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Phys · Written Answers

Written Answers

239 units across 15 domains — Written clinical-reasoning practice mapped to DCE long-case preparation.

Back to PhysJump to first domain
Physician Medicine Written Answers
Plate — physMedVellum Press
239Units
15Domains
general-medicinerenalhaematologicalhepaticgastrointestinalendocrinecardiovascularpharmacologicalrheumatologicalinfectiousrespiratoryoncologicalgeriatricdermatologicalneurological
AtlasPhysWritten Answers

Domain

general-medicine

43

Abdominal Examination Routine — Short Answer Question

DCE short-case preparation: structured written reasoning for the systematic abdominal examination routine, covering the twelve-step sequence, the interpretation of key physical signs, the differentiation of organomegaly, the evidence-based examination of ascites and AAA, and the oral presentation template, with model answers mapped to the FRACP DCE and MRCP PACES marking schemes.

Open

Anaphylaxis — Written Clinical Reasoning

DCE written preparation: structured clinical reasoning for anaphylaxis scenarios — bee sting with airway compromise, and refractory anaphylaxis in a beta-blocked patient.

Open

Cardiovascular Examination — Written Clinical Reasoning

DCE written assessment: structured reasoning for the cardiovascular system examination, covering the eleven-step routine, the timing-based murmur framework, the dynamic manoeuvres, the JVP waveform interpretation, the apex beat character, and the structured spoken presentation, with examiner discussion of the common pitfalls.

Open

Clinical Research AND Research Ethics — Written Clinical Reasoning

DCE-style written reasoning for Clinical Research AND Research Ethics.

Open

Confidentiality Privacy AND Mandatory Reporting — Written Clinical Reasoning

DCE-style written reasoning for Confidentiality Privacy AND Mandatory Reporting.

Open

Cranial Nerve Examination — Written Clinical Reasoning

DCE short-case and long-case preparation: structured written reasoning for a pupil-involving third nerve palsy (posterior communicating artery aneurysm) and the integrated interpretation of cranial-nerve findings in a brainstem stroke.

Open

Cultural Competence and Indigenous Health — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a 48-year-old Aboriginal woman from a remote community admitted with decompensated rheumatic heart disease, type 2 diabetes, chronic kidney disease, chronic otitis media and depression — 800 km from home, labelled non-compliant, no Aboriginal Health Worker involved (covering cultural safety, the social determinants, the ARF or RHD prevention pathway, integrated disease management, and culturally safe discharge planning); and the management of a 42-year-old Maori man with premature cardiovascular disease and diabetic kidney disease in the New Zealand health system (covering the Treaty of Waitangi principles, Te Whare Tapa Wha, Whanau Ora, and equitable cardiovascular risk management).

Open

Drug Allergy and Desensitisation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for drug allergy and desensitisation — the allergy-versus-intolerance distinction, the immediate IgE versus delayed T-cell classification, beta-lactam allergy with side-chain-based cross-reactivity and the modern risk-stratified delabeling strategy, non-beta-lactam allergies including aspirin-exacerbated respiratory disease, the severe cutaneous adverse reactions DRESS and SJS/TEN with RegiSCAR and SCORTEN scoring, and the Brigham 12-step desensitisation protocol with the 48-hour tolerance rule.

Open

END OF Life Decision Making — Written Clinical Reasoning

DCE-style written reasoning for END OF Life Decision Making.

Open

Evidence-Based Medicine and Critical Appraisal — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a 75-year-old woman with atrial fibrillation, moderate chronic kidney disease and a high bleeding risk in whom the evidence for a direct oral anticoagulant must be appraised, applied and shared (PICO formulation, applicability to a patient excluded from the pivotal trials, absolute risk reduction and NNT for her baseline risk, the GRADE strength and quality, and the shared decision), and the critical appraisal of a hypothetical meta-analysis of a new antiplatelet agent (forest plot, I-squared heterogeneity, fixed versus random effects, publication bias and applicability).

Open

Examination OF THE Unconscious Patient — Written Clinical Reasoning

DCE-style written reasoning for Examination OF THE Unconscious Patient.

Open

Lymph Node Examination and Organomegaly — Short Answer Question

DCE short-case preparation: structured written reasoning for the systematic examination of lymph nodes and organomegaly, covering the head-to-toe lymph node routine, the five characteristics of every node, the interpretation of node consistency, the significance of the Virchow node, the correct technique for splenomegaly, the differentiation of spleen from kidney, the grading of splenomegaly and the causes of massive splenomegaly, the examination of hepatomegaly, and the oral presentation template, with model answers mapped to the FRACP DCE and MRCP PACES marking schemes.

Open

Medical Errors and Open Disclosure — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for medical errors and open disclosure — the four definitions (medical error, adverse event, near miss, never event), the Swiss cheese model of Reason (active failures and latent conditions, slips lapses and mistakes), the high-alert medicines that concentrate risk (insulin, anticoagulants, opioids), the staged Australian Open Disclosure Framework with the apology that is not an admission of liability, the duty of candour, root cause analysis with the London Protocol contributory factors, the just culture algorithm, the second victim, and the reporting and medico-legal pathways (incident report, AHPRA mandatory notification, coronial referral, medical defence organisation).

Open

Medical Ethics Autonomy Beneficence NON Maleficence Justice — Written Clinical Reasoning

DCE-style written reasoning for Medical Ethics Autonomy Beneficence NON Maleficence Justice.

Open

Medical Ethics, Capacity and Consent — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a 78-year-old woman with severe dementia and pneumonia whose family demand intensive care (capacity, best interests, substituted judgement, ceiling of treatment, the role of the substitute decision-maker and the guardianship tribunal), and the management of a 55-year-old Witness patient with a massive upper gastrointestinal bleed who refuses blood products on religious grounds (capacity, capacitous refusal, blood-conserving strategies, and the limits of the doctrine of necessity).

Open

Multi-morbidity and Complex Care — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for an 82-year-old woman with heart failure, atrial fibrillation, type 2 diabetes, stage 3b CKD, osteoporosis and mild cognitive impairment, admitted with a fall, on 14 medications, requiring an integrated and prioritised management plan anchored to her goals of care (medication reconciliation and review, deprescribing, advance care planning, care coordination); and the management of a multi-morbid patient with acute illness and the sick-day rules for cardio-renal medications.

Open

Neurological Examination of the Lower Limbs — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic neurological examination of the lower limbs, covering the eight-step routine (gait, inspection, tone, power, reflexes, plantar, coordination, sensory), the interpretation of each sign, the UMN versus LMN framework, the gait patterns, the reflex dissociations (diabetic neuropathy, hypothyroidism), the Babinski sign, the heel-shin test, the Romberg test, the myotome map, and a model case discussion of Friedreich ataxia and a common peroneal nerve palsy.

Open

Neurological Examination of the Upper Limbs — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic neurological examination of the upper limbs, covering the eight-step routine, the interpretation of each sign, the UMN versus LMN framework, the localisation of wasting patterns, tremors, tone abnormalities, reflex patterns (including the inverted supinator sign), coordination deficits, and the spinothalamic and dorsal column sensory pathways, with a model case discussion of motor neuron disease and cervical myelopathy.

Open

Perioperative Medicine — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the preoperative assessment and optimisation of a complex elderly patient with atrial fibrillation on a DOAC, type 2 diabetes on insulin and an SGLT2 inhibitor, COPD, and a recent coronary stent, facing major intra-abdominal surgery. Covers cardiac risk stratification, perioperative diabetes, anticoagulation management, chronic medication review, and VTE prophylaxis.

Open

Physician Wellbeing Burnout AND Professional Resilience — Written Clinical Reasoning

DCE-style written reasoning for Physician Wellbeing Burnout AND Professional Resilience.

Open

Preoperative Medical Assessment AND Optimisation — Written Clinical Reasoning

DCE-style written reasoning for Preoperative Medical Assessment AND Optimisation.

