History Taking · Intermediate · Paediatrics

Febrile Fit Following Acute Fever in Young Child

Practise this PLAB 2 history taking station on Febrile Convulsion. 8-minute voice AI simulation with feedback on all 3 marking domains.

Clinical scenario

You are an FY2 doctor in the emergency department. Mr and Mrs Habib attend with their two-year-old daughter, Priya, who has just had a brief seizure. The parents are extremely anxious and frightened. Please take a focused history of the seizure and surrounding events, examine Priya, explain febrile convulsions, address parental fears, and discuss management including investigations, treatment, and prognosis.

Background notes: PMH: Nil significant

What this station tests

  • Simple febrile convulsion criteria: generalised, under 5 minutes, single episode, age 6 months to 5 years, with fever
  • Excluding meningitis clinically: no neck stiffness, no bulging fontanelle, no non-blanching rash, improving consciousness
  • Reassuring about epilepsy: febrile convulsions do not mean epilepsy, prevalence 1 in 20 children
  • No investigations needed for simple febrile convulsion: no EEG, no imaging, no LP if clinically reassuring
  • First aid education: recovery position, do not restrain, time the seizure, 999 if over 5 minutes

How to use your 8 minutes

  • 0-1 min — Introduction: Introduce yourself, confirm identity, open question. 'What's brought you in today?'
  • 1-4 min — Systematic History: Presenting complaint detail (SOCRATES for pain, timeline, severity). Systems review. PMH, medications, allergies.
  • 4-6 min — Context and ICE: Social history (smoking, alcohol, occupation, living situation). Family history. Ideas, Concerns, Expectations.
  • 6-7 min — Summary and Plan: Summarise findings back to patient. Share differential/working diagnosis. Outline investigation and management plan.
  • 7-8 min — Closing: Safety netting with specific red flags. Arrange follow-up. Check for questions.

Consultation approach

The opening

Febrile convulsion stations primarily test the candidate's ability to reassure terrified parents while providing accurate information about prognosis and recurrence. The parents believe their child may have meningitis or epilepsy. Priya is 2 years 3 months, had a 3-minute seizure at home during a fever 30 minutes ago. She is now post-ictal and drowsy. Parents are extremely frightened. Open with: 'I can see how frightened you both are. Priya is safe now. Let me examine her and explain what happened.'

Core approach

Confirm simple febrile convulsion. Duration under 5 minutes (3 minutes). Generalised (not focal). Single episode (no recurrence within 24 hours). Age 6 months to 5 years (she is 2.25 years). Associated with fever. Returns to normal neurologically after the post-ictal period. These features confirm a simple febrile convulsion.

Exclude meningitis (the parents' main fear). Check for meningism: neck stiffness, bulging fontanelle (may still be palpable at 2 years), photophobia. Check for non-blanching rash. Assess consciousness: drowsiness is expected post-ictally but should improve. No ongoing focal neurology. If all clear: meningitis is excluded clinically.

Identify the fever source. She had a runny nose and cough for 2 days (viral URTI is the commonest trigger). Temperature 39.2C at home. This establishes the febrile illness that triggered the convulsion.

Address the parents' fears directly. Father is terrified of epilepsy. Mother fears brain damage. Both need clear, specific reassurance.

Closing and safety netting

Reassure with specific information. 'This was a febrile convulsion. It is caused by the rapid rise in temperature, not by brain disease. It does not cause brain damage. It does not mean Priya has epilepsy. About 1 in 20 children have a febrile convulsion, and most never have another one.' Recurrence risk: approximately 30% will have another febrile convulsion, but this does not indicate epilepsy.

First aid education for future episodes. 'If it happens again: place her on her side, do not put anything in her mouth, time the seizure, call 999 if it lasts more than 5 minutes.' Paracetamol and ibuprofen for fever management (though antipyretics do not prevent febrile convulsions, they manage the illness).

