impetigo, orbital cellulitis, or other conditions are unlikely.
Reassurance addressing infection concerns, cosmetic worries, and expected recovery timeline.
Evidence-based management, including warm compresses, lid hygiene, and contact lens precautions.
Clear follow-up plan, ensuring timely review and patient education to prevent recurrence.

PITFALLS

Failing to differentiate between a stye, chalazion, and more serious conditions, such as preseptal or orbital cellulitis.
Automatically prescribing antibiotics without clear indications for bacterial infection.
Not addressing the patient’s cosmetic concerns, especially given her client-facing work.
Ignoring contact lens hygiene, missing an opportunity for prevention education.
Lack of safety-netting, failing to instruct the patient when to seek urgent review for worsening symptoms.

REFERENCES

MARKING

Each competency area is assessed 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 patient’s concerns and sociocultural context.
1.2 Engages the patient to gather information about symptoms, concerns, and expectations.
1.4 Communicates effectively in routine and difficult situations.

2. Clinical Information Gathering and Interpretation

2.1 Elicits a comprehensive history focused on eyelid swelling and risk factors.
2.2 Orders appropriate investigations only if necessary, considering clinical diagnosis.

3. Diagnosis, Decision-Making and Reasoning

3.1 Develops a structured differential diagnosis for eyelid swelling and irritation.
3.2 Identifies red flags requiring further assessment or urgent referral.

4. Clinical Management and Therapeutic Reasoning

4.1 Formulates an evidence-based treatment plan, using conservative and pharmacological options appropriately.
4.2 Provides pharmacological and non-pharmacological treatment options tailored to symptom severity.

5. Preventive and Population Health

5.1 Discusses eyelid hygiene and prevention strategies to reduce recurrence.

6. Professionalism

6.1 Maintains confidentiality and ethical decision-making.

7. General Practice Systems and Regulatory Requirements

7.1 Ensures accurate documentation and appropriate follow-up.

9. Managing Uncertainty

9.1 Provides reassurance and safety-netting when the diagnosis is unclear.

10. Identifying and Managing the Patient with Significant Illness

10.1 Recognises potential complications requiring escalation, such as preseptal or orbital cellulitis.

Competency at Fellowship Level

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