Open

Primary Immunodeficiency in Adults — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the workup of common variable immunodeficiency in an adult presenting with recurrent sinopulmonary infection, Giardia enteritis, and autoimmune thrombocytopenia (the diagnostic pathway, the immunoglobulin replacement decision, surveillance for the non-infectious complications), and the acute and prophylactic management of hereditary angioedema presenting to the emergency department.

Open

Quality AND Safety IN Medicine — Written Clinical Reasoning

DCE-style written reasoning for Quality AND Safety IN Medicine.

Open

Rapid Response Systems and MET Calls — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the post-MET-call patient, covering the four-limb RRS model, the afferent-limb analysis of a delayed escalation, the SBAR handover, the post-MET plan and ceiling of care, and the evidence synthesis for a hospital executive.

Open

Respiratory Examination — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic respiratory examination, covering the eleven-step routine, the physiological basis of the cardinal chest signs (consolidation, effusion, pneumothorax, collapse, fibrosis), the interpretation of clubbing and its lung causes, the significance of crackles (fine versus coarse), the tracheal deviation patterns, the presentation template, and the common exam traps.

Open

Rheumatological Examination of the Hands — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic rheumatological examination of the hands, covering the six-step routine, the synovitis versus bony swelling distinction, the discriminating deformities of RA, OA, PsA, gout, SLE (Jaccoud arthropathy), and SSc, the DAS28 joint count, the carpal tunnel bedside tests, and a model case discussion of rheumatoid arthritis with a second prompt on psoriatic arthritis.

Open

Rheumatological Examination Spine AND Lower Limbs — Written Clinical Reasoning

DCE-style written reasoning for Rheumatological Examination Spine AND Lower Limbs.

Open

Skin Examination for Systemic Disease — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic skin examination, covering the six-step routine (general inspection, hands, face, trunk, legs, specific patterns), the morphology vocabulary and the distribution clues, the high-yield skin-to-system sign map (malar rash of SLE, heliotrope and Gottron papules of dermatomyositis, acanthosis nigricans, erythema nodosum, pyoderma gangrenosum, necrobiosis lipoidica, pretibial myxoedema, dermatitis herpetiformis, palpable purpura, livedo patterns), the presentation template, and the common exam traps.

Open

Speech and Higher Mental Function Examination — Written Clinical Reasoning

DCE short-case and long-case preparation: structured written reasoning for an acute Wernicke aphasia (stroke versus delirium distinction) and the interpretation of a cognitive domain profile to differentiate dementia subtypes.

Open

The Deteriorating Ward Patient — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the acutely deteriorating ward patient, covering NEWS2 interpretation and escalation thresholds, the ABCDE systematic assessment, the discrimination of shock types, and the integration of sepsis management with comorbidity and ceiling-of-care decisions.

Open

The Undifferentiated Altered Mental Status — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the acutely confused patient, covering the ABCDE resuscitation-first principle, the DIMTOP differential, the collateral history, the tiered investigation ladder, the Confusion Assessment Method (CAM) diagnostic algorithm, the rapidly reversible causes (GHOST), and the management principle of treating the underlying cause with symptomatic sedation as a last resort.

Open

Thyroid Status Examination — Written Clinical Reasoning

DCE short-case preparation: structured written reasoning for the systematic thyroid status examination, covering the nine-step behind-the-patient routine, the hyperthyroid and hypothyroid clinical phenotypes, the Graves-specific eye and skin signs (exophthalmos, lid lag, lid retraction, ophthalmoplegia, thyroid acropachy, pretibial myxoedema), the Clinical Activity Score and NOSPECS classification, the retrosternal goitre signs, the significance of delayed-relaxation reflexes and the thyroid bruit, the presentation template, and the common exam traps.

Open

Undifferentiated Back Pain — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with undifferentiated back pain, covering the triage framework (mechanical, radicular, red-flag serious pathology), the complete differential (mechanical, inflammatory, infective, malignant, metabolic, referred), the NICE NG59 red flags and cauda equina syndrome, the focused history and the systematic spine and neurological examination (straight leg raise, femoral stretch test, per rectal), the targeted investigations, and the integration of competing diagnoses in the complex multimorbid patient.

Open

Undifferentiated Chest Pain — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with undifferentiated chest pain, covering the deadly six causes, the OPQRST history framework, the pain-character differential, the ECG interpretation including STEMI-equivalents and the Sgarbossa criteria, the high-sensitivity troponin 0/1h algorithm, the HEART score for risk stratification, the Wells score and D-dimer pathway for pulmonary embolism, and the integration of the diagnostic pathway in the complex multimorbid patient.

Open

Undifferentiated Dyspnoea — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with undifferentiated breathlessness, covering the time-course framework, the focused history and examination discriminators, the NT-proBNP algorithm for cardiac versus respiratory dyspnoea, the Wells score and D-dimer pathway for pulmonary embolism, the CURB-65 for pneumonia, Light's criteria for pleural effusion, and the integration of competing diagnoses in the complex multimorbid patient.

Open

Undifferentiated Fatigue — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for chronic fatigue — the three functional categories (physiological, psychological, physical or systemic), the Tier 1 screen and the targeted Tier 2, the management of the unexplained fatigue with reassurance, sleep hygiene, graded activity and the depression treatment, the specific guidance on ME/CFS (NICE 2021 NG206 — the withdrawal of the graded exercise therapy, the pacing), and the post-COVID condition.

Open

Undifferentiated Fever and Fever of Unknown Origin — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a 62-year-old man with six weeks of fever, night sweats and weight loss on a background of treated tuberculosis and adalimumab for psoriatic arthritis (staged diagnostic protocol, the role of FDG-PET-CT, the decision to withhold empiric therapy), and the diagnostic workup of culture-negative infective endocarditis in a patient with a prosthetic valve.

Open

Undifferentiated Lymphadenopathy — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with undifferentiated lymphadenopathy, covering the localised-versus-generalised framework, the regional differentials, the node characteristics and the red-flag screen, the first-tier investigations, the biopsy decision (excisional biopsy as the gold standard for lymphoma, FNA for metastatic or infective), the Lugano classification and the revised International Prognostic Index, and the integration of the competing diagnoses (lymphoma, disseminated tuberculosis, metastatic carcinoma) in the complex multimorbid patient.

Open

Undifferentiated Oedema — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with undifferentiated oedema, covering the Starling forces framework, the localised-versus-generalised classification, the serum-ascites albumin gradient, the NT-proBNP algorithm for cardiac oedema, the drug-induced oedema (amlodipine mechanism and management), the nephrotic syndrome work-up and the venous thromboembolism risk, and the integration of competing mechanisms in the complex multimorbid patient.

Open

Undifferentiated Palpitations — Written Clinical Reasoning

DCE long-case and short-case preparation: structured written reasoning for the diagnostic approach to undifferentiated palpitations, covering the four-descriptor classification (regular fast, irregular, missed beat, pounding), the focused history (onset, duration, termination, triggers, associated symptoms, drug and family history), the cardiovascular and thyroid examination, the mandatory 12-lead ECG interpretation, the tiered ambulatory monitoring strategy, the echocardiogram, the electrophysiology study, and the cause-directed management (sinus tachycardia, SVT, AF, ectopics, VT, channelopathies).

Open

Undifferentiated Presentations Abdominal Pain — Written Clinical Reasoning

DCE-style written reasoning for Undifferentiated Presentations Abdominal Pain.

Open

Undifferentiated Weight Loss — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the diagnostic approach to the patient with involuntary weight loss — the definition of the clinically significant loss, the two first-minute branch points (intentional versus involuntary; appetite preserved versus lost), the seven-category differential, the Tier 1 and the Tier 2 investigations, the Hernandez prediction score for malignancy, the Metalidis evidence supporting the observation after the normal workup, the Fearon cancer cachexia consensus, the nutritional assessment and the management ladder, the refeeding syndrome prevention, and the exam traps.

