Type 1b: management questions

Management questions often follow a GP or low-acuity ED assessment question. The examiner may provide additional findings or investigation results to clarify the diagnosis, then ask how you would manage the patient.

In emergency questions, assessment and management happen together: you treat life-threatening problems as you identify them. For a stable patient, a broader management structure helps you cover more than medication alone.

I used the following memory aid:

“Careful Doctors Find Patients that Need More Attention; Managing Illness Demands Monitoring, Safety, Follow-up.”

Each word prompts an aspect of management. Not every element will apply to every case—use the structure to guide your thinking, then tailor your answer to the patient.

C — Confirm the diagnosis

Review the history, examination findings and available results. Explain whether the diagnosis is established or whether uncertainty remains and consider whether further confirmation is needed. In this section if needed you may need to take a further targeted history and physical examination

D — Discuss the diagnosis

Explain the diagnosis sensitively, using language the patient can understand. Explore their concerns, expectations and preferences, check their understanding and give them an opportunity to ask questions.

Involve family or support people with the patient’s consent. Offer appropriate written information and use a structured approach to breaking bad news when relevant.

F — Further investigations

Consider whether additional investigations are needed to assess severity, establish a baseline, identify complications or guide treatment. Explain why each investigation is useful and how it can be accessed in the local setting.

P — Pharmacological management

Outline appropriate medication options, including relevant doses, routes and duration where you know them. Consider allergies, contraindications, interactions, adverse effects and any monitoring required.

N — Non-pharmacological management

Include relevant education, lifestyle measures, self-management strategies and practical advice. Make recommendations achievable for the patient’s circumstances. SNAP (smoking nutrition alcohol and physical activity) is always a great one to refer to here

M — Manage and monitor complications

Identify important complications of the condition and its treatment. Explain how you would prevent, detect and manage them moving forward

A — Arrange referrals to allied health and specialists

Consider which allied health professionals could support the patient. Know the services available in StAMPSville and be specific about local options, visiting services and access barriers. Also consider whether this needs referral for specialist management – again know which specialists visit your town and which don’t.

M — Management plans

Consider whether a formal care plan would help coordinate ongoing care, such as an appropriate mental health or chronic condition management plan. Explain its purpose and who would be involved.

I — Immunisations

Review immunisation needs where relevant to the diagnosis, treatment or the patient’s risk factors.

D — Driving and advance care planning

Consider whether the condition affects fitness to drive or other safety-sensitive activities. For progressive or life-limiting conditions, explore goals of care and advance care planning where appropriate.

M — Mental health

Explore the psychological impact of the diagnosis and whether the patient needs additional support. Consider coping, social supports and access to appropriate services.

S — Safety netting

Explain the symptoms or changes that should prompt review, how urgently the patient should seek help and where they should go. Make this advice specific to the condition and realistic for a rural setting.

F — Follow-up

State when you would review the patient, what you would reassess and who will follow up outstanding results. Include specialist referral where needed, considering availability and urgency.

Use the structure flexibly

Writing these prompts on your preparation page can help you deliver a rounded answer under pressure. However, they are a memory aid, not a complete checklist for every diagnosis.

Some conditions require additional actions, such as partner notification, contact tracing or public health notification. Include these when relevant, alongside any other condition-specific responsibilities.

If you are unsure about a medication or dose, be honest and explain how you would check it. For example:

“I would confirm the recommended regimen in Therapeutic Guidelines, check that it is appropriate for this patient and seek advice if needed.”

A structure cannot replace clinical knowledge, but it can help you demonstrate what you do know, recognise your limits and explain how you would resolve uncertainty safely.

The aim is to present a practical, patient-centred management plan that addresses treatment, ongoing support and follow-up in the StAMPSville setting.