RACGP KFP 2017.2.8 – Shortness of Breath

by | Jan 2, 2018

Sally is a 55 year old woman who presents with 3 months of slowly worsening cough and shortness of breath.

 

What are the key features on history you would want to elicit? (List 8)

  1. Sputum production
  2. Chest pain
  3. Smoking History
  4. Reduction in exercise tolerance
  5. Haemoptysis
  6. Unintentional weight loss
  7. Wheezing
  8. Night sweats

Murtaghs Chapter 83 – COPD discussed in “Confirm Diagnosis” which is the “C” in COPDX as described here and here as lists similar to this.

Red Flags

Murtaghs 6th Ed Ch 42 lists red flag features in history of cough, which are (almost) replicated here

  • Persistent cough for more than three weeks
  • Pleuritic chest pain
  • Dyspnoea
  • Haemoptysis
  • Persistent nocturnal cough
  • Wheeze
  • Recurrent chest infections
  • Coughing up phlegm every morning for more than three months of the year
  • Unintentional weight loss

There are also Red Flags for Pneumonia as a separate list which are worth committing to memory.

 

 

You request a CXR.

 

 

 

 

 

 

 

 

 

What is the most likely cause of this presentation? (List 1)

  1. COPD

Perhaps in the exam they wanted more differentials, not sure. I went for something obvious in this question but it would depend on the actual image shown.

This is straight up image interpretation of an x-ray. Based on the other exams describes in the Public Exam Reports it seems like there will generally be an image or an investigation picture like spirometry/ECG to interpret, which is a core skill to have so should be considered to be core content and totally fair game for all writtens and the OSCE.

 

These would be pretty much bread and butter within respiratory, are well described in all the RACGP literature and Murtaghs, and would have all been encountered heaps in all of medical experience to date. This question should score well for everyone I hope.

 

RACGP Feedback

This case required candidates to interpret the presentation of a female patient’s four-week history of cough and shortness of breath, in conjunction with a chest X-ray, and provide differential diagnoses, as well as those features on examination that would assist in the diagnosis.

The question asked for specific signs on clinical examination, though many candidates offered answers focusing on history or investigations, or provided non-specific answers. Another common error was to provide explanations of answers which formed lists of responses on each line, which led to candidates being penalised for providing extra responses.

The new exam support modules provided by gplearning address the issues of ‘over-coding’ (ie too many answers provided). These modules provide candidates support and advice on how to approach all the RACGP Fellowship assessments by using recent exam cases. The two KFP modules explore the different style of KFP cases and take the candidate through each of the questions with correct responses, common errors and methods for avoiding them

[Source]

GPCC Feedback

All of the topics within respiratory are fair game and should be among the first aspects mastered. The content is well described in Murtaghs and the AFPs.

References

  1. RACGP Sources
  2. Murtaghs Ch 83
  3. Murtaghs Ch 42