Open

Urticaria and Angioedema — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for urticaria and angioedema — the lesion-duration rule and the histamine-versus-bradykinin branch point, chronic spontaneous urticaria as a mast-cell autoimmune disease with the four-step EAACI treatment ladder (standard-dose H1, up to 4-fold H1, omalizumab, ciclosporin), hereditary angioedema with C1-INH concentrate and icatibant for acute attacks and lanadelumab for prophylaxis, ACE inhibitor angioedema with permanent drug cessation, and urticarial vasculitis with skin biopsy.

Open

Domain

renal

18

Acid-Base Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acid-base interpretation and management — applying the six-step algorithm to a complex patient, calculating compensation and the delta-delta, distinguishing high from normal anion gap acidoses, and integrating treatment with multimorbidity and polypharmacy.

Open

Acute Kidney Injury — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute kidney injury management, including problem-list synthesis, investigation interpretation, and integrated management planning with drug dosing and nephrotoxicity assessment.

Open

Chronic Kidney Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for CKD management, including problem-list synthesis, investigation interpretation, progression-slowing therapy, complication management, and integrated dialysis planning for the cardiorenal-metabolic patient.

Open

Diabetic Kidney Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for diabetic kidney disease management, including problem-list synthesis, investigation interpretation, progression-slowing therapy with SGLT2 inhibitors and finerenone, complication management, biopsy decision-making, and integrated multifactorial care for the cardiorenal-metabolic patient.

Open

Electrolyte Disorders (Calcium, Magnesium, Phosphate) — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for divalent ion scenarios — severe hypercalcaemia with suppressed PTH in myeloma, and acute post-thyroidectomy hypocalcaemia.

Open

Glomerulonephritis (Nephritic Spectrum) — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for glomerulonephritis management, including problem-list synthesis, complement and serology interpretation, biopsy classification, and evidence-based induction and maintenance immunosuppression.

Open

Hypertensive Nephrosclerosis and Renovascular Disease — Written Clinical Reasoning

DCE written preparation: structured reasoning for renovascular scenarios — the young woman with a bruit and the older vascular patient with a creatinine rise on ACE inhibition.

Open

Kidney Transplantation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for kidney transplantation — the diagnostic approach to a rising creatinine in a transplant recipient (rejection classification, BK nephropathy, CNI toxicity, surgical complications), the immunosuppression regimen and its complications (induction and maintenance, mTOR and belatacept alternatives), and the post-transplant infection timeline and malignancy surveillance.

Open

Nephrolithiasis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a recurrent stone former — the metabolic evaluation (24-hour urine, serum calcium and PTH), the five stone types and their distinguishing features, the dietary and pharmacological prevention strategy (normal calcium, thiazides, potassium citrate, allopurinol), the acute management of renal colic (NSAIDs, stone size-based management, MET after SUSPEND), the surgical interventions (ESWL, ureteroscopy, PCNL), and the emergency of obstructive pyelonephritis. Also covers enteric hyperoxaluria from Crohn disease, primary hyperparathyroidism, and cystinuria.

Open

Nephrotic Syndrome — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for nephrotic syndrome management, including problem-list synthesis, investigation interpretation, cause-specific immunosuppression (rituximab for membranous — MENTOR/GEMRITUX), renal vein thrombosis, and integrated complication prevention for the complex nephrotic patient.

Open

Polycystic Kidney Disease (ADPKD) — Written Clinical Reasoning

DCE written preparation: structured reasoning for ADPKD scenarios — the new diagnosis in a young man with preserved GFR, and the tolvaptan decision in a woman with rapid progression.

Open

Potassium Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for severe hyperkalaemia in a CKD patient on RAAS inhibitors, the four-pillar emergency management, insulin-dextrose hypoglycaemia surveillance, the decision to dialyse, and refractory hypokalaemia with the magnesium-first principle and the Conn's versus Bartter/Gitelman workup.

Open

Renal Cell Carcinoma AND Urothelial Malignancy — Written Clinical Reasoning

DCE-style written reasoning for Renal Cell Carcinoma AND Urothelial Malignancy.

Open

Renal Replacement Therapy — Written Clinical Reasoning

DCE long-case preparation for RRT: modality selection, IDEAL initiation, access planning, PD peritonitis, and conservative care as an active alternative.

Open

Renal Tubular Acidoses AND Inherited Tubular Disorders — Written Clinical Reasoning

DCE-style written reasoning for Renal Tubular Acidoses AND Inherited Tubular Disorders.

Open

Sodium Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for hyponatraemia and hypernatraemia, including symptom-stratified urgency, volume-status classification, urine biochemistry interpretation, the 3% saline bolus regimen and correction ceiling, SIADH management, free water deficit calculation, and diabetes insipidus workup.

Open

Tubulointerstitial Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute interstitial nephritis — a PPI-induced creatinine drift with deprescribing and steroid reasoning, and checkpoint-inhibitor AKI with rechallenge reasoning.

Open

Urinary Tract Infection AND Complicated UTI Pyelonephritis — Written Clinical Reasoning

DCE-style written reasoning for Urinary Tract Infection AND Complicated UTI Pyelonephritis.

Open

Domain

haematological

15

Acute Leukaemia — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute leukaemia — the APL emergency, risk-stratified AML induction and consolidation, the older unfit patient, neutropenic sepsis, differentiation syndrome, and paediatric-inspired ALL with Philadelphia-positive disease and MRD-guided escalation.

Open

Anaemia — Systematic Workup: Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the systematic workup of anaemia — applying the MCV classification and reticulocyte count, interpreting iron studies, and planning the integrated investigation and management of iron deficiency, macrocytosis, and haemolysis in complex patients.

Open

Bleeding Disorders AND Thrombocytopenia — Written Clinical Reasoning

DCE-style written reasoning for Bleeding Disorders AND Thrombocytopenia.

Open

Chronic Leukaemia and Myeloid Neoplasms — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for chronic leukaemia and the related myeloid neoplasms. Covers the CLL watch-and-wait principle and the fitness-and-biology treatment ladder (FCR for favourable biology, BR for the less fit, ibrutinib or venetoclax with obinutuzumab for TP53-disrupted or frail disease, and autoimmune haemolytic anaemia and Richter transformation), and a CML scenario covering the BCR-ABL1 monitoring milestones, treatment-free remission, the T315I mutation and ponatinib, and management in pregnancy.

Open

Coagulation Disorders: Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for coagulation disorders — interpreting the abnormal coagulation screen with mixing studies, diagnosing DIC, managing antiphospholipid syndrome, and planning the investigation and treatment of inherited and acquired coagulopathies.

Open

Haematological Investigation Blood Film Marrow Coagulation Tests — Written Clinical Reasoning

DCE-style written reasoning for Haematological Investigation Blood Film Marrow Coagulation Tests.

Open

Haematopoietic Stem Cell Transplantation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for stem cell transplantation — acute GVHD grading and management, CMV reactivation and preemptive therapy, veno-occlusive disease and defibrotide, haploidentical transplant with post-transplant cyclophosphamide, and the long-term survivorship plan.

Open

Haemolytic Anaemia — Written Clinical Reasoning

DCE-style written reasoning for Haemolytic Anaemia.

Open

Iron Deficiency — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for iron deficiency — the GI workup and management of a 68-year-old man with severe iron-deficiency anaemia, and functional iron deficiency in chronic kidney disease.

Open

Lymphoma — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for lymphoma — Hodgkin staging and PET-adapted ABVD, DLBCL with R-CHOP and the CNS-IPI, follicular watch-and-wait versus treatment, Burkitt as an oncological emergency, primary CNS lymphoma biopsy-first rule, relapsed DLBCL and CAR-T therapy.

