1. Paediatric Cases for OSCE
Eleanor Balmer
15/12/16

2. History Taking in Paediatrics
Explanation scenarios

3. 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
Body Language and Questioning Different to establish rapport with adult and young child.

4. Obstetric History – Scans / birth complications / prematurity / SCBU
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

6. Communication Stations

7. Explanation 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

8. 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?

9. 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

10. 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 syndrome. Heart murmur.
Discuss management with parents

11. 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

12. 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 her parents’ concerns

13. Summary Triadic communication skills Discussion not a monologue
Check understanding and explore concerns
Clear, jargon-free explanations
Be systematic
Knowledge accurate

14. Any questions?