RACGP KFP 2017.2.17 – Asymptomatic Thyroid Nodule

In Case 17 of RACGP KFP 2017.2, you meet Harold, a 45 year old patient who presents for check up and is noted to have a swelling in his anterior neck over his thyroid. You appreciate a solitary nodule within the thyroid on palpation.

What key features of history do you want to elicit to eliminate malignancy? (List 8)

Weight loss (history feature)
Night sweats (history feature)
Rapid growth
Recent hoarseness (history feature – red flag)
History of obesity (risk factor for thyroid cancer)
Family history of thyroid cancer (risk factor for thyroid cancer)
Smoking history (risk factor for thyroid cancer)
Radiation exposure (risk factor for thyroid cancer)

What are the most useful initial investigations? (List 3)

Serum TSH
Thyroid ultrasound
Thyroid Nuclear Scintigraphy
Ultrasound-guided Fine Needle Aspiration

Source – Diagnostic Imaging Pathways

RACGP Feedback – Case 17

This case focused on a patient presenting for routine screening and who was noted to have an asymptomatic neck swelling, thought to be from a thyroid nodule. Candidates were required to identify elements of the history that would suggest possible malignancy and provide the most useful initial investigations. Candidates often did not show an understanding of time sequence of investigations and provided investigations that formed at later stages of the investigation process.

RACGP Conclusion on Technique

As outlined above, there are some common themes and key issues to consider when approaching the KFP exam:

The KFP exam is not a simple short-answer paper. You must answer the question in the context of the clinical scenario provided, utilising all of the information provided. Read the scenario at least twice.
Keep your answers succinct.
Only provide the number of answers requested. Review your answer – have you created a list rather than one answer per line? If so, you will be penalised for extra answers.
Always read the question at least twice and, after you answer, check that you have answered the actual question asked.
Be specific in your answers, whether in the investigations being ordered or the treatment you are prescribing. Non-specific answers will not score or will attract a much lower score.
General answers such as ‘educate’, ‘refer’, ‘reassure’ or ‘review’ do not score without specific detail. For example, providing a review timeline and details about the specialist to whom you are referring (along with degree if urgency, if appropriate) may score marks if relevant to the scenario and question.
Be aware of clinical guidelines and any important changes or additions to treatments. If guidelines change very close to the exam, the marking keys are adapted to consider the original and the new guidelines so candidates are not penalised if they have not seen a guide published close to the exam sitting.
Access the practice exams provided after enrolment closes and utilise the RACGP assessment resources provided for candidates.