Open

Multiple Myeloma — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for multiple myeloma — the IMWG diagnostic criteria, cast nephropathy as a reversible emergency, transplant-eligible VRd induction with autologous transplant and lenalidomide maintenance, the transplant-ineligible daratumumab-based approach, and malignant epidural spinal cord compression.

Open

Myelodysplastic Syndromes — Written Clinical Reasoning

DCE-style written reasoning for Myelodysplastic Syndromes.

Open

Myeloproliferative Neoplasms — Written Clinical Reasoning

DCE-style written reasoning for Myeloproliferative Neoplasms.

Open

Thrombophilia and VTE — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for thrombophilia and VTE — the antiphospholipid syndrome patient with recurrent events (warfarin over DOACs, TRAPS trial), cancer-associated VTE (DOAC vs LMWH, Caravaggio and Hokusai-CANVAS), HIT management (4T score, non-heparin anticoagulant), and the timing of thrombophilia testing.

Open

Transfusion Medicine — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for transfusion scenarios — acute reaction discrimination and massive haemorrhage management on anticoagulation.

Open

Domain

hepatic

6

Acute Liver Failure — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute liver failure — the definition and the three temporal subtypes, the aetiological workup and cause-specific treatment, the King's College Criteria for transplant referral (paracetamol versus non-paracetamol) with the lactate adjunct, the management of cerebral oedema and coagulopathy, and the Wilson disease long case.

Open

Autoimmune Liver Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for autoimmune liver disease — the classification of the three diseases by the LFT pattern and autoantibody panel, the diagnostic algorithm for abnormal LFTs, the simplified score for AIH and the Paris criteria for AIH-PBC overlap, the management of PBC (UDCA plus second-line OCA or fibrates), PSC (surveillance and ERCP, no effective drug), and AIH (prednisolone plus azathioprine), and the transplant indications.

Open

Chronic Liver Disease and Cirrhosis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for decompensated cirrhosis management, including problem-list synthesis, ascites and SBP interpretation, hepatorenal syndrome workup, and integrated management planning.

Open

Hepatocellular Carcinoma — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for hepatocellular carcinoma — the BCLC staging system applied to a cirrhotic patient with a new liver lesion, the LI-RADS imaging-based diagnostic pathway, the treatment allocation by stage (resection, ablation, transplant within Milan criteria, TACE, systemic therapy from atezolizumab-bevacizumab through sorafenib and second-line TKIs), the management of the underlying liver disease, and the surveillance protocol.

Open

Portal Hypertension — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for portal hypertension management, including acute variceal bleeding, refractory ascites, hepatorenal syndrome, and hepatic encephalopathy.

Open

Viral Hepatitis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for hepatitis B serology interpretation, the four phases of chronic HBV and treatment selection, HCV DAA therapy planning, and perinatal transmission prevention.

Open

Domain

gastrointestinal

13

Acute Pancreatitis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute pancreatitis — the two-of-three diagnostic criteria, the I GET SMASHED aetiology with gallstones and alcohol dominant, the Revised Atlanta Classification severity tiers, goal-directed Ringer lactate fluids after WATERFALL, early enteral feeding within 24 to 48 hours, ERCP for cholangitis only, no prophylactic antibiotics, and the step-up approach for infected necrosis after PANTER. Also covers autoimmune pancreatitis (IgG4-related, steroid-responsive) and same-admission cholecystectomy for gallstone pancreatitis.

Open

Chronic Pancreatitis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for chronic pancreatitis — the irreversible fibroinflammatory definition (TIGAR-O), alcohol as the dominant cause with smoking as the key cofactor, the clinical triad of chronic pain, steatorrhoea from 90 per cent exocrine loss, and brittle type 3c diabetes, the investigations (faecal elastase below 200, CT calcification, MRCP, EUS Rosemont), the analgesic ladder and endoscopic-surgical drainage after Cahen, pancreatic enzyme replacement with a PPI, and pancreatic cancer surveillance. Also covers autoimmune (type 1, IgG4-related, steroid-responsive) and tropical calcific pancreatitis.

Open

Colorectal Cancer — Written Clinical Reasoning

DCE-style written reasoning for Colorectal Cancer.

Open

Functional GI Disorders — Written Clinical Reasoning

DCE-style written reasoning for Functional GI Disorders.

Open

Gallstone Disease AND Biliary Pathology — Written Clinical Reasoning

DCE-style written reasoning for Gallstone Disease AND Biliary Pathology.

Open

Gastrointestinal Bleeding — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute upper GI bleeding management, including problem-list synthesis, risk stratification, restrictive transfusion, anticoagulation management, and integrated management planning.

Open

GI Investigation Endoscopy Capsule Liver Biopsy Elastography — Written Clinical Reasoning

DCE-style written reasoning for GI Investigation Endoscopy Capsule Liver Biopsy Elastography.

Open

Inflammatory Bowel Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for inflammatory bowel disease management, including problem-list synthesis, investigation interpretation, and integrated management planning across acute severe UC flare, biologic selection and surveillance.

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Liver Transplantation — Written Clinical Reasoning

DCE-style written reasoning for Liver Transplantation.

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Malabsorption and Small Bowel Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for malabsorption and small bowel disease — the three-level pathophysiology (luminal, mucosal, transport), the diagnostic pathway using anaemia type to localise disease site (microcytic iron from proximal small bowel, macrocytic B12 or folate from terminal ileum), coeliac disease (anti-tTG IgA with total IgA, duodenal Marsh classification, gluten-free diet, refractory disease type 1 and type 2, EATL risk), Whipple disease (Tropheryma whipplei, PAS-positive macrophages, CSF-penetrating antibiotics), bile salt malabsorption (SeHCAT, cholestyramine), SIBO (risk factors, rifaximin), and short bowel syndrome (teduglutide, GLP-2).

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Nutrition IN Liver AND GI Disease — Written Clinical Reasoning

DCE-style written reasoning for Nutrition IN Liver AND GI Disease.

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Obstructive Jaundice — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for obstructive (surgical) jaundice — the conjugated hyperbilirubinaemia with elevated ALP and GGT, pale stools, dark urine, and pruritus, the causes classified by the level of obstruction (extrahepatic choledocholithiasis, pancreatic head cancer, cholangiocarcinoma, ampullary cancer, biliary stricture, parasites; intrahepatic drugs, PBC, PSC), the diagnostic approach from history (biliary colic versus painless jaundice, Charcot triad) and examination (Courvoisier sign), the staged imaging strategy (ultrasound first-line, MRCP gold-standard, CT for staging, EUS-FNA for tissue, ERCP therapeutic), the Tokyo Guidelines 2018 for cholangitis, the van der Gaag evidence on preoperative biliary drainage, and palliative care for advanced malignancy.

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Oesophageal Disorders — Written Clinical Reasoning

DCE-style written reasoning for oesophageal scenarios: progressive dysphagia with alarm features in an older smoker, and recurrent food bolus obstruction in a young atopic patient.

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Domain

endocrine

14

Adrenal Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for adrenal disorders — Addison's disease presenting as adrenal crisis, the three-step Cushing diagnostic algorithm, primary aldosteronism workup, and phaeochromocytoma preoperative preparation — with problem-list synthesis, investigation interpretation, and integrated management planning.

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Adrenal Incidentaloma AND Workup — Written Clinical Reasoning

DCE-style written reasoning for Adrenal Incidentaloma AND Workup.

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Calcium and Bone Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for calcium and bone disorders, including primary hyperparathyroidism with osteoporosis and CKD, hypercalcaemia of malignancy emergency management sequencing, post-surgical hypocalcaemia, hypomagnesaemia and refractory hypocalcaemia, osteoporosis treatment selection with FRAX integration, and osteomalacia recognition and treatment.

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Diabetes Mellitus — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for diabetes management, including problem-list synthesis, investigation interpretation, pharmacological hierarchy, and integrated management planning for a complex multi-morbidity patient.

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Disorders OF Sodium AND Water Homeostasis — Written Clinical Reasoning

DCE-style written reasoning for Disorders OF Sodium AND Water Homeostasis.

