Paediatrics Station 1

Setting:

You are a junior doctor working in paediatrics. This patient in brought in by her carer following and episode of limb jerking.

Name: Jennifer Thomas

Tasks:

1. Take a history from the carer.

2. Give your preferred diagnosis to the examiner.

3. Explain the diagnosis to the carer.

2. Answer the carer’s questions.

You are not required to examine the patient.

Briefing

Diagnosis: Febrile Convulsion
In this scenario we are asking you to role play a mother/father attending the Children’s Emergency Department after your daughter had an episode of limb jerking this morning. For this scenario, your details are:

Parent Name - Holly/Harry Thomas (age: 33)
Patient Name - Jennifer Thomas (age: 3)

Opening statement

““We were just about to feed Jenny this morning when she started shaking like she’d been electrocuted””

Information to Give Freely

Jenny’s been feeling a bit under the weather over the last few days, hasn’t been eating as much as normal and has had a temperature. She’s been ill before but never anything like this.

Presenting Complaint - before the seizure

What do you mean by ‘under the weather’? - She’s had a cough and runny nose for 2 days
Has she had a fever? - Yes, it’s been rising since last night. The last time you checked it was 38.7 a few hours before the seizure.
Did anything help reduce the fever? - You gave 1 dose of calpol but it didn’t seem to help so you were going to book a GP appointment for this afternoon.
Can you think of any triggers to the seizure? - No

Presenting Complaint - during the seizure

What did it look like? - Her whole body was jerking and moving
How long did it last? - 7 minutes
How did it progress - It didn’t progress or spread, it just started with the whole body shaking and then suddenly stopped
How many times has this happened in the last 24h? - only once
Did she lose consciousness - You aren’t completely sure
Did you manage to do anything to stop it? - No, it stopped by itself

Presenting Complaint - after the seizure

How was she afterwards? - She was drowsy for about 10 minutes and then came back to how she had been prior

Key Paediatric History Points

Pregnancy - no complications or issues. Took Folic Acid to 12 weeks otherwise no other meds.
Birth - Vaginal in hospital at term. No complications. Weight 3.4kg, no admission to hospital
Immunisations - up to date.
Nutrition/feeding - Eating and drinking same number of times per day, but taking less per meal
Development - No concerns in any of the 4 domains.

Past Medical History

No episodes like this before
Other conditions - Nil

Drug History

Prescribed - Nil
No over the counter meds used
Allergies - Nil

Family History

Epilepsy - No
Febrile seizures - No
Sudden infant deaths - No

Social History

Who’s at home - Just you and her mother/father
Smokers in the house? - No
Housing situation - Fixed abode, semi-detached house with stairs and appropriate safety measures
Social service involvement - No

Systemic Review

Positive Findings

Generalised Irritability

Cough and coryzal symptoms

Eating and drinking less than normal due to illnes

Important Negatives

No Rashes

No Developmental delays

No Head trauma

No Cyanosis or Breathlessness

Still having wet and dirty nappies as per normal

No ENT symptoms

No vomiting

Ideas / Concerns / Expectation

Ideas - “Is it a seizure of some sort?”
Concerns - “Does she have epilepsy?”
Expectations - “Can you do something to help with her temperature?”

Discussion

After taking a history, the candidate will confirm their diagnosis of (simple) febrile seizures with the examiner. Following this they will explain what this means to you. They should relay that children between 6 months - 6 years are at risk of having seizures if they develop a high temperature. If any jargon is used, act confused and ask the candidate to clarify.
They may suggest that Jennifer may need admitting following assessment due to her decreased feeding, you should be receptive to this.

Questions for you to ask

If the candidate has not already explained any of the following adequately, please prompt further:

“Will this happen again?”

“Is there any way to stop it?”

“If this was to happen again, does that mean I wouldn’t need to bring her into hospital?”

“Does this mean she’ll have epilepsy?”