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Paediatric Cases for OSCE

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.

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Paediatric Cases for OSCE

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  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. 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

  5. Communication Stations

  6. 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

  7. 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?

  8. 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

  9. 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

  10. 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

  11. 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

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

  13. Any questions?

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