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Practice case P2-16 · Manikin or simulator · with a ward nurse

“He’s gone all blotchy, doctor” — acutely unwell on the ward

You are bleeped to a surgical ward. A 34-year-old man has become unwell five minutes after his first dose of an intravenous antibiotic. A staff nurse is with him.

Reviewed and kept current

Station family: Acute care — ABCDE assessment and emergency treatment · 8-minute station · 1 min 30 s reading · Last editorial review: 20 September 2026.

Candidate instructions

Read this as you would outside the room

You have 1 minute 30 seconds to read, then 8 minutes. Candidates: everything below this section is folded away — leave it closed until you have finished the station.

	Information
Your role	Foundation Year 2 doctor covering the surgical wards. The medical emergency team is called on 2222. Your registrar is in theatre.
Patient	Mr Owen Pritchard, 34 — admitted this morning with cellulitis of the right forearm
Why you have been called	Staff Nurse Beth Morgan bleeped you: “He’s gone all blotchy, doctor, and he says his throat feels tight. His antibiotic went up five minutes ago.”
Chart	Drug chart: flucloxacillin 2 g intravenously, first dose started five minutes ago. Allergies: “none known”. Observations one hour ago: pulse 82, BP 126/78, respiratory rate 14, SpO₂ 98% on air, temperature 37.9 °C. No regular medication.
Set-up	A manikin — or a colleague lying on a couch — is the patient. The nurse stays with you and will do whatever you ask. To hand: oxygen and a non-rebreathe mask, monitoring, the ward emergency drug box, intravenous fluids, cannulas, syringes and needles. You will be told each finding as you assess it. Time is compressed: you will be told when simulated time has passed.

Your task

•

Assess and treat Mr Pritchard systematically.

•

This is a simulation: say aloud everything you do, give or ask for, as you would to a real team.

•

When you are told that he has improved, explain to him briefly what has happened and what happens next.

Folded away

For the actor and the examiner

1 · Actor script — role player only

Candidates: do not open until you have consulted.

How to run this station

Use three people if you can: the role player is the nurse and also voices Owen; the examiner reads the findings, announces the time and marks. With two, the role player reads the findings as “the monitor” and afterwards marks four things from memory: time to adrenaline; dose, strength, route and site said aloud; infusion stopped; second dose given.
Drugs are “given” by the doctor saying the drug, dose, strength, route and site aloud and miming the injection. If you are asked to give it yourself: “How much, what strength and where, doctor?” — repeat the order back, then say “Given.”

Persona and manner — Staff Nurse Beth Morgan

An experienced, capable staff nurse. Worried, but calm. You do exactly what the doctor asks, promptly, and repeat each instruction back (“Oxygen, 15 litres, non-rebreathe — going on now”).
You do not suggest treatments, doses or a diagnosis. If asked to fetch something, it is in the emergency drug box beside you.
You also speak for the patient when he is addressed: short, frightened phrases at first — “I can’t… breathe properly… my throat…” — and full sentences once he has improved.

Opening line — say this verbatim

“Thank you for coming so quickly. This is Owen — he was fine ten minutes ago. He’s gone all blotchy, he says his throat’s tight and he’s getting wheezy.”

Volunteer freely if given the space

The antibiotic went up five minutes ago. He started itching within a couple of minutes.
“I haven’t done a new set of obs yet — I called you straight away.”

Only if asked

The infusion is still running — you have not stopped it. (Stop it the moment you are told to.)
He has one cannula, in the left forearm, with the infusion attached.
He has not eaten anything unusual; no other new medicines today; no latex contact.
Allergies — one rule: to “Any allergies?” answer “The chart says none known.” To any question that goes beyond the chart — has he ever reacted to a medicine, an antibiotic or penicillin; “has anyone actually asked him?” — give the amoxicillin line from the ‘anything to add’ section.
As Owen, if asked directly about earlier reactions: “Amoxicillin — when I was about fifteen. I came out in a rash and my lips swelled. Nobody asked me this morning.”
He is not on a beta-blocker or any regular medicine. No asthma. Weight about 80 kg.

