Presentations of Paediatric Cases for OSCEs
Daniel Mattison
19-12-14
• History Taking in Paediatrics
• Communication scenarios
History Taking
• General principles– Introduce yourself to the child and the parents– With teenagers, state at the beginning that
part of the consultation will be with just the patient.
– Address questions to the child as much as possible
• PC, HPC, PMH, DH, FH, SH• Development
– Gross motor– Speech– Fine motor / vision– Social
• Obstetric History – Scans / birth complications / prematurity / SCBU
• Immunisations• Nutrition, feeding, weaning
Communication Stations
• Introduction / Manner / Environment and Timekeeping.• 2 way discussion not 1 way monologue• Allow parent to ask questions• Check current understanding of situation• Systematic presentation of findings• Diagnosis / differential diagnosis• Further Investigations• Treatment• Prognosis• Check understanding• Joint decision making
Case 1
• 4 year old boy. • 5th presentation to hospital with wheeze in 2
years. On this occasion he required 2 days on HDU on i.v. salbutamol
• Family history of atopy• No other past medical or birth history• Not currently on any regular medications
Child’s mother asks you what is wrong with him?
Case 2
• 6 week old girl.• Presented yesterday with fever and reduced
feeding• Already on i.v. antibiotics• WBC 22.5; Neut 17.5; CRP 68;• CSF: 1300 WBC, 90% polymorphs, 20 RBC,
Gluc 0.9; Prot 1.4
Explain the diagnosis and management to parents
Case 3
• You are asked to see a 2 day old baby by a midwife because she is not feeding well and looks unusual
• On examination: Facial features of Down sydrome. Heart murmur.
• Discuss management with parents
Case 4
• 18 month old boy• Admitted after 10 minute tonic-clonic convulsion.
Full recovery in the emergency department. • On examination, Temperature 39.5, coryzal, red
pharynx. Otherwise normal examination. No previous medical or developmental concerns
• Older brother has epilepsy and learning difficulties
Explain the diagnosis and management to parents
Case 5
• 4 year old girl attending clinic
• Referred because parents have refused permission for their child to have immunisations and would like to talk to a paediatrician
Explore parents concerns
Any Questions
Summary
• Be professional and warm• Establish previous knowledge• Give information in a structured manner• Summarise, check understanding and
allow questions throughout• Joint decision making and management
with parents• Ensure parents know what to do if they
have questions after you leave
