Return to Scenario ListShow Learning Points most relevant to Phase 1:

Chronic sputum production

Clinical Discipline(s)/Organ System(s)
Respiratory Medicine, Respiratory System, Immunology, Infectious Diseases, Medical Genetics, Microbiology
Progress Test Topic(s)
A 25 year old NZ European woman, who has recently moved into the area, presents to your GP clinic with an increase of her cough and sputum production and recurrent small haemoptyses (about a teaspoon in volume). She has a history of cough and purulent sputum production since early childhood.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of respiratory tract; particularly airways
   - Microanatomy of the lung including production of airway lining fluid and mucus layer, muco-ciliary clearance; role of Clara cells, goblet cells and mucus glands
   - Radiology of thorax, including high-resolution CT scan
   - Lung defence mechanisms including cellular and immunologic mechanisms; mucociliary clearance
   - Consequences of impairment of lung defence mechanisms
   - Ion and water transport; relevance to disease and pharmacology
   - Microbiology of chronic lung infection; biofilm formation
   - Pathology of bronchiectasis
   - Pulmonary and non-pulmonary manifestations of cystic fibrosis
   - Inheritance of disease - phenotype-genotype correlations
   - Pharmacology of macrolides, rifampicin, anti-microbial agents (particularly anti-pseudomonal antibiotics); mechanisms of drug action and potential drug interactions
   - Pharmacology of isoniazid
Clinical and Communication Skills 
   - History from a patient with chronic sputum production
   - Examination of the respiratory system
   - Assess co-morbidities e.g. upper respiratory tract disease
   - Perform and interpret
spirometry and arterial blood gas
   - Interpret results of sputum culture (past and present), chest X-ray
   - Indications for: high resolution CT, detailed pulmonary function tests, bronchoscopy, sweat chloride test, serum immunoglobulin quantitation, genotyping
   - Differential diagnosis of chronic sputum production
   - Outline the management of bronchiectasis: physiotherapy, pharmacological and surgical
   - Complications of bronchiectasis and cystic fibrosis
   - Prognosis of bronchiectasis and cystic fibrosis
   - Outline the management of cystic fibrosis including pathophysiologic rationale
   - Managing chronic disease - patient education, support, pharmaceutical management, involving the multidisciplinary team including palliative care
   - Transition from paediatric to adult care
Personal and Professional Skills 
   - Be aware of issues around multiple therapies (complexity for patient and doctor, potential for error, effect on adherence, adverse effects, increased potential for drug interactions)
   - Managing professional/personal boundary issues with long-term patients
   - Death and dying in young patients
Hauora Māori 
   - Appropriate engagement and consultation with whānau
   - Awareness of differing risk profiles for Māori compared with non-Māori
   - Understanding of inequities in access to health services and quality of medical care for Māori, and application of this to clinical decision-making and management
Population Health 
   - Social and economic determinants of health
   - Adult health consequences of paediatric disease
   - Epidemiology of bronchiectasis and cystic fibrosis
   - National newborn screening for genetic disease
   - Patient advocacy
   - Role of community organisations
Conditions to be considered relating to this scenario
bronchiectasis, chronic obstructive pulmonary disease, cystic fibrosis
Less common but 'important not to miss'
allergic bronchopulmonary aspergillosis, ciliary dyskinesia syndrome, immunoglobulin deficiency