Impact on daily life — once he can talk again (only if asked)

He is a postman and a single father; his six-year-old daughter is with her grandmother today and he was hoping to collect her tonight.
He has never been in hospital before and is frightened that it will happen again at home.
He wants to know whether he can ever have antibiotics again.

Ideas, concerns and expectations — once he has improved

Idea: “Was that the infection getting into my blood?”
Concerns: “I thought I was dying.” Will it happen again tonight? Can he ever take antibiotics?
Expectation: to go home this evening.

Cues to deliver, timed

Minute 1, if the infusion has not been stopped: glance at the drip — “His antibiotic’s still going through, doctor.”
Minute 3, if no adrenaline has been given: say unprompted — “He’s getting drowsy, doctor. BP 70 over 40, sats 85.”
About one minute of real time after the first dose: announce “That’s five minutes since the adrenaline.” Give the second set of findings as the doctor re-checks each part. If nothing is re-checked within 20 seconds: “He still doesn’t look right, doctor — shall I repeat his obs?”
About 45 seconds after the second dose and the fluid bolus: “Another five minutes have gone by.” Give the third set as he is reassessed. He should be improving by about 5:00.
About 5:30, once he has improved: “The emergency team’s just arrived, doctor — can you hand over?” Listen as the team leader would.
If there is still no adrenaline by minute 5: “The emergency team has arrived and given adrenaline” — give the improved findings so that the explanation can still be attempted.
Safety challenges, once each: antihistamine or steroid asked for before adrenaline — “Before the adrenaline, doctor?”; adrenaline asked for intravenously — “IV? Are you sure — not in the thigh?”; a wrong volume or strength — repeat it back as a question (“Five mils of one in a thousand, doctor? Each ampoule is only one.”), then do as told; if he is sat upright or stood up while his pressure is low — “He’s gone very pale — he says he feels faint.”

If the doctor summarises (or hands over) and asks whether you want to add anything

If a previous antibiotic reaction has not come out: “One thing — his mum rang the ward a minute ago. She says amoxicillin gave him a rash and swollen lips as a teenager. It isn’t on his drug chart.”
If it has: “He’s asking whether he can go home tonight — he has to collect his daughter.”

How to respond — as the nurse

Clear instructions, one at a time, with doses: you carry them out at once and say so.
Vague instructions (“give him some adrenaline”): “How much, and where, doctor?”
If asked to put out a 2222 call: “What shall I tell them, doctor?” Then repeat exactly what you are told — “Medical emergency — [the doctor’s words] — Ward 7, bay 2. Calling now.” Never supply the word “anaphylaxis” yourself.
If asked to draw up the drug: you hand over “adrenaline 1 milligram in 1 millilitre — one in a thousand”.

How to respond — as Owen, once improved

If the doctor explains plainly that this was a severe allergic reaction to the antibiotic, that the injection reversed it, and that he must stay under observation because it can come back: “OK… so I’m not going home tonight, then.”
If told he can go home in an hour or two: relieved — “Brilliant.”
If nobody explains anything to him: “What just happened to me?”

Do not

Stop the infusion, give oxygen, lay him flat or call for help until you are asked to (apart from the timed cues).
Suggest a drug, a dose, a route — or the diagnosis.
Volunteer the amoxicillin history unless asked beyond the chart, or invited to add anything.

Findings to give the candidate — only if asked for

This is a simulation. Give each finding only as the candidate assesses that part of the patient — except the time announcements and the minute-3 deterioration, which you say unprompted (see the timed cues). (Where a separate examiner is present, the examiner reads the findings and announces the time.)

