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