Telephone Consultation · Intermediate · Paediatrics

Ear Pain and Fever in a 3 year old

Practise this PLAB 2 telephone consultation station on Acute Otitis Media. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor providing out-of-hours telephone advice. Mrs Moira Hooper has called because her three-year-old daughter Sophie is unwell. Sophie has been complaining of ear pain, has a fever, and is generally miserable. Please take a focused telephone history and advise on the need for hospital assessment versus home management.

Background notes: PMH: Born at term, normal delivery, birthweight 3.2kg. Chickenpox age 2 (uncomplicated). No recurrent infections. Immunisations up to date

What this station tests

  • Remote triage: determining whether the child needs A&E tonight or can wait for GP tomorrow
  • Red flag screening over the phone: non-blanching rash, unresponsiveness, inability to drink, seizure
  • Antipyretic advice: alternating paracetamol and ibuprofen for fever management
  • Empowering the parent: 'you know your child best, if something feels wrong, bring her in'
  • Arranging appropriate follow-up: GP tomorrow morning for examination, not leaving the case open-ended

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself and confirm patient identity. Explain purpose and check they can talk. Verify phone number for callback.
  • 1-3 min — Gather Information: Take focused history. Compensate for lack of visual cues with explicit questions about severity.
  • 3-5 min — Assessment: Summarise findings. Share working assessment. Identify any red flags requiring face-to-face review.
  • 5-7 min — Management Plan: Discuss management. Clear instructions. Ensure patient has means to follow plan (medications, transport to hospital).
  • 7-8 min — Safety Netting: Explicit safety netting (patient cannot see your expressions). When to call back, when to go to A&E. Confirm understanding.

Consultation approach

The opening

Telephone assessment of a child with ear pain tests remote triage: can this wait until morning or does it need urgent attendance? Mrs Hooper is calling out-of-hours about her 3-year-old Sophie who has ear pain and fever. Open with: 'Mrs Hooper, I want to make sure Sophie is safe. Can you tell me how she is right now?'

Core approach

Remote severity assessment. Is Sophie alert and responsive? (Yes, crying but interactive.) Any rash? (No, specifically no non-blanching rash.) Fever: temperature checked? (38.8C.) Has paracetamol or ibuprofen been given? (Paracetamol 2 hours ago, some improvement.) Is she drinking? (Taking sips, not as much as usual.) Any neck stiffness? (No.) Any vomiting? (Once.)

Identify the likely diagnosis over the phone. Ear pain in a 3-year-old following coryzal symptoms is most likely AOM. This does not need A&E attendance tonight if the child is responsive, drinking, and fever is responding to antipyretics.

Red flags requiring immediate attendance: non-blanching rash, unresponsive or very drowsy, unable to drink, high-pitched cry, bulging fontanelle (not applicable at 3 years), seizure, breathing difficulty. None present.

Mother is tired (it is evening), worried, and wants to know if she needs to take Sophie to A&E.

Closing and safety netting

Advise: 'Sophie can be managed safely at home tonight. This sounds like an ear infection. Give regular paracetamol and ibuprofen (alternating). Offer fluids frequently. Keep her comfortable. She does not need A&E tonight.' Arrange GP appointment tomorrow morning for ear examination and possible delayed prescription.

Red flag safety netting (must be clear and memorable over the phone): 'Call 999 or go to A&E immediately if: Sophie develops a rash that does not fade when you press a glass against it, she becomes very drowsy or difficult to wake, she has a seizure, she cannot swallow fluids at all, or you are seriously worried about her at any point.' Trust the mother's instinct: 'You know Sophie best. If something feels wrong, bring her in.' Follow-up: GP first thing tomorrow.

How examiners mark this station

Examiners will assess all three domains, with particular attention to how you compensate for the lack of visual cues. Domain 1 (Data Gathering) focuses on your ability to take a thorough history remotely. Domain 2 (Clinical Management) assesses the clarity of your management plan and quality of safety netting. Domain 3 (Interpersonal Skills) assesses your telephone communication skills.

Domain 1: Data Gathering, Technical and Assessment Skills (Primary focus)

Scores well: Remote severity assessed (responsiveness, drinking, fever response, rash check). Red flags excluded over phone. Likely AOM identified. Mother's anxiety level assessed.

Costs marks: Not checking red flags. Not assessing drinking. Not checking rash.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Correct triage (home tonight, GP tomorrow). Antipyretic advice. Clear telephone safety netting. GP appointment arranged. Not prescribing antibiotics over phone without examination.

Costs marks: Unnecessary A&E referral. No safety netting. Prescribing without examination. No follow-up.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Reassuring the tired, worried mother. Empowering her with 'you know Sophie best.' Clear, calm telephone manner. Structured advice she can act on.

Costs marks: Dismissing her concern. Being condescending. Leaving her anxious without a plan.

Common examiner feedback (and how to fix it)

Did not gather sufficient information to make an adequate assessment of the patient's condition

Fix: Ask explicitly about things you would normally observe: 'Can you describe the rash for me?', 'How severe is the pain on a scale of 1-10?', 'Are you able to walk around?'

Did not provide adequate safety netting

Fix: Be very specific: 'If you develop X, Y, or Z, go directly to A&E or call 999.' Confirm the patient has understood and can access care if needed.

Common mistakes in this station

  1. Sending to A&E unnecessarily. A responsive 3-year-old with ear pain, fever responding to paracetamol, and drinking fluids does not need A&E tonight. Candidates who send every febrile child to hospital demonstrate over-triage.
  2. Not providing clear telephone safety netting. Over the phone, safety netting must be especially clear and memorable. Candidates who give vague advice ('come in if she gets worse') provide inadequate telephone guidance.
  3. Not arranging GP follow-up. Saying 'wait and see' without arranging a definite appointment tomorrow leaves the mother without a plan. Candidates must close the loop with a specific follow-up.

Resitting PLAB 2?

If telephone consultation stations have been difficult, remember that you must compensate for the lack of visual cues with explicit verbal checking. Describe what you would normally observe, ask about severity in concrete terms, and provide very clear safety netting since the patient cannot see your facial expressions.

Example opening

Hello, am I speaking with [patient name]? Could I confirm your date of birth please? My name is Dr [Name], I'm calling from [surgery/hospital]. Is this a good time to talk? Are you somewhere private?

Frequently asked questions

How should I run this acute otitis media telephone consultation in PLAB 2?

Telephone assessment of a child with ear pain tests remote triage: can this wait until morning or does it need urgent attendance? Mrs Hooper is calling out-of-hours about her 3-year-old Sophie who has ear pain and fever. Open with: 'Mrs Hooper, I want to make sure Sophie is safe. Can you tell me how she is right now?'

What are examiners marking in this acute otitis media station?

Marks are won for: Remote severity assessed (responsiveness, drinking, fever response, rash check). Red flags excluded over phone. Likely AOM identified. Mother's anxiety level assessed. Marks are lost for: Not checking red flags. Not assessing drinking. Not checking rash.

What is the most common mistake candidates make in this acute otitis media station?

Sending to A&E unnecessarily. A responsive 3-year-old with ear pain, fever responding to paracetamol, and drinking fluids does not need A&E tonight. Candidates who send every febrile child to hospital demonstrate over-triage.

How do I prepare for this station if I have not managed acute otitis media in clinical practice?

This station rewards process over personal experience. The skill being assessed: Red flag screening over the phone: non-blanching rash, unresponsiveness, inability to drink, seizure. The written guidance on this page covers the full approach, and practising the consultation aloud builds the fluency the examiner is listening for.

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