On arrival. Airway: hoarse voice — “my throat feels tight”; lips and tongue slightly swollen; no stridor. Breathing: respiratory rate 28, SpO₂ 89% on air, widespread wheeze, speaking in short phrases. Circulation: pulse 128, BP 82/48, capillary refill 3 seconds, flushed. Disability: alert and frightened; glucose 5.8 mmol/L. Exposure: raised itchy rash (urticaria) over the chest and arms; the flucloxacillin infusion is still running through a cannula in the left arm; temperature 37.8 °C. Second set — “five minutes” after the first intramuscular adrenaline (with oxygen, lying flat, infusion stopped): respiratory rate 26, pulse 118, BP 88/52, SpO₂ 94% on high-flow oxygen, still wheezy, voice still hoarse. If the infusion is still running: no improvement at all. Third set — after a second dose and a fluid bolus: respiratory rate 20, pulse 102, BP 108/64, SpO₂ 97% on oxygen, wheeze settling, voice normal, rash fading. If only one of the two has been given: BP 94/56, still wheezy — “His pressure’s still low, doctor.” If no adrenaline has been given by minute 3: he becomes drowsy; BP 70/40, SpO₂ 85%.

2 · Examiner mark sheet — generic scheme plus the key facts for this case

Domain marks — with the key facts that earn a 4 at this station

Domain (GMC wording) · key facts for this case	1	2	3	4	Score
1 · Data gathering, technical and assessment skills Recognises and names anaphylaxis at once — sudden airway, breathing and circulation problems with urticaria minutes after an intravenous drug — and calls for help (2222) Red flags found on a structured ABCDE: throat tightness and hoarse voice, wheeze with SpO₂ 89%, BP 82/48, the infusion still running Technical: infusion stopped; lies him flat (legs raised if possible); high-flow oxygen; monitoring; IM adrenaline into the outer mid-thigh — given or ordered in full; reassesses after every step Once he can talk: ICE (thought he was dying; wants to go home tonight) and impact — his daughter, fear of antibiotics; asks beyond the chart about previous drug reactions	☐	☐	☐	☐	/4
2 · Clinical management skills Adrenaline 500 micrograms IM (0.5 mL of 1 mg/mL) without delay; IV access and a 500–1000 mL crystalloid bolus; repeated at 5 minutes; no antihistamine or steroid first; no IV adrenaline SBAR handover to the arriving team and check for anything to add, then the working diagnosis: anaphylaxis to flucloxacillin — why not sepsis, asthma, a faint or a panic attack Afterwards: stays under observation (12 hours here) with senior review; flucloxacillin stopped, both penicillin reactions recorded; timed tryptase; allergy clinic referral. Incident report and Yellow Card — credit if offered Safety-net: symptoms can return within hours — throat tightening again, wheeze getting worse, feeling faint or the rash spreading → call bell at once (999 after discharge) · Follow-up: senior review today; allergy clinic referral; GP and drug chart updated	☐	☐	☐	☐	/4
3 · Interpersonal skills Calm, audible leadership: one clear instruction at a time, doses stated, closed-loop communication with the nurse Talks to the patient while treating him — says what each step is for Uses the nurse’s safety challenges rather than overriding them; thanks her Afterwards: plain-language explanation, honest about the missed allergy history, checks what he has understood	☐	☐	☐	☐	/4
Station total					/12

Examiner's overall judgement (standard-setting only — it does not decide your result): ☐ Unsatisfactory ☐ Borderline ☐ Satisfactory ☐ Good

Marks are 1 to 4 in each domain; the generic descriptor for each mark is on the mark scheme page, and the structure of the eight minutes is on the 8-minute station page. The full standard for this case is in section 3 and the GMC feedback statements, with examples from this case, are in section 4. The examination findings that the role player gives — only if the candidate asks for them — are at the end of section 1.

3 · Expanded station-specific marking standard — what earns 4, 3, 2 and 1 here

The top row is the full picture of what a competent F2 could do at this station, including the working diagnosis with its justified differentials, the safety-net and the follow-up; lower rows describe how performance falls away. It is a debriefing aid, not a checklist to recite: nobody says every line in eight minutes, and a 4 is a judgement that the essentials — the italic key facts on the mark sheet — were done well, in plain language and at the patient’s pace. Acumen training standard — the GMC does not publish station mark sheets.