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DKA and HHS — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the management of a hyperglycaemic emergency — applying the JBDS diagnostic criteria to a complex patient, differentiating DKA from HHS and euglycaemic DKA, constructing the fluid-insulin-potassium protocol, and anticipating complications including cerebral oedema and hypokalaemia.

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Hypoglycaemia — Written Clinical Reasoning

DCE-style written reasoning for Hypoglycaemia.

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Metabolic Bone Disease AND Vitamin D Disorders — Written Clinical Reasoning

DCE-style written reasoning for Metabolic Bone Disease AND Vitamin D Disorders.

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Multiple Endocrine Neoplasia — Written Clinical Reasoning

DCE-style written reasoning for Multiple Endocrine Neoplasia.

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Pituitary Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pituitary disease management, including acromegaly workup and treatment, pituitary apoplexy emergency management, and hypopituitarism hormone replacement.

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Reproductive Endocrinology — Written Clinical Reasoning

DCE-style written reasoning for Reproductive Endocrinology.

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Thyroid Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for thyroid disorders, including cause discrimination in thyrotoxicosis (Graves vs thyroiditis vs amiodarone), Graves disease with comorbid atrial fibrillation and orbitopathy, antithyroid drug pharmacology, radioactive iodine and surgery decision-making, thyroid storm and myxoedema coma emergencies, and thyroid nodule Bethesda-based management.

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Thyroid Nodules AND Thyroid Cancer — Written Clinical Reasoning

DCE-style written reasoning for Thyroid Nodules AND Thyroid Cancer.

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Transgender Medicine AND Hormone Therapy — Written Clinical Reasoning

DCE-style written reasoning for Transgender Medicine AND Hormone Therapy.

Open

Domain

cardiovascular

20

Adult Congenital Heart Disease — Written Clinical Reasoning

DCE-style written reasoning for Adult Congenital Heart Disease.

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Anticoagulation and Antiplatelet Therapy — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for perioperative anticoagulation planning and for major gastrointestinal bleeding on a direct oral anticoagulant.

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Aortic Disease — Written Clinical Reasoning

DCE-style written reasoning for Aortic Disease.

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Arrhythmias and Conduction Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for arrhythmia scenarios — new AF with rapid ventricular response in sepsis, and syncope with bifascicular block.

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Atrial Fibrillation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for atrial fibrillation management, including CHA₂DS₂-VASc decision-making, rate versus rhythm strategy, DOAC dose selection, and integrated comorbidity management.

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Cardiac Investigations — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for cardiac investigation selection, including stress test choice, CT coronary angiography interpretation, cardiac MRI LGE pattern analysis, and integrated investigation planning across stable chest pain, heart failure, and valvular disease.

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Cardiac Tumours AND Systemic Manifestations OF Cardiac Disease — Written Clinical Reasoning

DCE-style written reasoning for Cardiac Tumours AND Systemic Manifestations OF Cardiac Disease.

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Cardiomyopathies — Written Clinical Reasoning

DCE long-case and short-case preparation: structured written reasoning for the approach to the newly diagnosed cardiomyopathy, covering the phenotype-first classification (HCM, DCM, ARVC, restrictive), the genetic basis (sarcomeric, desmosomal, titin, LMNA), the cardiac MRI late gadolinium enhancement patterns, the HCM sudden cardiac death risk stratification with the HCM Risk-SCD calculator, the GDMT four pillars for dilated cardiomyopathy, the ARVC Task Force Criteria, the differentiation of restrictive cardiomyopathy from constrictive pericarditis, and the disease-modifying therapies (mavacamten, tafamidis, disopyramide).

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Cardiovascular Prevention and Rehabilitation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for cardiovascular prevention scenarios — primary prevention assessment with a strong family history, and the post-MI secondary prevention bundle with statin intolerance.

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Coronary Artery Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute coronary syndrome management, including problem-list synthesis, investigation interpretation, risk stratification, and integrated secondary prevention planning.

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ECG Interpretation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for physician-level ECG interpretation, including the systematic approach, ischaemia/mimic discrimination, and integration of the ECG into a complex patient's management plan.

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Heart Failure — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for heart failure management, including problem-list synthesis, investigation interpretation, and integrated management planning.

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Hypertension — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for hypertension management, including problem-list synthesis, secondary cause workup, resistant hypertension management, and integrated management planning.

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Infective Endocarditis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for infective endocarditis management, including problem-list synthesis, Modified Duke criteria application, investigation interpretation, empiric and culture-directed therapy, surgical decision-making, and prophylaxis.

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Pericardial Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pericardial disease management, including problem-list synthesis, investigation interpretation, and integrated management planning across acute pericarditis, tamponade, constriction, and recurrent disease.

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Pulmonary Hypertension — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pulmonary hypertension, including the haemodynamic definition and WHO classification, the diagnostic workup culminating in right heart catheterisation, the ESC/ERS 2022 three-strata risk assessment, and the evidence-based combination therapy strategy across Group 1 PAH and Group 4 CTEPH.

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Rheumatic Fever AND Rheumatic Heart Disease — Written Clinical Reasoning

DCE-style written reasoning for Rheumatic Fever AND Rheumatic Heart Disease.

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Sudden Cardiac Death AND ICD CRT Therapy — Written Clinical Reasoning

DCE-style written reasoning for Sudden Cardiac Death AND ICD CRT Therapy.

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Syncope — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for syncope, including the ESC 2018 three-category classification, the directed investigation pathway from ECG to implantable loop recorder, risk stratification of high-risk features, and the evidence-based management of reflex, orthostatic, and cardiac syncope informed by the PC-Trial, POST2, POST4, and ISSUE-3.

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Valvular Heart Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for valvular heart disease management, including problem-list synthesis, investigation interpretation, and integrated management planning across the four valves and prosthetic valves.

Open

Domain

pharmacological

15

Adverse Drug Reactions — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex patient with a severe adverse drug reaction (DRESS to allopurinol in chronic kidney disease) and a separate severe cutaneous adverse reaction scenario requiring SCORTEN calculation and burns-unit management — for FRACP DCE and MRCP Part 2 preparation.

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Australian Envenomation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for Australian snake bite envenomation — the five clinical syndromes of elapid envenomation, the pressure immobilisation bandage, the Snake Venom Detection Kit, monovalent antivenom selection and dosing, the venom-induced consumption coagulopathy (VICC) versus disseminated intravascular coagulation (DIC) distinction, the role of fresh frozen plasma, and the management of complications including thrombotic microangiopathy, serum sickness and presynaptic neurotoxicity requiring ventilation.

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Beta Blocker AND Calcium Channel Blocker Toxicity — Written Clinical Reasoning

DCE-style written reasoning for Beta Blocker AND Calcium Channel Blocker Toxicity.

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Cardiac Glycoside — Written Clinical Reasoning

DCE-style written reasoning for Cardiac Glycoside.

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Iron Toxicity — Written Clinical Reasoning

DCE-style written reasoning for Iron Toxicity.

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Lithium Toxicity — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex elderly patient with chronic lithium toxicity precipitated by a drug interaction, with acute kidney injury and chronic end-organ effects, and a second prompt on the management of lithium toxicity in the setting of reduced renal function — for FRACP DCE and MRCP Part 2 preparation.

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Opioid Benzodiazepine AND Alcohol Withdrawal — Written Clinical Reasoning

DCE-style written reasoning for Opioid Benzodiazepine AND Alcohol Withdrawal.

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Paracetamol Toxicity — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for paracetamol toxicity — the single acute overdose and the nomogram decision, the staggered overdose that defeats the nomogram, N-acetylcysteine therapy and its adverse reactions, and the King's College Criteria for transplant referral with the lactate adjunct.

