PLAB 2 Mock test feedback:: Pediatrics: Mild Head Injury In A 9 Month old

Mock Date: 01/08/2025
Case 1:
Topic: Paediatrics; Case UID: PaedsMiscOwn1
Case Name: MildHeadInjury9Month
Action Items:
Practice and Review the case in the OSCE workbench:	Click Here
Watch the (Private) Mock Test Video Recording:	Click Here
Read the Case Blog:	Click Here
Additional Resources:	Click Here
Deep Dive into your (Private) performance below:
Scenario Summary:
Your patient is Lenore Howard, who is very worried because her 9-month-old daughter, Abby, fell from the sofa an hour ago. Abby has a swelling on her head and vomited once after the fall, but she currently appears well and is playing.
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 practising, 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	Response	Remarks
Data Gathering	Confirm the patient's full name and age: Abby Howard, 9 months old	Yes	You confirmed Abby's full name and age clearly at the beginning.
Data Gathering	Confirm Lenore’s full name and relationship to Abby.	Yes	You asked for the parent's name and confirmed her relationship to Abby. Well done.
Data Gathering	Ask an open question to explore the presenting complaint – “Could you please tell me what happened when Abby fell?”	Yes	You asked for a detailed account using open-ended questioning, which allowed the parent to narrate the incident.
Data Gathering	Ask about the exact mechanism of the fall – Where did she fall from? What was the height of the sofa? What was Abby doing at the time? Ask who witnessed the fall?	Yes	You explored the mechanism well, including who witnessed the fall, what Abby was doing, and the height of the sofa.
Data Gathering	Explore symptoms immediately after the fall – Any loss of consciousness, seizures, abnormal movements, or confusion? Did she feel confused? Did she vomit?	Yes	You covered LOC, seizures, abnormal movements, and vomiting thoroughly.
Data Gathering	Ask about red flag symptoms – drowsiness, repeated vomiting, weakness in limbs, bleeding or fluid from ears or nose, or unusual behavior.	No	You did not specifically ask about drowsiness, limb weakness, bleeding from ears/nose, or unusual behavior – these are essential red flags in paediatric head trauma and should be screened. Consider using a checklist approach next time.
Data Gathering	Screen for non-accidental injury – Any other unexplained bruises or injuries? Any similar incidents in the past? Who lives at home? Is the father biological?	Partial	You asked who lives at home and if this was the first time it happened, but you missed asking about unexplained bruises and whether the father is biological. Please remember safeguarding includes screening explicitly for non-accidental injury.
Data Gathering	Inquire about past medical history, medication history and developmental milestones – Any known conditions? Has Abby met her age-appropriate developmental milestones?	Yes	You asked about medical history and development milestones, and parent confirmed normal development.
Data Gathering	Confirm vaccination status and birth history – Any complications during pregnancy or delivery? Type of delivery? Neonatal issues?	Partial	You asked about birth history and vaccination, but you didn’t ask about pregnancy complications or type of delivery. This information is essential in paediatric cases.
Data Gathering	Elicit ICE (Ideas, Concerns, Expectations) – What do you think caused it? What worries you the most? What were you hoping to find out today?	Partial	You addressed her concern (worry about the fall and CT), but you didn’t directly explore her ideas or expectations beyond the CT scan. You can improve by explicitly asking, “What were you worried might have happened?” or “What were you hoping we’d do today?”
Data Gathering	Examination Vitals, General physical examination.	Partial	You mentioned wanting to examine the child, but you didn’t clearly verbalize specific components like vitals, which are critical in paediatric assessment.
Data Gathering	Perform a full head-to-toe assessment: general appearance (alert, playful, consolable), vitals (HR, RR, temp, O2), head/scalp for injury, pupils, eye movements, limb movement, signs of pain or increased ICP (e.g., bulging fontanelle)	No	You didn’t clearly outline or request the full head-to-toe assessment components. This is a significant miss. Always state specific components like “I’d check for bulging fontanelle, limb movements, eye response…” as verbalization is needed for you to receive the relevant findings.
Management	Explain the Diagnosis: Reassure the mother that it appears to be a mild head injury	Partial	You gave reassurance but didn’t clearly state that this appeared to be a mild head injury, which would have helped clarify the clinical assessment. Being explicit helps allay parental anxiety.
Management	Explain why a CT scan is not necessary due to the mild nature of the injury and the risks of radiation	Yes	You did well to explain the harm from radiation and why a CT may not be needed. Good job balancing safety and parental concerns.
Management	Clarify what the bruise means and why it’s not a major concern	No	You didn’t address what the bruise indicates – explaining that a superficial bump isn’t always serious would help reassure and educate the parent.
Management	Advise observation in the emergency department for 4–6 hours to monitor for any delayed symptoms	No	You did not mention this. Observation in ED is a standard practice in such cases. You could say: “We’d like to monitor Abby for a few hours to watch for any signs that might develop later.”
Management	Provide a clear list of warning signs to look out for over the next 48 hours (e.g., vomiting more than once, seizures, confusion, drowsiness).	No	You didn’t provide safety netting advice on red flag symptoms to watch for at home. This is vital in head injury. Please make sure you list them out clearly in future.
Management	Safety Netting: Emphasize the importance of returning to the hospital if any concerning symptoms develop	No	No explicit safety netting advice was given. You must always say something like: “If Abby becomes drowsy, vomits again, or anything worries you, please come back straight away.”
Management	Provide a leaflet about head injuries for additional guidance	No	This wasn’t mentioned. Even just stating “I’ll give you a leaflet on head injuries” is enough for this point.
Management	Inform Lenore that a senior doctor will also assess Abby before discharge for reassurance and confirmation	No	You didn’t mention that a senior would review. This gives parents reassurance and shows you’re working within your level.
Management	Arrange a follow-up with the GP in 2 weeks to check Abby's recovery and developmental progress	No	No follow-up was arranged. You should say “I’ll also arrange a follow-up with your GP to check on Abby’s progress.”
Management	Document the encounter thoroughly, especially history, findings, and red flag discussion	No	Documentation wasn’t mentioned. Even a verbal note like “I’ll make sure this is documented in Abby’s notes” would help you earn this point.
Interpersonal Skills	Use empathetic language throughout – e.g., “I understand this must have been very frightening for you.”	Yes	You acknowledged her concerns several times. Saying “I understand it can be scary” was a good empathetic touch.
Interpersonal Skills	Provide clear, simple explanations to alleviate her worries	Yes	You did explain radiation risks well in a way she could understand.
Interpersonal Skills	Effective Communication: Summarize the information provided to ensure understanding	No	You did not summarize the history or plan back to the parent. This helps ensure shared understanding and is a good communication habit.
Interpersonal Skills	Answer all questions patiently and thoroughly	Yes	You answered her CT scan concerns patiently and thoroughly. Good job.
Interpersonal Skills	Maintain a calm, patient-centered approach throughout – Avoid medical jargon, and ensure Lenore feels heard and supported	Yes	You kept your tone calm and non-judgmental throughout. You addressed her as “Lana” and stayed supportive. Nicely done.