Mark	Domain 1 · Data gathering, technical and assessment skills	Domain 2 · Clinical management skills	Domain 3 · Interpersonal skills
4	Arrives, introduces self to patient and nurse, and recognises within a minute that this is anaphylaxis — and says so: sudden-onset airway, breathing and circulation problems with skin changes, minutes after an intravenous drug Calls for help early — asks the nurse to put out a 2222 medical emergency call, telling her what to say — and stops the infusion Structured ABCDE, finding the red flags: hoarse voice and swelling (airway); wheeze, respiratory rate 28, SpO₂ 89% (breathing); pulse 128, BP 82/48, capillary refill 3 seconds (circulation); alert, glucose checked (disability); urticaria and the running infusion (exposure) Position: lies him flat, with his legs raised if possible (semi-recumbent only if breathing demands it); does not sit him bolt upright or stand him up while he is hypotensive High-flow oxygen through a non-rebreathe mask; pulse oximetry, ECG and blood pressure monitoring Technical skill: checks the ampoule — adrenaline 1 mg/mL (1:1000); draws up 0.5 mL; injects intramuscularly into the anterolateral middle third of the thigh; notes the time — or gives the nurse a complete order (drug, dose, strength and volume, route, site) and checks the ampoule with her Reassesses ABCDE after each intervention and when told that five minutes have passed; second large-bore cannula and bloods without delaying treatment Once he can talk — ICE: thought he was dying, fears it will happen again, expects to go home tonight; impact on daily living: a single father who was due to collect his daughter; asks beyond the chart about previous reactions to medicines	Adrenaline 500 micrograms intramuscularly (0.5 mL of 1 mg/mL, 1:1000) as soon as anaphylaxis is recognised — before any other drug Intravenous access and a rapid crystalloid bolus of 500–1000 mL early, because he is hypotensive; repeats the same IM dose after five minutes because airway, breathing and circulation problems persist Does not give an antihistamine or a steroid as first-line treatment: a non-sedating oral antihistamine is for skin symptoms once he is stable; steroids are only for refractory reactions or ongoing asthma or shock. Credit if offered, not required: the next step if two doses fail — refractory anaphylaxis: expert help and critical care, an adrenaline infusion set up by experienced staff, IM doses every five minutes meanwhile, never an intravenous bolus Hands over to the arriving team in SBAR form and checks whether the nurse has anything to add Working diagnosis with justified differentials: anaphylaxis to intravenous flucloxacillin — sudden airway, breathing and circulation compromise with urticaria within minutes of the drug. Septic shock from the cellulitis would not explain the rash, the wheeze and the throat tightness, or the timing; acute asthma does not cause hypotension and urticaria; a faint gives a slow pulse and pallor and recovers on lying flat; a panic attack does not drop the blood pressure or the oxygen saturation After stabilisation: timed mast cell tryptase samples; observation for at least 12 hours after his symptoms resolve (severe respiratory compromise — two doses alone would mean a minimum of 6 hours), decided by a senior. “At least six hours, probably overnight — my senior will decide” is acceptable Flucloxacillin stopped and crossed off; the reaction and the earlier amoxicillin reaction recorded on the drug chart, notes and wristband as an allergy to all penicillins; an alternative non-beta-lactam antibiotic (for example clarithromycin, doxycycline or clindamycin — NICE NG141) agreed with the registrar or microbiology; no cephalosporin without specialist advice Referral to a specialist allergy service; an open explanation and apology to him for the missed allergy