How to use this ACD IMG flashcard deck

The ACD IMG assessment is typically a structured, interview-style assessment using clinical scenarios. Your answer needs to show more than dermatological knowledge. You need to recognise urgency, explain your reasoning, choose proportionate investigations, manage risk and communicate safely in an Australian or New Zealand setting.

This deck is designed for one focused study session. Do not read it as a revision list. Turn each card, answer aloud before revealing the answer, then grade yourself:

  • Again: you missed the central action or gave an unsafe answer.
  • Hard: you reached the answer but needed prompting or missed an important qualification.
  • Good: your answer was accurate and sufficiently ordered.
  • Easy: you answered clearly, with the relevant safety detail, without hesitation.

For an oral assessment, a card is only useful if you can say the answer in a structured way. Aim to give the first sentence as a prioritised summary, then expand under clear headings.

In MySummaries, a deck on ACD IMG clinical reasoning is studied one card at a time, with the answer revealed after you commit to your response:

Cards — ACD IMG — Clinical scenarios18 due

What six headings give a safe structure for an ACD IMG clinical scenario answer?

Structure: Problem summary and triage; key history and examination; prioritised differentials and red flags; investigations or biopsy plan; acute and longer-term management; follow-up, safety-netting and communication.

All 18 cards
What six headings give a safe structure for an ACD IMG clinical scenario answer?Structure: Problem summary and triage; key history and examination; prioritised differentials and red flags; investigations or biopsy plan; acute and longer-term management; follow-up, safety-netting and communication.
What features make a suspected severe cutaneous adverse reaction time-critical?Red flags: Skin pain or tenderness, blistering or epidermal detachment, mucosal involvement, fever or systemic illness, facial oedema, and rapid progression, particularly after a new medicine.
What is the immediate priority when SJS/TEN is suspected?Escalate: Stop suspected non-essential culprit medicines, arrange urgent hospital assessment, assess airway and physiological stability, and involve dermatology and critical-care or burns services as appropriate.
What makes erythroderma an urgent presentation rather than simply widespread dermatitis?Risk: Extensive inflammation can cause temperature dysregulation, fluid and electrolyte disturbance, high-output cardiac strain and infection risk. Assess the patient promptly and arrange urgent specialist or hospital care if unwell.
How should you approach a non-blanching purpuric rash in a systemically unwell patient?Triage first: Treat it as potentially serious, assess observations and sepsis or meningococcal features, escalate urgently, and investigate and manage according to the patient's clinical condition rather than assuming a benign dermatological cause.
What is the preferred biopsy approach for a clinically suspicious melanoma when it is feasible?Biopsy: Complete excision biopsy of the lesion with a narrow clinical margin is preferred where feasible, with accurate site identification and pathology information; arrange urgent specialist review when melanoma is a concern.
What information should accompany a dermatology biopsy specimen?Context: Patient details, exact anatomical site, lesion duration and change, relevant examination findings, the clinical differential, and any important history such as immunosuppression or previous skin cancer.
When should you order an investigation in an ACD IMG scenario?Reasoning: Order a test when its result is likely to change diagnosis, urgency or management. Explain what you are looking for and avoid broad testing that will not alter the plan.
Which pattern should make you question a diagnosis of simple bilateral lower-leg cellulitis?Mimic: Bilateral, symmetrical lower-leg erythema without systemic illness should prompt consideration of venous eczema, lipodermatosclerosis or another inflammatory mimic rather than automatically treating cellulitis.
What must be assessed when urticaria is accompanied by breathing difficulty or circulatory symptoms?Anaphylaxis: Assess airway, breathing and circulation immediately, call for emergency assistance and give intramuscular adrenaline according to current Australian guidance; do not manage it as isolated urticaria.
Why is a painful vesicular eruption in an immunosuppressed patient potentially urgent?Escalation: Immunosuppression increases concern about extensive or disseminated infection and complications. Assess systemic illness, ocular or neurological involvement, and arrange urgent medical and specialist assessment.
What should a safety-net statement contain?Safety-net: Name the symptoms that require urgent help, state who to contact and when, explain the planned review interval, and check that the patient knows what to do if the diagnosis or symptoms change.
What are the essential elements of consent for a procedure or biopsy?Consent: Explain the purpose, what will happen, material risks, alternatives and the consequences of declining; check understanding and confirm a voluntary decision from a patient with capacity.
How should you respond if a patient lacks decision-making capacity for an urgent dermatological intervention?Capacity: Assess and document capacity for that decision, involve the appropriate substitute decision-maker where required, act in the patient's best interests, and escalate if there is disagreement or immediate risk.
What makes an urgent dermatology referral clinically useful?Handover: State the working diagnosis, urgency, red flags, relevant history and medicines, observations, examination findings, investigations, treatment already given and the specific question for the receiving service.
What should you do if a patient declines a recommended urgent referral?Refusal: Check capacity and understanding, explain the material risks of declining, explore the reason and alternatives, offer a safer plan where possible, provide explicit safety-netting, and document the discussion and decision.
Why should an interpreter be used when language affects safe communication?Communication: Use a qualified health interpreter rather than relying on family for complex consent, risk or management discussions; speak directly to the patient and check understanding.
What should your documentation show after a high-risk dermatology consultation?Record: Document the problem representation, relevant positives and negatives, differential and risk assessment, investigations, decisions and their rationale, consent or capacity issues, referrals, advice and follow-up.
An ACD IMG flashcard deck covering clinical reasoning, safe practice and communication.

