PLAB 2 Clinical History-Taking & Communication — Questions and Answers
Question 1: In the Calgary-Cambridge model of consultation, which phase involves establishing why the patient has come to see you today?
- Initiating the session (Correct answer)
- Gathering information
- Physical examination
- Explanation and planning
Correct answer: Initiating the session
The Calgary-Cambridge model begins with initiating the session: preparation, establishing initial rapport, identifying the reason(s) for the consultation, and agreeing the agenda. This is where you greet the patient, introduce yourself, and explore the presenting complaint(s) before moving to information gathering.
Question 2: A patient presents with chest pain. Using the SOCRATES framework, which aspect of the pain does 'R' represent?
- Rate (speed of onset)
- Radiation — where does the pain spread to? (Correct answer)
- Response to treatment
- Recurrence frequency
Correct answer: Radiation — where does the pain spread to?
SOCRATES: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/relieving factors, Severity. 'R' is Radiation — asking where the pain spreads to (e.g., left arm, jaw in MI; back in aortic dissection; right shoulder tip in biliary colic).
Question 3: During a consultation, a patient suddenly becomes tearful. What is the most appropriate immediate response?
- Continue with the history to collect all the information needed
- Pause, acknowledge the emotion with empathy ('I can see this is upsetting for you'), allow silence, and offer a tissue if available (Correct answer)
- Refer immediately to a counsellor
- Move directly to examination to save time
Correct answer: Pause, acknowledge the emotion with empathy ('I can see this is upsetting for you'), allow silence, and offer a tissue if available
Effective consultation requires responding to emotional cues before continuing to gather information. Acknowledging the patient's distress with empathy validates their feelings, builds rapport, and creates a safe space. Ignoring emotions and continuing mechanically with the history impairs communication and trust.
Question 4: What does the ICE framework stand for in patient-centred consulting?
- Information, Confidence, Evidence
- Ideas, Concerns, and Expectations (Correct answer)
- Initial Complaint Evaluation
- Investigation, Care, and Explanation
Correct answer: Ideas, Concerns, and Expectations
ICE — Ideas (what the patient thinks is wrong), Concerns (what they are worried about), Expectations (what they hope will happen) — is a cornerstone of patient-centred consulting. Eliciting ICE helps understand the patient's perspective, address hidden agendas, and provide appropriate reassurance or management.
Question 5: During a PLAB 2 station, you are taking a history from a patient who gives only 'yes' and 'no' answers. Which type of question would be most useful to elicit more information?
- Closed questions
- Leading questions
- Open-ended questions (Correct answer)
- Multiple-choice questions
Correct answer: Open-ended questions
Open-ended questions ('Tell me more about that', 'How has this affected you?') encourage the patient to expand in their own words and provide richer information. After opening up with open questions, you can use closed questions to clarify specific details. Starting with closed questions limits the patient's responses.
Question 6: When taking a drug history, which four categories of medication should always be specifically asked about?
- Antibiotics, analgesics, vitamins, and vaccines
- Prescribed medications, over-the-counter drugs, herbal/complementary remedies, and recreational drugs (including alcohol and smoking) (Correct answer)
- IV drugs, oral drugs, inhaled drugs, and topical drugs
- Recent medications, current medications, allergies, and family medications
Correct answer: Prescribed medications, over-the-counter drugs, herbal/complementary remedies, and recreational drugs (including alcohol and smoking)
A complete drug history includes all four categories: prescribed medications (including dose, frequency, and compliance), OTC medications (many patients don't consider these 'real' drugs), herbal/complementary remedies (significant interactions, e.g., St John's Wort), and social/recreational substances (alcohol, tobacco, illicit drugs) — all clinically relevant.
PLAB 2 Clinical History-Taking & Communication
In the Calgary-Cambridge model of consultation, which phase involves establishing why the patient has come to see you today?