history. Credit if offered, not required: incident report, MHRA Yellow Card, letter to the GP, and that an adrenaline auto-injector is not needed when the trigger was a drug that can easily be avoided Safety-net: anaphylaxis can recur hours later (a biphasic reaction): if his throat tightens again, the wheeze gets worse, he feels faint or the rash spreads he presses the call bell at once — and after discharge rings 999 and says “anaphylaxis”; the nursing staff are asked for frequent observations and told the same triggers; he is given written information before he leaves. Follow-up: review by the registrar or the medical emergency team today, who decide how long he is observed — a minimum of 6 hours after his symptoms resolve because he needed two doses, and at least 12 hours here because the reaction involved severe respiratory compromise (SpO₂ 89% with wheeze); the second tryptase sample 1–2 hours after onset and a baseline sample at least 24 hours after complete resolution (or at the allergy clinic); referral to a specialist allergy service; a letter to his GP; the allergy recorded on the drug chart, the notes and a red wristband before the next dose of anything is given.	Calm and audible; takes the lead without shouting; one instruction at a time, with the dose and the route Closed-loop communication: listens for the nurse’s read-back and thanks her; uses her concerns (“before the adrenaline, doctor?”) rather than overriding them Keeps talking to the patient: tells him what is happening and what each step is for Afterwards: plain-language explanation of what happened; honest that his earlier amoxicillin reaction had not been recorded, with an apology and no blame; answers the question about going home truthfully Answers “can I ever have antibiotics again?” — yes, but not penicillins, and the allergy clinic will advise Checks that he can say what to do if the symptoms come back
3	Anaphylaxis recognised and named, with oxygen, positioning and the infusion stopped; one of the early call for help, monitoring or reassessment late or prompted by the nurse.	Correct adrenaline dose, route and repeat, with fluids; diagnosis stated; most of the aftercare covered — one of the tryptase samples, the observation period, the allergy documentation or the referral missing.	Clear leadership and kind to the patient; the explanation afterwards a little thin.
2	Works through ABCDE but slowly, and most of it prompted: the infusion left running until the nurse points it out, little reassessment, findings collected but not acted on.	Adrenaline given but the dose hesitant or wrong at first and corrected; second dose or fluids omitted despite persisting hypotension; antihistamine and steroid given prominence; aftercare vague.	Competent but silent — treats the monitor, not the man; instructions vague, so the nurse has to ask for doses; explanation afterwards rushed.
1	Disorganised; anaphylaxis not recognised or named; no call for help; examination continues while the patient deteriorates. Or unsafe: life-threatening airway, breathing or circulation problems not recognised as such; the patient sat bolt upright, stood or walked while hypotensive; or the infusion left running throughout.	Adrenaline given late — after an antihistamine and a steroid, or only after the nurse’s prompts — or under-dosed; “observe” with no plan after recovery. Or unsafe: no adrenaline given at all; an intravenous bolus of adrenaline on the ward; a tenfold dose error (for example 5 mL of 1:1000) carried through despite the nurse’s challenge; flucloxacillin continued or another penicillin prescribed; or tells him he can go home in an hour or two.	Flustered or brusque; ignores the nurse’s prompts; patient told nothing. Or unsafe: shouts at or blames the nurse; dismisses her safety challenge; or conceals the missed allergy from the patient.

