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