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Pharmacokinetics in Organ Failure — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for medication review and dose adjustment in organ failure — applying pharmacokinetic principles to a complex elderly patient with CKD, cirrhosis, AF and polypharmacy, renal and hepatic dose adjustment, therapeutic drug monitoring, and the Beers/STOPP-START framework.

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Poisoning — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the poisoned patient — applying the ABCDE-plus-toxidrome approach, the decontamination decision (when to give charcoal, when to intubate first), the enhanced-elimination logic, and the antidote table to a complex mixed overdose.

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Salicylate Toxicity — Written Clinical Reasoning

DCE-style written reasoning for Salicylate Toxicity.

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Serotonin Syndrome and NMS — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the recognition and management of serotonin syndrome and neuroleptic malignant syndrome, including the Hunter criteria, the SS-versus-NMS distinction, cyproheptadine and dantrolene pharmacology, and the management of withdrawal-emergent NMS in Parkinson disease.

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Therapeutic Drug Monitoring — Written Clinical Reasoning

DCE-style written reasoning for Therapeutic Drug Monitoring.

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Toxic Alcohols — Written Clinical Reasoning

DCE-style written reasoning for Toxic Alcohols.

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Tricyclic Antidepressant AND Sodium Channel Blocker Toxicity — Written Clinical Reasoning

DCE-style written reasoning for Tricyclic Antidepressant AND Sodium Channel Blocker Toxicity.

Open

Domain

rheumatological

18

Allergic Rhinitis AND Asthma — Written Clinical Reasoning

DCE-style written reasoning for Allergic Rhinitis AND Asthma.

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Antiphospholipid Syndrome — Written Clinical Reasoning

DCE-style written reasoning for Antiphospholipid Syndrome.

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Complement Deficiencies AND Recurrent Infections — Written Clinical Reasoning

DCE-style written reasoning for Complement Deficiencies AND Recurrent Infections.

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Crystal Arthropathies — Written Clinical Reasoning

DCE-style written reasoning for Crystal Arthropathies.

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Drug Induced Rheumatological Disease AND Biologics Safety — Written Clinical Reasoning

DCE-style written reasoning for Drug Induced Rheumatological Disease AND Biologics Safety.

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Eosinophilic Disorders — Written Clinical Reasoning

DCE-style written reasoning for Eosinophilic Disorders.

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Fibromyalgia and Chronic Widespread Pain — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with fibromyalgia and comorbid inflammatory disease, covering the 2016 ACR diagnostic criteria (WPI and SSS), the central sensitisation mechanism, the distinction from inflammatory and endocrine mimics, the recognition of secondary fibromyalgia inflating composite disease-activity scores, the non-pharmacological-first management (exercise as the EULAR strong-for recommendation), symptom-targeted pharmacotherapy (amitriptyline, duloxetine, pregabalin), and the explicit avoidance of opioids and glucocorticoids.

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IgG4-Related Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a 62-year-old man with IgG4-related disease presenting as painless jaundice, bilateral submandibular gland enlargement and renal impairment — the one-disease-many-organs concept, the clinicopathological diagnosis (histopathology triad of dense lymphoplasmacytic infiltrate, storiform fibrosis and obliterative phlebitis with IgG4-positive plasma cells), the correct use and limits of serum IgG4, the exclusion of pancreatobiliary malignancy and Sjogren syndrome, the 2019 ACR and EULAR classification criteria and the 2020 revised comprehensive diagnostic criteria, and the treatment ladder of glucocorticoids first-line and rituximab for relapsing or multi-organ disease.

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Immunological Investigation Immunoglobulins Complement Flow Cytometry — Written Clinical Reasoning

DCE-style written reasoning for Immunological Investigation Immunoglobulins Complement Flow Cytometry.

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Osteoarthritis — Written Clinical Reasoning

DCE-style written reasoning for Osteoarthritis.

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Rheumatoid Arthritis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with newly diagnosed seropositive rheumatoid arthritis requiring treat-to-target management, and a complex patient with long-standing RA presenting with interstitial lung disease and cardiovascular comorbidity.

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Rheumatological Investigation Autoantibodies Imaging Synovial Fluid — Written Clinical Reasoning

DCE-style written reasoning for Rheumatological Investigation Autoantibodies Imaging Synovial Fluid.

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SJ Gren S Syndrome AND Inflammatory Myopathies — Written Clinical Reasoning

DCE-style written reasoning for SJ Gren S Syndrome AND Inflammatory Myopathies.

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Spondyloarthropathies — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with newly diagnosed axial spondyloarthritis (ankylosing spondylitis) requiring NSAID, physiotherapy and biologic escalation management, plus a complex patient with long-standing AS presenting with uveitis, aortic regurgitation and apical pulmonary fibrosis.

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Systemic Autoinflammatory Syndromes — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the systemic autoinflammatory syndromes — the innate-versus-adaptive immune framework, familial Mediterranean fever with colchicine prophylaxis and AA amyloidosis, the cryopyrin-associated periodic syndromes with interleukin-1 blockade, adult-onset Still disease with the Yamaguchi criteria, Schnitzler syndrome with monoclonal IgM gammopathy, the diagnostic approach using attack pattern and a targeted genetic panel, and the treatment principle that IL-1 blockade is transformative for the IL-1-driven syndromes.

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Systemic Lupus Erythematosus — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with proliferative class IV lupus nephritis requiring integrated induction and maintenance immunosuppression, and a young woman with SLE and antiphospholipid syndrome planning pregnancy.

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Systemic Sclerosis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for systemic sclerosis — the ACR/EULAR 2013 classification, limited versus diffuse subtypes and their autoantibodies, scleroderma renal crisis as the ACE-inhibitor emergency, interstitial lung disease with mycophenolate and nintedanib, pulmonary arterial hypertension screening and management, and autologous stem cell transplant for severe early diffuse disease.

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The Systemic Vasculitides — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the systemic vasculitides — the Chapel Hill 2012 vessel-size classification, giant cell arteritis with urgent steroids and tocilizumab, polyarteritis nodosa with microaneurysms and HBV association, ANCA-associated vasculitis with rituximab induction and plasma exchange for anti-GBM overlap, cryoglobulinaemic vasculitis with HCV and low complement, IgA vasculitis in children, Behcet disease, the diagnostic approach using biopsy, angiography, ANCA and complement, and the treatment framework of steroids first-line with cyclophosphamide or rituximab for organ-threatening disease.

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Domain

infectious

16

Antimicrobial Stewardship and Resistance — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for severe Clostridioides difficile infection complicating broad-spectrum antibiotic therapy (severity stratification, fidaxomicin versus vancomycin, bezlotoxumab, recurrence prevention), and the management of carbapenem-resistant Enterobacteriaceae bacteraemia in a patient repatriated from overseas.

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Bloodstream Infections and Infective Endocarditis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for bloodstream infection scenarios — S. aureus bacteraemia in a dialysis catheter patient, and fever with a new murmur and an embolic phenomenon.

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Bone AND Joint Infections — Written Clinical Reasoning

DCE-style written reasoning for Bone AND Joint Infections.

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CNS Infections — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for suspected bacterial meningitis and for encephalitis, including management sequencing, CT-before-LP criteria, and CSF interpretation.

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Fungal Infections — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for invasive pulmonary aspergillosis in a neutropenic patient after AML induction (the CT and galactomannan diagnostic strategy, voriconazole first-line therapy, therapeutic drug monitoring, and the role of secondary prophylaxis), and for candidaemia in a post-operative ICU patient (echinocandin choice, mandatory line removal and fundoscopy, and the duration of therapy).

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Healthcare-Associated Infections — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a postoperative patient who develops a catheter-related bloodstream infection and ventilator-associated pneumonia simultaneously (device management, empiric therapy, de-escalation, prevention bundle), and the management of an outbreak of carbapenem-resistant Enterobacteriaceae on a surgical ward.