4 · GMC feedback statements — where underperformance was identified — with case-specific examples

A feedback statement marks where underperformance was identified in the consultation. With PLAB 2 results the GMC may attach any combination of the ten statements to a station — none, one or several. The right-hand column shows what each one looks like at this station. Record the statements that applied in the practice log.

GMC feedback statement	Underperformance it signals (generic)	Case-specific examples
1 · Consultation	Disorganised or unstructured consultation	Takes a history at the bedside while the infusion runs; examines the rash in detail before airway, breathing and circulation; no recognisable ABCDE, no reassessment, no handover.
2 · Issues	Key issues or priorities not recognised	Does not recognise anaphylaxis — treats it as “an allergic rash” or as sepsis; does not see that the priorities are adrenaline, help and stopping the drug.
3 · Time	Poor time management	Three minutes gone before adrenaline is mentioned; never reaches the second dose, the fluids or the explanation to the patient.
4 · Findings	Abnormal findings or results, or their implications, not identified	Is told BP 82/48, SpO₂ 89% and a hoarse voice and does not name them as life-threatening; does not notice that the infusion is still running; is told “that’s five minutes since the adrenaline” with BP 88/52 and does not act on it.
5 · Examination	Physical examination or use of instruments not competent	Unstructured assessment; does not look at the airway or listen to the chest; sits him bolt upright although he is hypotensive; wrong injection site (deltoid or buttock), or cannot say how the dose is drawn up; no monitoring attached.
6 · Diagnosis	Working diagnosis or differential diagnoses not correct	“Probably a reaction to the antibiotic” with no mention of anaphylaxis; cannot say why this is not septic shock, asthma, a faint or a panic attack.
7 · Management	Management plan not reflecting current best practice	Chlorphenamine and hydrocortisone first; adrenaline 0.5 mg intravenously, or the wrong strength or volume; no repeat dose at five minutes; no fluids; no tryptase; “he can go home later today”; allergy not recorded; a cephalosporin substituted without advice; no allergy referral, nothing said about symptoms coming back.
8 · Rapport	Rapport and sensitivity to the patient’s feelings and concerns not shown	Says nothing to a terrified man who thinks he is dying; talks over the nurse; afterwards blames “whoever clerked him” in front of the patient.
9 · Listening	Verbal and non-verbal cues not used; poor active listening	Ignores “his antibiotic’s still going through, doctor” and “before the adrenaline, doctor?”; asks only “any allergies?” and never goes beyond the chart; does not ask the nurse whether she has anything to add, so the amoxicillin reaction is never heard.
10 · Language	Language or explanations not understandable; understanding not checked	“Give 0.5 of adrenaline” — no units, strength or route; and to the patient afterwards: “you had a type 1 hypersensitivity reaction with bronchospasm and distributive shock”.

