Itching during an intravenous antibiotic
PLAB 2 practice station

The task

You are the foundation doctor on a surgical ward. Mrs Beatriz Santos, aged 68, is two days after bowel surgery. This morning you prescribed intravenous co-amoxiclav. You have just realised her notes record a penicillin allergy. The nurse tells you the first dose was started 30 minutes ago. Mrs Santos is sitting up in bed and tells you she is itchy. Staff Nurse Aoife Byrne is with you and will carry out your requests. Assess her, deal with the immediate problem, and speak to her about what has happened. The examiner will not take part in the conversation.

What this station tests

• Treat the patient first, then tell them; do not delay the apology.
• The duty of candour requires prompt, honest disclosure, an apology, an explanation and a plan.
• Check allergy status on the chart and wristband before prescribing.
• Report incidents so systems can improve; speak to your senior early.
• Mild allergic reactions can progress, so repeat observations and know when to call 2222.

Sources for the clinical content

• GMC Openness and honesty when things go wrong: the professional duty of candour
• NICE CG183: Drug allergy: diagnosis and management
• Resuscitation Council UK: Emergency treatment of anaphylaxis, guidelines for healthcare providers

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

Practise next

• A woman with an infected foot who wants to go home
• Follow-up after an emergency hospital visit
• Young teenager seeing the GP alone
• Concern about a struggling colleague