PLAB 2 Mock Test Feedback :: Kawasaki Disease :: Paediatrics

Mock Date: 23/04/2025

Action Items:

• Practice and Review the case in the OSCE workbench: Click Here

• Read the Mock Feedback Blog:  Click Here

• Additional Resources: Click Here

• Deep Dive into your performance below:

cenario Summary:

Elliot Morgan, a 3-year-old boy, presents with a five-day history of fever, rash, right-sided lymph node swelling, red eyes, and swollen hands and feet. He has been given Calpol without significant improvement. Elliot is accompanied by his father who is concerned about his persistent symptoms.

My Performance:

🔍Let’s Deep Dive into your performance:

The Domain-wise evaluation shows areas where you did well and others where you have room to grow. 

• A "Yes" means you covered that point effectively

• A "Partial" indicates that you did some of it well but missed some key details. 

• A "No" means there was an important opportunity that wasn’t addressed.

Don’t worry if you see several areas marked "No" or "Partial"—this is common and simply highlights where you can focus your learning. 

By reflecting on these areas and practicing, you’ll be able to improve and feel more confident in your consultations. Remember, every bit of feedback is an opportunity to grow, and you’re on the right path by taking these steps.

Timestamps are provided to show exactly when during the consultation you covered or missed key points. Reviewing these can help you see how well you're managing your time and where you might need to be more efficient in addressing important areas.

Domain	Point	Timestamp	Response	Remarks
Data Gathering	Confirm the patient's full name and age	0:07	Yes	You confirmed the patient’s name and age at the beginning, which was appropriate and clearly done.
Data Gathering	Clarify parental concern at the start: "I can see you’re worried about Elliot’s fever and swelling. Let's go through it together."	0:15	No	You did not acknowledge the father's emotional state early on. It would have been good to show empathy upfront—saying something like "You seem quite worried—let’s go through everything carefully" can help build rapport immediately.
Data Gathering	Inquire about lymph node swelling – when it was first noticed, whether it’s painful, and if other lymph nodes are involved.	0:26	No	You didn’t ask about the swelling in terms of pain or timing specifically. You could have asked something like "When did you first notice the swelling? Is it tender or painful? Any swelling elsewhere?"
Data Gathering	Explore fever details including onset, pattern (continuous/intermittent), and duration to establish timeline and severity.	0:26	Partial	You asked about the fever's onset and duration, but missed asking if it was continuous or intermittent which is important to narrow down differentials.
Data Gathering	Ask about rash – onset, progression, location, texture, blanching nature, and whether it is itchy or painful.	1:00	Partial	You asked about the onset and spread but missed texture, blanching, and whether it's itchy or painful. These are important for differentiating between infective vs inflammatory causes.
Data Gathering	Assess associated symptoms – ask about red eyes (onset, discharge, photophobia), and hand/foot swelling (redness, pain, peeling, functional limitation).	1:15	Partial	You asked about peeling of fingers and general condition but missed red eyes completely. In Kawasaki disease, red eyes are a key sign—this was a missed opportunity to confirm the diagnosis.
Data Gathering	Feeding and drinking habits	1:20	No	You didn’t ask about feeding or drinking, which is very important in a child with fever and rash—especially to assess for dehydration.
Data Gathering	Screen for recent infections or exposures – contacts with viral/bacterial illnesses, recent travel, or immunisation history	2:10	Partial	You asked about contact with someone with chickenpox, which is good. But you didn’t ask about immunisations or any recent travel which could have helped support/contrast the working diagnosis.
Data Gathering	Past medical history, including birth history and vaccination status	1:45	Partial	You asked about birth history, which is good. However, vaccination status was not covered. Asking if he’s up to date with vaccinations could also give reassurance or raise suspicion for certain illnesses.
Data Gathering	Family history of similar symptoms or chronic illnesses	1:50	No	You missed this. Asking “Has anyone in the family had anything similar?” would have helped identify genetic or contagious conditions.
Data Gathering	Medication history and any treatments tried so far	0:36	Yes	You asked and confirmed paracetamol use—well done.
Data Gathering	Social and developmental history	1:50	No	Not asked at all—this is crucial in paediatrics. You could have said, “How is he developing for his age? Any concerns about his speech or motor skills?”
Data Gathering	General physical examination focusing on fever, lymph node swelling, rash, red eyes, and swollen hands and feet	3:30	Partial	You mentioned examining the rash and body, but not specifically eyes, lymph nodes or hands and feet. A brief statement like "I'll check his eyes for redness and hands for any swelling" would have shown better focus.
Management	Explain suspected diagnosis clearly – Kawasaki Disease, a condition causing inflammation in blood vessels mostly in young children.	4:10	Yes	You named the diagnosis and gave a brief explanation—this was good.
Management	Reassure about its treatability – most children recover well with early treatment.	4:50	Partial	You reassured but didn’t specify that most children recover well, which is a key message that helps reduce parental anxiety.
Management	Urgent hospital referral – explain the need for admission for IV immunoglobulin (IVIG) and aspirin to reduce inflammation and heart complications	5:00	No	You said you would admit and give steroids but didn’t mention IVIG or aspirin—these are the mainstay of Kawasaki management. Make sure to mention these specific treatments.
Management	Ensure the father understands the importance of early diagnosis and treatment to prevent complications	5:00	No	This wasn’t explained. A statement like “Starting treatment early helps prevent serious complications like heart issues” would’ve made it clearer.
Management	Explain the likely hospital treatments: intravenous immunoglobulin (IVIG) and aspirin	5:00	No	You only mentioned steroids. These treatments should be stated explicitly so the parent knows what to expect.
Management	Monitoring with an echocardiogram to check heart health	N/A	No	Not mentioned. You should say “We’ll also do an echocardiogram to check the heart as this condition can affect it.”
Management	Supportive care at home: plenty of fluids, continue paracetamol for fever and discomfort	4:30	Partial	You mentioned paracetamol but didn’t advise on fluids or supportive care clearly.
Management	Watch for concerning signs: extreme tiredness, difficulty breathing, persistent fever	N/A	No	Missed. Always advise what red flag signs to look out for even during admission. This shows good safety netting.
Management	Follow-up with a pediatric cardiologist for heart health monitoring	N/A	No	Missed. This is critical in Kawasaki disease. You could have said “He will also need to see a heart specialist later for follow-up.”
Management	Mention follow-up plan – regular reviews with the paediatrician and paediatric cardiologist, including repeat echo.	N/A	No	Not mentioned. This adds clarity and reassurance for the parent about what to expect going forward.
Management	Provide educational leaflet – about Kawasaki Disease, its course, treatment, and what to expect.	N/A	No	Missed. You could say “I’ll also give you a leaflet to read more about Kawasaki disease and what to expect.”
Interpersonal Skills	Acknowledge and validate the father's concerns	2:30	Partial	You did this a little when saying "anyone in your position would feel the same", but you could have acknowledged his emotions more throughout.
Interpersonal Skills	Use sensitive and empathetic language	2:30	Partial	You had some empathetic tone but also missed several chances to reflect his distress. Try repeating his concern and showing you understand how distressing it is.
Interpersonal Skills	Reassure the father about the treatment and prognosis	4:45	Partial	You reassured somewhat, but didn't clearly say "we expect a good recovery with treatment", which would help the parent feel more at ease.
Interpersonal Skills	Address any concerns and answer questions	5:00	Partial	You allowed him to ask about prognosis, but didn’t fully address the question about steroids or reassure about full recovery.
Interpersonal Skills	Signpost throughout the consultation	N/A	No	No clear signposting. You could have said “Now I’d like to ask more about his rash”, or “Let’s go through his history first, then I’ll explain what I think.”
Interpersonal Skills	Use layman terms to explain medical conditions and treatments	4:15	Partial	You used basic terms mostly, but some explanations (e.g., about defensive particles) could have been simplified and clarified further. A quick check for understanding would have helped.