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HIV and AIDS — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for HIV — ART initiation in a complex patient with TB co-infection, hepatitis B co-infection and renal impairment, plus opportunistic infection management covering PCP, toxoplasma encephalitis, cryptococcal meningitis, IRIS, and prophylaxis by CD4 threshold.

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Infections in the Immunocompromised Host — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for febrile neutropenia in the post-chemotherapy patient (door-to-antibiotic protocol, empiric piperacillin-tazobactam, escalation with antifungal at 3 to 5 days, and the role of G-CSF), and the prevention of hepatitis B reactivation in a patient about to receive rituximab.

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Sepsis and Septic Shock — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the Surviving Sepsis Campaign Hour-1 Bundle in a patient with septic shock, vasopressor escalation and fluid responsiveness assessment, and the management of neutropenic sepsis.

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Sexually Transmitted Infections — Written Clinical Reasoning

DCE-style written reasoning for Sexually Transmitted Infections.

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Tropical and Travel-Related Infections — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the febrile returning traveller, covering the rule-out-malaria-first principle and severe falciparum malaria management with IV artesunate, and the management of dengue with warning signs during the critical plasma-leakage phase.

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Tuberculosis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pulmonary tuberculosis with comorbidities — problem-list synthesis, investigation interpretation (smear, GeneXpert, culture), standard RIPE regimen, rifampicin drug interactions, infection control and the second SAQ on latent TB management before biologic therapy.

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Tuberculosis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for tuberculosis scenarios — reactivation risk in an anti-TNF candidate, and tuberculous meningitis with HIV co-infection.

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Vaccine-Preventable Diseases — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the immunisation decisions in the immunocompromised patient, covering the pre-immunosuppression window (before rituximab, anti-TNF, transplant, chemotherapy), the live-versus-inactivated principle, the sequential pneumococcal schedule, the asplenic vaccination bundle, maternal immunisation (influenza and dTpa in every pregnancy), travel medicine, and vaccine adverse events and contraindications.

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Viral Hepatitis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for infectious-diseases viral hepatitis scenarios — HBV reactivation prophylaxis before chemotherapy, and the HCV test-and-cure pathway in a newly diagnosed patient.

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Zoonotic and Vector-Borne Infections — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the patient with a suspected zoonotic infection, covering the exposure-history framework, the phase I and II serology of Q fever endocarditis, the empiric doxycycline principle for rickettsial disease, the combination therapy for brucellosis, the folinic acid versus folic acid distinction in cerebral toxoplasmosis, and the ANZ-specific principle that Lyme disease is not locally endemic — structured for FRACP DCE long-case preparation.

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Domain

respiratory

16

Asthma and Severe Asthma — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for severe asthma management, including problem-list synthesis, phenotype-driven biologic selection, investigation interpretation, and integrated management planning.

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Bronchiectasis AND Suppurative Lung Disease — Written Clinical Reasoning

DCE-style written reasoning for Bronchiectasis AND Suppurative Lung Disease.

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COPD — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for COPD exacerbation management, problem-list synthesis, investigation interpretation, and integrated management planning including NIV.

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Diffuse Alveolar Haemorrhage — Written Clinical Reasoning

DCE written preparation: structured reasoning for diffuse alveolar haemorrhage scenarios — diagnosis when haemoptysis is absent, and management of anti-GBM disease with pulmonary-renal syndrome.

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Interstitial Lung Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for interstitial lung disease management, including problem-list synthesis, HRCT interpretation, investigation interpretation, and integrated management planning for IPF and CTD-ILD.

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Lung Cancer — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for lung cancer scenarios — the growing solitary pulmonary nodule in a smoker, and SVC obstruction at first presentation.

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Lung Transplantation — Written Clinical Reasoning

DCE-style written reasoning for Lung Transplantation.

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Obstructive Sleep Apnoea — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for severe obstructive sleep apnoea with excessive daytime sleepiness, resistant hypertension, and atrial fibrillation — covering diagnosis by polysomnography and AHI severity, the treatment ladder (lifestyle, CPAP, oral appliances, hypoglossal stimulation, bariatric surgery), CPAP adherence, the SAVE trial cardiovascular evidence, and the medico-legal duty regarding driving.

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Occupational AND Environmental Lung Disease — Written Clinical Reasoning

DCE-style written reasoning for Occupational AND Environmental Lung Disease.

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Pleural Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pleural effusion (Light's criteria, pleural fluid analysis, parapneumonic effusion and empyema) and malignant pleural effusion with mesothelioma, including the BTS 2023 approach, intrapleural tPA-DNase, pleurodesis versus indwelling pleural catheter, and pemetrexed-cisplatin chemotherapy.

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Pneumonia — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for severe CAP management — severity stratification, empiric therapy, corticosteroid adjunct, parapneumonic effusion management, and investigation interpretation.

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Pulmonary Embolism — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for pulmonary embolism, including diagnostic algorithm application (Wells, D-dimer, CTPA/VQ), risk stratification (sPESI, biomarkers, echo), and integrated management planning (anticoagulation, reperfusion, duration).

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Pulmonary Vascular Disease AND COR Pulmonale — Written Clinical Reasoning

DCE-style written reasoning for Pulmonary Vascular Disease AND COR Pulmonale.

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Respiratory Failure and Non-Invasive Ventilation — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute respiratory failure — the acidotic COPD exacerbation and the hypoxaemic pneumonia support decision.

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Respiratory Investigation — Written Clinical Reasoning

DCE written preparation: structured reasoning for respiratory investigation scenarios — interpreting three PFT panels (ILD vs obesity vs neuromuscular weakness) and working up a unilateral exudative pleural effusion.

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Solitary Pulmonary Nodule — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for solitary pulmonary nodule scenarios — the 9 mm solid nodule in a 60-year-old smoker, and the 12 mm part-solid nodule with a 7 mm solid component.

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Domain

oncological

8

Breakthrough Cancer Pain AND Opioid Titration — Written Clinical Reasoning

DCE-style written reasoning for Breakthrough Cancer Pain AND Opioid Titration.

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Breast Cancer — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for breast cancer — the receptor subtype framework (ER/PR, HER2, triple-negative) applied to a 52-year-old woman with HER2-positive disease, the neoadjuvant TCHP decision and the KATHERINE-based response-adapted strategy, the trastuzumab cardiotoxicity monitoring protocol, and the BRCA testing and olaparib (OlympiA) discussion, plus a triple-negative scenario covering neoadjuvant pembrolizumab (KEYNOTE-522).

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Cancer Cachexia AND Nutritional Support — Written Clinical Reasoning

DCE-style written reasoning for Cancer Cachexia AND Nutritional Support.

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Immune Checkpoint Inhibitor Toxicity — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient on combination checkpoint inhibition presenting with multisystem immune-related toxicity (grade 3 colitis, hypophysitis with adrenal crisis, hepatitis, and skin rash), and a second prompt on the recognition and emergency management of checkpoint-inhibitor myocarditis.

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Oncologic Emergencies — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for two high-yield oncologic emergencies — a lymphoma patient who develops febrile neutropenia and tumour lysis syndrome simultaneously, and a breast cancer patient presenting with malignant spinal cord compression and hypercalcaemia.

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Pain Management IN Cancer AND Chronic Disease — Written Clinical Reasoning

DCE-style written reasoning for Pain Management IN Cancer AND Chronic Disease.

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Palliative Care — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex patient with metastatic cancer presenting with multiple uncontrolled symptoms (pain, nausea, breathlessness, constipation, agitation) and goals-of-care decisions, and a second patient in the last days of life requiring anticipatory prescribing and family communication — for FRACP DCE and MRCP Part 2 preparation.

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Prostate Cancer — Written Clinical Reasoning

DCE-style written reasoning for Prostate Cancer.

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Domain

geriatric

12

Comprehensive Geriatric Assessment and Frailty — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex frail older woman with multiple comorbidities, functional decline, falls, polypharmacy, and malnutrition assessed by comprehensive geriatric assessment, and an older man with a hip fracture assessed by CGA under an orthogeriatric model — for FRACP DCE and MRCP Part 2 preparation.

