History Taking · Intermediate · Paediatrics

Severe Abdominal Pain with Bloody Stool - Infant

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

Clinical scenario

You are an FY2 doctor in the paediatric Emergency Department. You see Ayo, a nine-month-old boy, brought by his mother Sarah with severe intermittent colicky abdominal pain and what she describes as red-currant jelly stools. Please take a focused history, perform an appropriate examination, and discuss urgent investigation and management.

Background notes: PMH: Normal term pregnancy, normal development, previous viral URIs

What this station tests

  • Classic intussusception triad: intermittent colicky pain (drawing legs up), vomiting (progressing to bilious), red-currant jelly stools
  • Peak age recognition: 6 to 18 months, male predominance
  • Red-currant jelly stools as a late sign indicating mucosal ischaemia: this makes the presentation urgent
  • Air enema reduction as first-line treatment: non-surgical, successful in approximately 75%
  • Urgent hospital transfer: do not delay for primary care investigations

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

Intussusception is a paediatric surgical emergency. The candidate must recognise the classic triad (intermittent colicky pain, vomiting, and red-currant jelly stools) in an infant and arrange urgent hospital assessment. Ayo is 9 months old, brought by his mother Sarah with 6 hours of intermittent severe pain and red-currant jelly stools. Open with: 'Sarah, I can see Ayo is in a lot of distress. Tell me what has been happening.'

Core approach

Recognise the classic pattern. Intermittent colicky pain: Ayo draws his legs up, screams, then has periods of relative calm (the colicky cycle of intussusception). Vomiting: started with feeds, now bilious (green, suggesting obstruction). Red-currant jelly stools: blood and mucus mixed together, a late and concerning sign indicating mucosal ischaemia. He is pale, lethargic between episodes, and not feeding.

Age and demographics. Intussusception is commonest at 6 to 18 months, with a male predominance. Ayo at 9 months is in the peak age range. Often preceded by a viral illness (check: any recent URTI or gastroenteritis that could have caused lymphoid hyperplasia as a lead point).

Assess for complications. Is Ayo becoming increasingly lethargic (shock)? Any fever (perforation)? Abdominal distension (obstruction)? Absent bowel sounds? A palpable sausage-shaped mass in the right upper quadrant may be felt (though this is an examination finding). Dehydration from vomiting and poor feeding.

This is urgent. Do not take a prolonged history. The red-currant jelly stools and intermittent colicky pain in a 9-month-old is intussusception until proven otherwise.

Closing and safety netting

Arrange emergency hospital transfer. 'Sarah, the pattern of Ayo's pain, the vomiting, and the blood in his stool suggest a condition where part of his bowel has telescoped into itself. This is called intussusception and it needs urgent hospital treatment.' He needs IV access, fluid resuscitation, and urgent USS abdomen (target sign on ultrasound confirms diagnosis).

Treatment: air or barium enema reduction is first-line (non-surgical, successful in approximately 75% of cases). If reduction fails or there are signs of perforation: emergency surgery. Do not delay transfer for investigations in primary care.

Reassure the mother: 'This is treatable. Most children recover fully with the right treatment.' Safety net: he is being transferred urgently, so monitoring is built into the pathway. Keep nil by mouth. Support the mother during what is a frightening experience.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for intussusception. 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: Triad recognised (colicky pain, vomiting, red-currant jelly stools). Age and demographics fit. Complications assessed (lethargy, dehydration, distension). Preceding viral illness asked.

Costs marks: Not recognising the triad. Diagnosing gastroenteritis. Not assessing for shock.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Emergency hospital transfer arranged immediately. Nil by mouth. IV access if possible. USS as diagnostic investigation mentioned. Air enema reduction as treatment. Surgery if reduction fails.

Costs marks: Managing in primary care. Not transferring urgently. Not knowing the treatment pathway.

Domain 3: Interpersonal Skills (Adapted to emergency)

Scores well: Explaining intussusception in simple terms. Reassuring about treatability. Supporting the mother through a frightening situation. Acting quickly while maintaining calm.

Costs marks: Being alarmist without action. Not explaining what is happening. Ignoring the mother's distress.

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. Not recognising the triad. Intermittent colicky pain with drawing up of legs, bilious vomiting, and red-currant jelly stools in a 9-month-old is intussusception. Candidates who diagnose gastroenteritis or colic miss a surgical emergency.
  2. Attempting to manage in primary care. Intussusception needs USS confirmation and enema reduction or surgery. Candidates who take a prolonged history, examine, and arrange outpatient investigations delay life-saving treatment.
  3. Not recognising red-currant jelly stools as a late sign. By the time blood and mucus appear, there is mucosal ischaemia. This increases the urgency. Candidates who do not communicate this urgency may allow bowel necrosis.

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 intussusception station?

Intussusception is a paediatric surgical emergency. The candidate must recognise the classic triad (intermittent colicky pain, vomiting, and red-currant jelly stools) in an infant and arrange urgent hospital assessment. Ayo is 9 months old, brought by his mother Sarah with 6 hours of intermittent severe pain and red-currant jelly stools.

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

Strong performances show: Triad recognised (colicky pain, vomiting, red-currant jelly stools). Age and demographics fit. Complications assessed (lethargy, dehydration, distension). Preceding viral illness asked. Weak performances: Not recognising the triad. Diagnosing gastroenteritis. Not assessing for shock.

What is the biggest pitfall in this intussusception station?

Not recognising the triad. Intermittent colicky pain with drawing up of legs, bilious vomiting, and red-currant jelly stools in a 9-month-old is intussusception. Candidates who diagnose gastroenteritis or colic miss a surgical emergency.

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

This station rewards process over personal experience. The skill being assessed: Peak age recognition: 6 to 18 months, male predominance. Use the domain breakdown on this page to target your preparation, then practise the station aloud so your structure survives exam pressure.

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