Paediatric Cases for OSCE Eleanor Balmer 151216 History

Paediatric Cases for OSCE Eleanor Balmer 15/12/16

History Taking in Paediatrics Explanation 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 Body Language and Questioning Different to establish rapport with adult and young child.

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

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

Case 1 4 year old boy. 5 th 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 syndrome. 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 her parents’ concerns

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

Any questions?