Feedback Statement Checklist

	Feedback Statements:	Needs Improvement
Consultation	Disorganised structure; signposting and follow-up questioning were missing.	✔️
Diagnosis
Examination
Findings	Missed key signs (e.g., red eyes, lymph node involvement).	✔️
Issues	Missed key aspects like IVIG, aspirin, echo.	✔️
Management	Missed important treatment and follow-up details.	✔️
Rapport	Some empathy shown but more needed; could reflect emotions more naturally.	✔️
Listening	Missed cues about ongoing parental worry and didn’t ask further questions based on some responses.	✔️
Language	Could simplify explanations more and check understanding.	✔️
Time

Additional Remarks:

Data Gathering:

You covered many of the basics, but missed some critical paediatric-specific questions such as feeding, hydration, and developmental history. As per the examiner top tips, follow-up questions are key and you must not assume things based on initial answers​. Also, make sure to confirm specific signs of Kawasaki disease like red eyes and lymph node involvement which were missed here.

Management:

The diagnosis was introduced well, but the management discussion was not thorough. You must include IVIG, aspirin, echo, and follow-up for Kawasaki disease. According to examiner guidance, candidates should show they are aware of current best practices and safety-netting​.

Interpersonal Skills:

You showed effort in building rapport but missed many chances to show warmth, reflect the parent's distress, and clearly signpost. As per examiner tips, using kind words and body language, not just stock phrases, is key​.