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Delirium — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex elderly patient with postoperative delirium superimposed on dementia, and a hypoactive delirium with multiple precipitants — for FRACP DCE and MRCP Part 2 preparation.

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Dementia — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex elderly patient with mixed Alzheimer and vascular dementia presenting with worsening confusion and behavioural change, and a patient with dementia with Lewy bodies admitted with behavioural disturbance — for FRACP DCE and MRCP Part 2 preparation.

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Elder Abuse and Safeguarding — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for an 82-year-old woman with moderate Alzheimer disease admitted with dehydration and malnutrition whose daughter has been managing her finances and may be financially and psychologically abusing her (recognition, capacity assessment, safeguarding enquiry, tribunal referral, and the autonomy-protection balance), and the management of a 79-year-old woman with intact cognition who discloses financial and psychological abuse by her son but declines formal intervention (capacitous refusal, harm reduction, confidentiality versus duty to protect).

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End-of-Life Care and Advance Care Planning — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for an 82-year-old man with end-stage heart failure and chronic kidney disease admitted with a decompensation, who triggers the Surprise Question and requires an advance care planning conversation, a documented goals-of-care plan and a ceiling of treatment; and the management of a 77-year-old woman with metastatic ovarian cancer now in the last days of life with refractory symptoms requiring a structured dying-patient care bundle and anticipatory prescribing.

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Falls and Syncope in Older Adults — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex older patient with multifactorial falls and drug-induced orthostatic hypotension on a polypharmacy background, and an older patient with exertional syncope from severe aortic stenosis — for FRACP DCE and MRCP Part 2 preparation.

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Nutrition AND Hydration IN Older Adults — Written Clinical Reasoning

DCE-style written reasoning for Nutrition AND Hydration IN Older Adults.

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Orthogeriatrics AND Perioperative Medicine IN Older Adults — Written Clinical Reasoning

DCE-style written reasoning for Orthogeriatrics AND Perioperative Medicine IN Older Adults.

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Parkinson S Disease IN Older Adults — Written Clinical Reasoning

DCE-style written reasoning for Parkinson S Disease IN Older Adults.

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Polypharmacy and Deprescribing — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a complex elderly patient with polypharmacy, frailty, falls and an adverse drug event, and a prescribing cascade in an older woman — for FRACP DCE and MRCP Part 2 preparation.

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Pressure Injuries AND Wound Care — Written Clinical Reasoning

DCE-style written reasoning for Pressure Injuries AND Wound Care.

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Urinary Incontinence IN Older Adults — Written Clinical Reasoning

DCE-style written reasoning for Urinary Incontinence IN Older Adults.

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Domain

dermatological

8

Cutaneous Manifestations of Systemic Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with adult-onset dermatomyositis as a paraneoplastic marker requiring an integrated malignancy search, and a dialysis patient with calciphylaxis requiring urgent multidisciplinary management.

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Drug Eruptions AND Severe Cutaneous Adverse Reactions — Written Clinical Reasoning

DCE-style written reasoning for Drug Eruptions AND Severe Cutaneous Adverse Reactions.

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Erythema Nodosum AND Panniculitis — Written Clinical Reasoning

DCE-style written reasoning for Erythema Nodosum AND Panniculitis.

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Genodermatoses with Systemic Significance — Written Clinical Reasoning

DCE-style written reasoning for Genodermatoses with Systemic Significance.

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Malignant Skin Lesions — Written Clinical Reasoning

DCE-style written reasoning for Malignant Skin Lesions.

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Pyoderma Gangrenosum AND Neutrophilic Dermatoses — Written Clinical Reasoning

DCE-style written reasoning for Pyoderma Gangrenosum AND Neutrophilic Dermatoses.

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Skin Signs OF Internal Malignancy — Written Clinical Reasoning

DCE-style written reasoning for Skin Signs OF Internal Malignancy.

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Vasculitic Skin Lesions — Written Clinical Reasoning

DCE-style written reasoning for Vasculitic Skin Lesions.

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Domain

neurological

17

Epilepsy — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for status epilepticus management, syndrome-based drug selection, and women-with-epilepsy preconception care.

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Guillain-Barre Syndrome — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with severe post-Campylobacter Guillain-Barre syndrome at the respiratory-failure threshold, and a Miller Fisher syndrome case requiring variant recognition, antibody interpretation and management — for FRACP DCE and MRCP Part 2 preparation.

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Headache — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for thunderclap headache and subarachnoid haemorrhage workup, giant cell arteritis urgent management, chronic migraine with medication overuse, and idiopathic intracranial hypertension diagnostic reasoning.

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Meningitis and Encephalitis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for empiric therapy in suspected bacterial meningitis with immunocompromise, CSF interpretation across bacterial/viral/TB/fungal patterns, HSV encephalitis management, and cryptococcal meningitis with raised intracranial pressure.

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Motor Neuron Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for the integrated management of bulbar-onset ALS with respiratory muscle weakness and nutritional decline, and the diagnostic approach to a mimic (multifocal motor neuropathy) that must not be missed.

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Movement Disorders — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for Parkinson's disease with motor complications and hallucinations, plus a young patient with suspected Wilson disease — for FRACP DCE and MRCP Part 2 preparation.

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Multiple Sclerosis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for multiple sclerosis — the clinical course (RRMS 85 per cent, SPMS, PPMS 15 per cent), the McDonald 2017 diagnostic criteria (dissemination in space and time, CSF oligoclonal bands), the DMT landscape (interferon, glatiramer, dimethyl fumarate, fingolimod, cladribine, siponimod, natalizumab with PML risk, ocrelizumab for PPMS and RRMS, alemtuzumab), acute relapse management (methylprednisolone, plasma exchange), symptom management, and pregnancy planning (washout, PRIMS relapse pattern, breastfeeding).

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Myasthenia Gravis — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for myasthenic crisis management and the integrated management of AChR-positive generalized MG with a thymoma.

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Neurocutaneous Syndromes — Written Clinical Reasoning

DCE-style written reasoning for Neurocutaneous Syndromes.

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Neurological Investigation LP EMG NCS EEG Neuroimaging — Written Clinical Reasoning

DCE-style written reasoning for Neurological Investigation LP EMG NCS EEG Neuroimaging.

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Peripheral Neuropathy — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for peripheral neuropathy — the four classification axes (fibre type, distribution, time course, axonal versus demyelinating), the approach to a diagnostic challenge combining diabetic distal symmetric polyneuropathy with a superimposed vasculitic mononeuritis multiplex, the investigation pathway (NCS/EMG, blood panels, CSF, genetics, biopsy), and the three-pillar management (treat the cause, neuropathic pain, foot care and falls prevention).

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Raised Intracranial Pressure AND Brain Tumours — Written Clinical Reasoning

DCE-style written reasoning for Raised Intracranial Pressure AND Brain Tumours.

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Spinal Cord Disease — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for a patient with metastatic spinal cord compression requiring emergency management, and a young adult with nitrous oxide-related subacute combined degeneration requiring diagnosis and treatment — for FRACP DCE and MRCP Part 2 preparation.

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Stroke — Written Clinical Reasoning

DCE long-case preparation: structured written reasoning for acute stroke management, including problem-list synthesis, investigation interpretation, and integrated secondary prevention planning.

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Subarachnoid Haemorrhage AND Intracranial Haemorrhage — Written Clinical Reasoning

DCE-style written reasoning for Subarachnoid Haemorrhage AND Intracranial Haemorrhage.

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TIA and Carotid Disease — Written Clinical Reasoning

DCE-style written reasoning for high-risk TIA: urgent pathway, dual antiplatelet therapy, carotid imaging and revascularisation thresholds.

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Vestibular Disorders — Written Clinical Reasoning

DCE-style written reasoning for Vestibular Disorders.

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