RACGP KFP 2017 Case 18 sees Barbara, a 33 year old female who presents with absent periods for the last 3-4 months. She has a history of depression on 250mg Sertraline daily and Schizophrenia on Risperidone daily.  She has no surgical history. She has been exercising much more lately at the gym and lost 15kg in the last 2 months from this and dietary intervention.

What are the most likely differential causes of Barbara’s symptoms? (list 8)

1. Exercise induced hypothalamic amennorhoea
2. Pregnancy
3. Premature Menopause
4. Hyperthyroidism
5. Prolactinoma
6. Hyperprolactinaemia secondary to Risperidone
7. Hyperprolactinaemia secondary to Sertraline
8. PCOS

What are the most appropriate initial investigations? (list 8)

1. Pregnancy test
2. Serum prolactin
3. MRI Brain
4. TFTs
5. Ultrasound of Pelvis/Ovaries (PCOS)
6. LH
7. FSH
8. Androgen Studies

References:

1. https://www.aafp.org/afp/2013/0601/p781.html
2. https://patient.info/doctor/hyperprolactinaemia-and-prolactinoma,
3. Murtaghs 5th ed
4. https://www.racgp.org.au/afp/2017/june/premature-ovarian-insufficiency-in-general-practice-meeting-the-needs-of-women/
5. https://emedicine.medscape.com/article/124634-overview

RACGP Feedback – Case 18

This case featured a female patient presenting with symptoms of secondary amenorrhea. Questions focused on providing the most likely differential diagnoses, and candidates were also asked to select the initial investigations according to the information in the scenario.

Common errors in this question included providing similar answers over two lines, such as ‘premature ovarian failure’ and ‘early menopause’, or ‘pituitary adenoma’ and ‘prolactinoma’. Candidates only gained one mark in such an instance. It is important candidates are specific in their answers, and responses such as ‘pituitary axis failure’ are too broad and are not a diagnosis, but cover a range of specific diagnoses.

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.