Unwell toddler with fever and a rash
PLAB 2 practice station

The task

You are a doctor in a GP surgery. Mrs Sophie Clarke has brought her 3-year-old son Archie because he has had a fever and a rash. Archie is on her lap and is not able to give a history. Take a focused history from his mother. Then explain to her what you think is happening and what needs to be done now, answering her questions, and tell her what to do if things change. Ask the examiner for any findings you need. Otherwise the examiner will not take part in the conversation.

What this station tests

• A child with fever and a non-blanching rash who is unwell needs emergency treatment and hospital transfer; do not wait for tests.
• In strongly suspected meningococcal disease, give IV or IM ceftriaxone or benzylpenicillin outside hospital as soon as possible, unless this delays transfer or there is a severe allergy.
• Ask whether the rash blanches; use a glass if available.
• Recognise red flags: drowsiness, floppiness, delayed capillary refill, fast heart and breathing rates.
• Explain honestly to a frightened parent and let them stay with the child.

Sources for the clinical content

• NICE NG143: Fever in under 5s: assessment and initial management
• NICE NG240: Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management

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

Practise next

• Severe headache since yesterday
• Chest tightness that comes and goes
• Breathlessness and cough in a long-term smoker
• Lower abdominal pain in a young woman
• Low mood and poor sleep