That is a MySummaries deck, filled with ACD IMG material. Yours is written from your own notes. Start free

The five cards to know before the session ends

The full deck is deliberately broad, but five ideas recur across many scenario questions. They are the cards that prevent an otherwise knowledgeable answer from becoming unsafe:

  1. Prioritise triage before naming a diagnosis. Start with whether the patient is stable and whether the presentation is time-critical.
  2. Make red flags explicit. Say what you are looking for: mucosal disease, skin pain, blistering, systemic illness, rapid progression, ocular involvement or immunosuppression.
  3. Choose investigations that change management. Explain the purpose of a test, biopsy or photograph rather than listing every possible investigation.
  4. Close the loop. A management plan needs escalation, follow-up, safety-netting and documentation.
  5. Show safe professional judgement. Address consent, capacity, interpreters, refusal of care and appropriate referral when the scenario requires it.

A compact core from the deck might look like this:

Must not miss coreACD IMG — Clinical scenarios
Triage first: State whether the patient is stable and identify time-critical dermatological emergencies.
Red flags: Ask about mucosal or ocular involvement, skin pain, blistering, systemic illness, rapid progression and immunosuppression.
Investigate with purpose: Select tests or biopsy when the result will alter diagnosis, urgency or management; include useful clinical information with specimens.
Manage and escalate: Give immediate treatment, identify the receiving service, communicate a clear handover and document the rationale.
Safety-net and consent: Explain risks, alternatives, follow-up and warning symptoms; check understanding, capacity and the patient's preferences.
The five-item ACD IMG core checklist cut from the full clinical reasoning deck.

How to study the deck aloud

Use a three-pass routine rather than trying to memorise every sentence.

Pass one: answer for safety

On the first pass, your only aim is to avoid a dangerous omission. For each card, give a short answer that identifies urgency, the immediate action and the next review or escalation step. If you cannot do that, grade the card Again.

For example, on the severe drug-reaction card, a safe first answer is not simply “I would take a drug history”. It should identify the combination of rapid progression, skin pain, blistering, mucosal involvement or systemic illness, then state that urgent hospital assessment is needed.

Pass two: add the reasoning

Return to cards graded Again or Hard. Add the explanation an examiner needs to hear. If you recommend a biopsy, say what question it answers and what information you would send to pathology. If you recommend referral, say why it is urgent and what you will communicate.

Avoid long unprioritised lists. A candidate who names ten differentials without identifying the dangerous one has not demonstrated clinical reasoning. Start with the most consequential possibilities, then add common or less dangerous explanations.

Pass three: practise the communication finish

A strong clinical answer ends with the patient, not just the disease. Explain the plan in plain language, check understanding, address consent or capacity, arrange follow-up and state the warning symptoms that should prompt earlier review.

You should be able to say something like: “I would explain that the current features could represent a serious reaction and that waiting at home may be unsafe. I would check understanding, arrange urgent assessment, document the discussion and tell the patient which symptoms require immediate emergency help.” Adapt the wording to the scenario rather than repeating a script mechanically.

Remediate the cards you keep missing

If you miss the same card twice, do not simply place it back in the general deck. Reduce the problem to the single decision that caused the error. For example, a candidate may know that melanoma requires referral but repeatedly fail to distinguish a biopsy plan from a definitive treatment plan. That needs a narrower prompt.

A remediation tray for this deck could contain:

Remediation tray

You lost this mark twice: a patient has a changing pigmented lesion that is clinically suspicious for melanoma. What is your immediate diagnostic plan, and what information must accompany the specimen?

Add cardDismiss
A remediation card targeting a repeated error about prioritising a suspicious pigmented lesion.

Answer the tray card in two parts: first, explain that complete excision biopsy with a narrow clinical margin is preferred where feasible and that urgent specialist review should not be delayed when concern is high; second, list the exact site, clinical history, changes, examination findings and differential for the pathology request.

Keep remediation cards short enough to answer in under a minute. Once you can answer one accurately on two separate sessions, return it to the main deck and test it in a longer scenario.

A practical review schedule

Study the 18 cards in a 20–25-minute session today. Spend roughly one minute answering and grading each card, then use the remaining time on the remediation tray. Tomorrow, review only the cards graded Again or Hard. Two or three days later, answer the whole deck aloud, but force yourself to change the clinical context: a new medicine, an immunosuppressed patient, a distressed patient or a patient declining referral.

The aim is not to recite fixed wording. It is to make the sequence automatic: represent the problem, triage risk, identify red flags, investigate proportionately, manage and escalate, then communicate and safety-net.

How MySummaries helps

MySummaries lets you build an ACD IMG board from your own notes, turn the board into spaced-repetition cards, and keep repeatedly missed points in a remediation tray. Its written mock exams and recorded oral practice can then test whether you apply the same structure under pressure. Open the study platform.