28 May 2014

History station (Medical students)

The examiner briefly presents a clinical scenario, e.g. “A 6 month old infant is brought to the paediatric casualty with fever. How would you assess this patient?”

Do not immediately start asking questions at random. “I will first introduce myself and ask the child’s name. I already know that he is 6 months of age. My assessment involves, first, taking a history, followed by a physical examination, and finally, investigations, if indicated.”

Having stated your overall plan, proceed to take a history. “I will ask the parent to tell me about his or her concerns.” At this point the examiner may give you additional information. You will need to ask specific questions on the presenting complaint: “When did you first notice that the child had a fever? Did you measure the temperature? How did you take the temperature? Did the child look ill or was he still smiling and playing? Is he feeding normally? Where there any other symptoms? Did you give the child any medications?”

After the history of presenting complaint, state that you would proceeed to take a full history, including (1) pregnancy, birth and neonatal period; (2) nutrition and development; (3) past medical and surgical history; (4) vaccines, drugs and allergies; (5) social and family history. “In this case I will be interested to know especially if the child had received the primary vaccines and if there are any other family members who may be ill.”

At this point the examiner may ask you about the likely or differential diagnosis, and perhaps, about physical examination, investigations and management.

It is unlikely that you will be asked drug dosages; if you are not sure, say so. “I do not know the dose of paracetamol for a 6 month infant. In practice I will refer to the BNF. It is essential to give the correct dose since paracetamol hepatotoxic in overdose.” Do not hazard a guess! You don’t know everything (who does?), but at least show your examiner that you will practice SAFE medicine.

If you realize that you made a mistake, say so clearly, and give an explanation. “I said the baby has an asthmatic attack. That is incorrect. The diagnosis of asthma can only be made later on in the child's life. In infancy we speak of ‘bronchiolitis’ or ‘wheezy bronchitis.’” 

Finally, and most importantly, be CONFIDENT! Show that you have the basic knowledge of the subject, and that you can be trusted as reasonable and safe doctor.

Suggested Topics
  • Febrile infant and older child
  • Vomiting and/or diarrhoea (GE and differential diagnosis, including meningitis, intestinal obstruction, DKA)
  • Cough and/or shortness of breath (croup, wheezy bronchitis, asthma, foreign body inhalation, anaphylaxis)
  • Febrile convulsions
  • Skin rash (septicaemia, HSP, etc)
  • Headache
  • Prolonged jaundice