History Taking · Intermediate · Surgery

Fall on Hospital Ward - Acute Hip Pain

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

Clinical scenario

You are an FY2 doctor on the orthopaedic ward. Mrs Annie Jenkins, a 72-year-old woman who was admitted yesterday for pneumonia management, has fallen beside her bed. She is complaining of severe left hip pain. Please assess the incident, take a focused history, and discuss initial management.

Background notes: PMH: Pneumonia (admitted yesterday), Osteoporosis, Hypertension, Hypothyroidism, Early cataracts

What this station tests

  • Immediate analgesia before assessment: do not delay pain relief for X-ray or history
  • Investigating why the fall happened: medication review, infection-related dehydration, call bell accessibility, new medications
  • Duty of candour for inpatient falls: open disclosure, incident documentation, Datix completion
  • Coordinating two active problems: hip fracture management alongside ongoing pneumonia treatment
  • Falls prevention measures: medication review, call bell access, supervision, physiotherapy assessment

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

An inpatient fall adds complexity: the candidate must assess the injury, investigate why the fall happened (it may be iatrogenic), and handle the duty of candour. Mrs Jenkins is 72, admitted yesterday for pneumonia, fell beside her bed this morning, now has severe left hip pain. Open with: 'Mrs Jenkins, I am sorry you have had a fall. I can see you are in pain. Let me get you pain relief and then I need to examine your hip.'

Core approach

Assess the injury. Left hip pain, cannot weight-bear, leg may be shortened and externally rotated. Do not move her unnecessarily. Analgesia immediately (IV paracetamol, morphine if severe). X-ray of left hip. Check for other injuries: did she hit her head? Any head injury signs?

Investigate why she fell. She woke feeling dizzy and unsteady. She is on antibiotics for pneumonia and has been febrile (infection can cause orthostatic hypotension). Check: has she been given sedatives, opioids, or any new medications that could affect balance? Is she dehydrated? Blood glucose (she is not diabetic but check). Was she trying to get to the toilet independently when she should have called for help? Was the call bell within reach?

This is an inpatient fall: duty of candour applies. Document the incident thoroughly: time, circumstances, witnesses, injuries. Complete a Datix (incident report). Inform the nursing team and the medical consultant. The patient and family must be informed openly about what happened.

Closing and safety netting

If X-ray confirms fracture: orthopaedic referral for surgical fixation. Pre-operative assessment considering her pneumonia (she now has two active problems requiring coordinated management). Surgery should ideally proceed within 36 hours but her pneumonia may need to be optimised first.

Falls prevention: review medications (any contributing to falls?), ensure call bell is accessible, consider 1:1 supervision or bed sensor, mobility assessment by physiotherapy. Address her distress: 'I am very sorry this happened while you were in our care. We are going to look after your hip and also investigate how to prevent this happening to other patients.' Inform her daughter. Safety net: she remains an inpatient with ongoing monitoring.

How examiners mark this station

Examiners will focus on the thoroughness and structure of your history taking for femoral neck fracture. 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: Injury assessed (hip examination, check for head injury). Fall circumstances investigated (why she fell). Medication review. Call bell accessibility checked. Dehydration assessed.

Costs marks: Not investigating fall cause. Not checking for head injury. Not reviewing medications.

Domain 2: Clinical Management Skills (Primary focus)

Scores well: Immediate analgesia. X-ray arranged. Orthopaedic referral if fracture. Incident documentation (Datix). Falls prevention measures. Coordinating fracture with pneumonia management.

Costs marks: Delayed analgesia. No incident reporting. No falls prevention. Not coordinating both problems.

Domain 3: Interpersonal Skills (Primary focus)

Scores well: Apologising for the inpatient fall (duty of candour). Informing her daughter. Acknowledging her distress. Explaining what happened honestly.

Costs marks: Not apologising. Not informing family. Being defensive about the fall. Not acknowledging 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 investigating why the fall happened. An inpatient fall is not just about the injury. Candidates who manage the fracture without asking about medications, hydration, and call bell accessibility miss the system failure investigation.
  2. Not completing a Datix or mentioning incident reporting. Inpatient falls require formal incident documentation. Candidates who treat the injury without mentioning incident reporting miss the governance requirement.
  3. Not addressing duty of candour. The patient and family must be informed openly about what happened. Candidates who do not apologise or explain demonstrate a gap in professional standards.

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 should I structure the femoral neck fracture history in this PLAB 2 station?

An inpatient fall adds complexity: the candidate must assess the injury, investigate why the fall happened (it may be iatrogenic), and handle the duty of candour. Mrs Jenkins is 72, admitted yesterday for pneumonia, fell beside her bed this morning, now has severe left hip pain.

What are examiners marking in this femoral neck fracture station?

Marks are won for: Injury assessed (hip examination, check for head injury). Fall circumstances investigated (why she fell). Medication review. Call bell accessibility checked. Marks are lost for: Not investigating fall cause. Not checking for head injury. Not reviewing medications.

What is the most common mistake candidates make in this femoral neck fracture station?

Not investigating why the fall happened. An inpatient fall is not just about the injury. Candidates who manage the fracture without asking about medications, hydration, and call bell accessibility miss the system failure investigation.

How do I prepare for this station if I have not managed femoral neck fracture in clinical practice?

This station rewards process over personal experience. The skill being assessed: Investigating why the fall happened: medication review, infection-related dehydration, call bell accessibility, new medications. 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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