5 · Examiner points of fact and guidelines

Points of fact the examiner should have to hand

Recognition (Resuscitation Council UK, 2021): anaphylaxis is likely when there is sudden onset of airway and/or breathing and/or circulation problems, usually with skin changes such as an itchy rash. Skin changes alone are not anaphylaxis — and they are absent in some cases.
2222 is the standard internal telephone number for cardiac arrest and medical emergency calls in UK hospitals — recommended nationally by the National Patient Safety Agency (2004) and in the Resuscitation Council UK quality standards for acute care. State the team needed, the problem and the exact location (“medical emergency team, anaphylaxis, Ward 7, bay 2”).
Immediate steps: call for help (resuscitation team or ambulance); remove the trigger — stop any infusion; lie the patient flat, with or without the legs raised (sitting may help breathing; left side if pregnant); avoid sudden changes of posture.
Adrenaline 1 mg/mL (1:1000): adults and children over 12 — 500 micrograms IM (0.5 mL) into the anterolateral middle third of the thigh; children 6–12 years 300 micrograms; 6 months to 6 years 150 micrograms; under 6 months 100–150 micrograms. Then establish the airway, give high-flow oxygen (later titrated to 94–98%) and apply monitoring. If there is no response, repeat the IM adrenaline after five minutes and give an intravenous crystalloid bolus — 500–1000 mL in adults; start fluids early if the patient is hypotensive.
Refractory anaphylaxis = no improvement in breathing or circulation after two appropriate IM doses: expert help and critical care; rapid fluid bolus; IM adrenaline every five minutes until a low-dose adrenaline infusion is running. Intravenous adrenaline is for experienced specialists only. If the patient takes a beta-blocker and remains refractory to an adrenaline infusion and adequate fluids, glucagon may be considered.
Antihistamines are a third-line treatment — not part of initial emergency care, and never a reason to delay adrenaline; they help skin symptoms only, and a non-sedating oral antihistamine is preferred once the patient is stable. The routine use of corticosteroids is not advised; consider them after resuscitation for refractory reactions or ongoing asthma or shock.
Mast cell tryptase: at minimum one sample, ideally within two hours and no later than four hours after onset; ideally three timed samples — as soon as feasible (never delaying treatment), at 1–2 hours, and a baseline at least 24 hours after complete resolution. A normal result does not exclude anaphylaxis.
Observation after recovery (NICE NG258; RCUK 2021) is timed from the resolution of symptoms. Consider discharge after 2 hours only if there was a good response to a single dose given within 30 minutes of onset, symptoms have fully resolved, the person already has two in-date auto-injectors and knows how to use them, and there is adequate supervision at home; a minimum of 6 hours if two doses were needed or there has been a previous biphasic reaction; a minimum of 12 hours after severe anaphylaxis needing more than two doses, severe asthma or severe respiratory compromise, possible continuing absorption of the allergen, an out-of-hours presentation, a person who could not respond to a deterioration, or difficult access to emergency care. A senior clinician makes the decision.
Before discharge (NICE NG258, May 2026 — which replaced CG134; RCUK 2021): information about anaphylaxis and biphasic reactions, what to do if it recurs, how to avoid the trigger, and referral to a specialist allergy service. People leave with two in-date adrenaline auto-injectors and training in their use — unless the anaphylaxis was due to a drug that can easily be avoided, as here.
“Can I ever have antibiotics again?” — yes. He must avoid all penicillins, and should not be given cephalosporins or other beta-lactams without specialist advice, until the allergy clinic has assessed him; other classes of antibiotic remain available (BNF; NICE CG183). For cellulitis NICE NG141 lists clarithromycin or doxycycline — or clindamycin in severe infection — when a penicillin cannot be used.
Record and report: the drug, the drug class to avoid and the reaction in the notes, on the drug chart and the wristband, and in the letter to the GP (NICE CG183); an incident report when an allergy history was missed, with an honest explanation to the patient (duty of candour); an MHRA Yellow Card for the adverse drug reaction.

Where candidates lose marks at this station

Taking a history while the infusion is still running.
Chlorphenamine and hydrocortisone before adrenaline.
“Adrenaline 0.5” — with no units, strength or route.
Adrenaline into a vein on a general ward.
No second dose at five minutes although he is still hypotensive.
Sitting a hypotensive patient bolt upright — or sending him home that evening.

Guidelines for this station

6 · MLA content map tags for this case

MLA content map	This station
Domain 1 · Areas of clinical practice	Acute and emergency
Domain 3 · Clinical and professional capabilities	Emergency and acute management plans · Performing procedures safely · Team working · Safe prescribing · Managing risk
Domain 5 · Patient presentations	Anaphylaxis · Shock · Wheeze · Deteriorating patient · Allergy/ allergic reaction
Domain 6 · Conditions	Anaphylaxis · Shock · Adverse drug effects
Station family	Acute care, ethics and safeguarding — Acute care — ABCDE assessment and emergency treatment

7 · My marks and reflection — practice log form

Record your three domain marks, your station total, the GMC feedback statements that applied (where underperformance was identified), and what you will keep and change. The form is already labelled with this case and its web address; a copy of your entry is emailed to you, so your practice log builds up in your inbox and can be downloaded.

Record my marks and reflection for P2-16

Revision link for this case: acumenprimarycare.com/plab-2-osce/case-16-acutely-unwell-after-an-antibiotic

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Independence & scope. Independent, formative training material from MD Acumen Ltd. Not affiliated with, endorsed by, or delivered on behalf of the General Medical Council. The GMC does not publish its station mark sheets: every mark scheme and descriptor on these pages is an Acumen training tool calibrated to the GMC's published marking domains, feedback statements and the MLA content map. Practice scores are not a prediction of examination performance. Clinical content reflects UK guidance at the date of editorial review — always check the current guideline. All patients are fictional.

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