Persistent fever in a three-year-old
AMC Clinical practice station

The task

You are a doctor in a general practice. Mrs Sophie Lambert has brought her three-year-old son Noah, who has had a fever. Noah is asleep in his pram beside her. Take a focused history from Mrs Lambert. Then explain what you think needs to happen next and why, and answer her questions. If you would phone another service, say aloud what you would tell them. Examination findings will be given if you tell the examiner what you would like to examine. The examiner will not take part in the conversation.

What this station tests

• Fever for several days with red eyes, mouth changes, rash, swollen hands or feet, or a neck node should prompt you to consider Kawasaki disease. The current Royal Children’s Hospital guideline uses fever of 4 days or more.
• Ask about each feature directly: parents often do not link red eyes, lips and swollen hands to the fever.
• Say you suspect a condition and need urgent assessment; you do not need to confirm the diagnosis in clinic.
• Hand over to the receiving team with ISBAR before the family leaves.
• Acknowledge an earlier missed assessment without blaming colleagues.

Sources for the clinical content

• Royal Children’s Hospital Melbourne: Kawasaki disease clinical practice guideline
• Royal Children’s Hospital Melbourne: Kids Health Info on Kawasaki disease
• ACSQHC: Communicating for Safety Standard

An original practice scenario with invented patients. Not an exam question.

Practise next

• Chest tightness that is not settling
• Shortness of breath building over months
• Young man with worsening abdominal pain
• Bleeding when opening the bowels
• Vaginal bleeding and lower abdominal pain