Investigations: none needed for a simple febrile convulsion with clear source (URTI). No EEG, no imaging. Safety net: 'If she has another seizure, develops a rash that does not fade with pressure, becomes very drowsy or difficult to wake, or you are worried, come back or call 999.' Follow-up with GP in 1 to 2 days.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for febrile convulsion. Domain 1 (Data Gathering) carries the most weight: expect marks for systematic coverage of presenting complaint, red flags, PMH, medications, social and family history. Domain 2 (Clinical Management) requires a clear differential, appropriate investigations, and a safe management plan with safety netting. Domain 3 (Interpersonal Skills) is assessed throughout: genuine exploration of ICE, active listening, empathic responses, and clear communication without jargon.

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

Scores well: Simple febrile convulsion confirmed (duration, type, age, fever). Meningitis excluded (neck stiffness, fontanelle, rash). Fever source identified (URTI). Post-ictal status improving.

Costs marks: Not confirming simple criteria. Not excluding meningitis. Not identifying fever source.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: No unnecessary investigations. Fever management (paracetamol, ibuprofen). First aid education. Recurrence risk communicated (30%). Meningitis and seizure safety netting.

Costs marks: Ordering EEG or imaging. Not providing first aid education. No safety netting.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Acknowledging parental terror. Specific reassurance about brain damage and epilepsy. Clear, memorable first aid instructions. Calm, confident manner. Allowing parents to ask questions.

Costs marks: Dismissing parental fear. Vague reassurance. Not addressing epilepsy concern directly. Being clinical without empathy.

Common examiner feedback (and how to fix it)

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

Fix: Use a consistent framework for every history. After covering the presenting complaint, systematically move through PMH, drug history, social history, family history, and ICE. Keep a mental checklist.

Did not identify the patient's problems and/or did not develop a management plan adequately

Fix: Reserve the final 2 minutes to summarise your findings, share your working diagnosis with the patient, and outline your investigation and management plan including safety netting.

Common mistakes in this station

  1. Ordering EEG or imaging for a simple febrile convulsion. NICE does not recommend EEG, CT, or MRI for simple febrile convulsions. Candidates who investigate demonstrate over-investigation.
  2. Not excluding meningitis. The parents fear meningitis, and the candidate must check for meningeal signs and provide specific clinical reassurance. Candidates who reassure without examining miss a safety step.
  3. Not providing first aid education. Parents need to know what to do if it happens again. Candidates who reassure about the current episode without teaching management of future episodes leave the parents unprepared.

Resitting PLAB 2?

If you have previously struggled with history taking stations, focus on building a consistent systematic framework that you apply to every case. Practise structuring your history into clear phases (presenting complaint, systems review, PMH, social, ICE) so that even under pressure, you cover all domains. Many resitters lose marks not on knowledge but on organisation and time management.

Example opening

Good morning/afternoon, my name is Dr [Name], I'm one of the doctors here today. Could I confirm your name and date of birth please? Thank you. So, what's brought you in to see me today?

Frequently asked questions

How do I approach the consultation in this febrile convulsion station?

Febrile convulsion stations primarily test the candidate's ability to reassure terrified parents while providing accurate information about prognosis and recurrence. The parents believe their child may have meningitis or epilepsy. Priya is 2 years 3 months, had a 3-minute seizure at home during a fever 30 minutes ago.

What does a strong performance look like to the examiner in this station?

Strong performances show: Simple febrile convulsion confirmed (duration, type, age, fever). Meningitis excluded (neck stiffness, fontanelle, rash). Fever source identified (URTI). Weak performances: Not confirming simple criteria. Not excluding meningitis. Not identifying fever source.

What is the biggest pitfall in this febrile convulsion station?

Ordering EEG or imaging for a simple febrile convulsion. NICE does not recommend EEG, CT, or MRI for simple febrile convulsions. Candidates who investigate demonstrate over-investigation.

How should I prepare for febrile convulsion if I have never seen it in practice?

Structure beats experience here. Focus on excluding meningitis clinically: no neck stiffness, no bulging fontanelle, no non-blanching rash, improving consciousness. 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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