	Feedback Statements:	Needs Improvement
Consultation	Disorganised / unstructured consultation. Includes illogical and disordered approach to questioning. You did not demonstrate sufficiently the ability to follow a logical structure in your consultation. For example, your history taking may have appeared disjointed, with your line of questioning erratic and not following reasoned thinking. You may have undertaken practical tasks or examination in an illogical order that suggested you did not have a full grasp of the reason for completing them or a plan for the consultation.	✔️
Diagnosis	Does not make the correct working diagnosis or identify an appropriate range of differential possibilities.	✔️
Examination	Does not undertake physical examination competently, or use instruments proficiently.	✔️
Findings	Does not identify abnormal findings or results or fails to recognise their implications. You did not identify or recognise significant findings in the history, examination or data interpretation.
Issues	Does not recognise the issues or priorities in the consultation (for example, the patient’s key problem or the immediate management of an acutely ill patient). You did not recognise the key element of importance in the station. For example, giving health and lifestyle advice to an acutely ill patient.	✔️
Management	Does not develop a management plan reflecting current best practice, including follow up and safety netting.	✔️
Rapport	Does not appear to develop rapport or show sensitivity for the patient’s feelings and concerns, including use of stock phrases. You did not demonstrate sufficiently the ability to conduct a patient centred consultation. Perhaps you did not show appropriate empathy or sympathy, or understanding of the patient’s concerns. You may have used stock phrases that show that you were not sensitive to the patient as an individual, or failed to seek agreement to your management plan.
Listening	Does not make adequate use of verbal & non-verbal cues. Poor active listening skills. You did not demonstrate sufficiently that you were paying full attention to the patient’s agenda, beliefs and preferences. For example, you may have asked a series of questions but not listened to the answers and acted on them.
Language	Does not use language or explanations that are relevant and understandable to the patient, including not checking understanding. The examiner may have felt, for example, that you used medical jargon, or spoke too quickly for the patient to take in what you were saying.
Time	Shows poor time management. You showed poor time management, probably taking too long over some elements of the encounter at the expense of other, perhaps more important areas.	✔️

Data_gathering	Management	IPS
3	1	3