History Taking · Intermediate · Paediatrics

Infant with Coryzal Symptoms and Wheeze

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

Clinical scenario

You are an FY2 doctor in a GP surgery. Mrs Shirley Lovell has brought her four-month-old son Oliver to see you. He has had a runny nose and mild cough for three days, and today he has developed a wheeze. He is feeding well but his mother is very concerned. Please take a focused history and discuss management.

Background notes: PMH: Born at term 40 weeks, normal delivery, birthweight 3kg, no neonatal complications. Exclusively breastfed. Immunisations up to date

What this station tests

  • NICE bronchiolitis severity assessment: feeding ability, respiratory distress, and SpO2 as the three key parameters
  • Admission criteria: SpO2 <92%, apnoea, unable to maintain 50-75% of usual feed volume, severe distress
  • Not prescribing antibiotics, bronchodilators, or steroids: none have evidence in bronchiolitis
  • Natural history: peak illness day 3-5, recovery within 7-10 days
  • Practical home management: frequent small feeds, nasal saline, upright positioning

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

Bronchiolitis in infants tests the candidate's ability to assess severity, identify admission criteria, and resist prescribing unnecessary treatments. Oliver is 4 months old with 3 days of coryzal symptoms and now wheeze and feeding difficulty. Open with: 'Mrs Lovell, tell me about Oliver's breathing and how he has been feeding today.'

Core approach

Assess severity using NICE bronchiolitis criteria. Mild: feeding well, mild respiratory distress, SpO2 >92%. Moderate: some feeding difficulty, moderate recession, SpO2 92%. Severe: unable to feed, significant distress, SpO2 <92%, apnoeas. Oliver has coryzal prodrome (3 days of runny nose), now with wheeze, subcostal recession, and reduced feeding (taking half usual volumes). Check respiratory rate, work of breathing, SpO2, and hydration.

Admission criteria (NICE NG9): SpO2 <92%, apnoea, unable to maintain adequate oral intake (less than 50 to 75% of usual volume), severe respiratory distress. If Oliver is taking less than 50% of feeds or SpO2 is below 92%, he needs admission.

Key age consideration: he is 4 months. Infants under 3 months, premature, or with comorbidities (cardiac, chronic lung disease) are at higher risk. At 4 months, born at term, with no comorbidities, he is not in the highest-risk group, but feeding difficulty is still the key determinant.

Do NOT prescribe: antibiotics (viral illness), bronchodilators (no evidence in bronchiolitis), corticosteroids (no evidence), nebulised saline (limited evidence in primary care).

Closing and safety netting

If mild (feeding adequately, SpO2 >92%): manage at home. Frequent small feeds, nasal saline drops before feeds to clear nasal congestion, upright positioning, monitor for deterioration. If moderate or severe: refer to hospital for observation, nasogastric feeding if needed, supplemental oxygen if SpO2 <92%.

Reassure: 'Bronchiolitis is a very common viral chest infection in babies. Most babies recover at home within 7 to 10 days. The peak of illness is usually day 3 to 5, so Oliver may get slightly worse before he gets better.' Safety net: 'If Oliver stops feeding, has pauses in breathing, his lips turn blue, or he becomes very drowsy, call 999.' Follow-up in 24 to 48 hours.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for viral bronchiolitis. 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: Severity assessed (feeding, distress, SpO2). Admission criteria checked. Age and risk factors noted. Hydration assessed. Natural history stage identified (day 3-5 of illness).

Costs marks: Not assessing feeding. Not checking SpO2. Not identifying severity.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Correct disposition (home vs admit based on criteria). No unnecessary medications. Practical home advice. Peak illness warning. Clear safety netting (apnoea, cyanosis, feeding cessation).

Costs marks: Prescribing bronchodilators or antibiotics. Not providing safety netting. Wrong disposition.

Domain 3: Interpersonal Skills (Throughout)

Scores well: Reassuring about common and self-limiting nature. Empowering parent with practical feeding advice. Clear, memorable safety netting. Peak illness warning.

Costs marks: Being alarmist. Not providing practical advice. Vague safety netting.

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. Prescribing salbutamol. Bronchodilators have no evidence of benefit in bronchiolitis and are not recommended by NICE. Candidates who prescribe salbutamol demonstrate guideline unfamiliarity.
  2. Not assessing feeding adequately. The decision to admit hinges on whether the infant can maintain adequate oral intake. Candidates who focus on auscultation without quantifying feed volume miss the key assessment.
  3. Not providing the peak illness warning. Parents need to know the baby may worsen before improving (peak day 3 to 5). Candidates who say 'he should get better from here' without this warning set false expectations.

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 viral bronchiolitis station?

Bronchiolitis in infants tests the candidate's ability to assess severity, identify admission criteria, and resist prescribing unnecessary treatments. Oliver is 4 months old with 3 days of coryzal symptoms and now wheeze and feeding difficulty. Open with: 'Mrs Lovell, tell me about Oliver's breathing and how he has been feeding today.'

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

Strong performances show: Severity assessed (feeding, distress, SpO2). Admission criteria checked. Age and risk factors noted. Hydration assessed. Natural history stage identified (day 3-5 of illness). Weak performances: Not assessing feeding. Not checking SpO2. Not identifying severity.

What is the biggest pitfall in this viral bronchiolitis station?

Prescribing salbutamol. Bronchodilators have no evidence of benefit in bronchiolitis and are not recommended by NICE. Candidates who prescribe salbutamol demonstrate guideline unfamiliarity.

How should I prepare for viral bronchiolitis if I have never seen it in practice?

Structure beats experience here. Focus on admission criteria: SpO2 <92%, apnoea, unable to maintain 50-75% of usual feed volume, severe distress. 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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