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PUID: 53 || PLAB 2 Mock :: Paediatrics: Mild HeadInjury in a 9 Month

Summary:

This scenario involves a young child, Abby, brought in by her mother after sustaining a head injury from a fall. The mother is anxious and requests a CT scan, but the clinical findings point towards a mild head injury that does not warrant imaging. The case tests the candidate’s ability to perform a focused paediatric assessment, rule out red flags, reassure the caregiver, and deliver evidence-based management and safety netting.


Key Points:


History Taking & Data Gathering

  • Use open-ended questions initially to allow the caregiver to express concerns.

  • Focus history on:

    • Mechanism of injury

    • Immediate symptoms (e.g., loss of consciousness, seizures, confusion, vomiting)

    • Red flags (e.g., drowsiness, repeated vomiting, bleeding from ears/nose)

    • Non-accidental injury screen: previous injuries, who lives at home

    • Past medical history, medications, developmental milestones

    • Vaccination and birth history (keep concise)


Physical Examination

  • General physical examination: Vitals (HR, BP, RR, temp)

  • Focused exam: Examine the site of the bruise/injury

  • Bedside tests: Urine dipstick if appropriate

  • Mention explicitly all examinations you would perform – verbalizing earns marks



Important Considerations

  • Time management: transition to management by the 6-minute bell

  • Don't repeat detailed questions unnecessarily

  • Be systematic, focused, and efficient

  • Avoid rehearsed or artificial empathy – respond genuinely

  • Normalize the injury when appropriate and avoid triggering terms (e.g., “internal injury”)


Diagnostic Approach

  1. Initial assessment with open questions about the fall

  2. Focused history addressing:

    • Symptoms immediately post-fall

    • Red flag symptoms

    • Possibility of non-accidental injury

  3. Physical examination

  4. Assess risk using guidelines for paediatric head trauma (e.g., NICE guidelines)


Management

  • Explain diagnosis: mild head injury, no indication for CT

  • Observe child in ED for 4–6 hours

  • Provide clear safety netting:

    • What symptoms to watch for (e.g., persistent vomiting, seizures, lethargy)

    • Duration (typically 48 hours)

  • Offer leaflets and follow-up advice

  • Reassure the mother empathetically but firmly:

    • A CT scan is not indicated and could expose child to unnecessary radiation

    • Senior doctor will assess before discharge

  • Document history, examination findings, red flag screening, and CT discussion

  • Arrange follow-up with GP


Communication Skills

  • Open with empathic listening: “Tell me more about what happened”

  • Avoid phrases like “May I ask you…” or “Is that OK?” when unnecessary

  • Normalize the parent’s concern and show understanding

  • Repeat explanations using paraphrasing if caregiver is anxious

  • Keep responses calm, patient-centred, and jargon-free

  • Ensure mutual understanding through summaries and checking comprehension


Ethical Considerations

  • Safeguarding: be alert to signs of non-accidental injury

  • Be honest about limitations of CT scan and clinical need

  • Respect parental concern without over-investigating

  • Ensure consent and confidentiality throughout


Additional Resources

  • NICE Clinical Guideline: Head Injury: assessment and early management

  • GMC Good Medical Practice – Domains 1 & 2

  • PLAB 2 Consultation Time Management Strategies

  • Safety netting guidance for paediatric minor head trauma

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