Osce

Question 1

Baby BLS <1yr

Answer 1

• SSS (safe stimulate shout)
• Air way opening manoeuvres
• Look listen feel for breathing If not breathing 5 initial breaths. Mouth over nose and mouth
  Pulse check 5-10 secs (brachial/femoral)
  15 Chest compression with correct finger/ hand technique. Two thumbs on lower 1/3 of sternum with hand round thorax or two fingers on lower 1/3 of sternum.
• 15:2 ratio
• Call emergency services

Question 2

Child/adolescent BLS >1yr

Answer 2

• SSS (safe stimulate shout)
• Air way opening manoeuvres
• Look listen feel for breathing If not breathing 5 initial breaths. Pinch nose and cover mouth only.
  Pulse check 5-10 secs (carotid/femoral) 15 Chest compression with correct finger/ hand technique. Heel of 1 hand over lower 1/3 of sternum (younger child). Both hand for older child. Compress at least 1/3 chest for both.
• 15:2 ratio
• Call emergency services

Question 3

Choking

Answer 3

• Coughing Y/N
• If yes - encourage to cough and check for deteriation
• If no - consciouss/unconsciouss
• If Consciouss - 5 back blows:5 chest thrusts (<1yr) 5 abdo thrusts (child)
• If unconsciouss - BLS
  Chest thrust
• Two fingers on sternum pushing up and in
  Abdo thrust
• One hand in fist above umbilicus and below xiphisternum
• One hand on top
• Thrust in and up

Question 4

General paeds Hx

Answer 4

• Introduction + consent
• Patient details
• Relationship of adult PC
• SOCRATES
• HPC DH
• Allergies
• Immunisations PMH
• ObHx
• Development Hx
• PSH FHx/SHx
• Family trees
• Housings, Education, Smoking, Pets
• HHEADS (if adolescent)
• ?Consanguinity
• ICE Feeding/Nutrition
• breast/formula
• nappies
• stools/wee’s
  SummaryDDManagement

Question 5

Respiratory History exam DD management

Answer 5

Resp symptoms: Cough Describe the cough: moist/dry, barking, blood?

• Time of day? early morning,middle of night (disturbs sleep) = asthma
• SoB
• Dysopnoea
• Wheeze
• Chest pain
• Blue breath holding
• Intermitent (sp) symtpoms (between wheeze attacks)
• Coryzal sx
  Systemic sx
• FTT (weight loss and growth stunting)?
• Syncope
• Blue breath holding
• fever
• lymphadenopathy
  PMH: atopySH: exposure to cigarette smoke, recently abroad

Question 6

Respiratory Exam

Answer 6

1. Introduction, confirm patient details & consent2. Wash hands3. End of bed examination & General Appearance Chest wall
   * Scars
   * Lines
   * Shape (assymetry)
   * noises/ask to cough (see attached picture)
   * Signs of resp distress: intercostal/subcostal recession, trachael tug, nostral flaring, using accessory mm
   * Cyanosis
   * Energetic/apathetic/tired
   * Comment on anything round bed (inhalers, sats monitors)
2. Inspect peripheriesHands:
   * Clubbing: CF, chronic lung disease, IBD
   * Peripheral cyanosis
   * Older children: CAP refill
   RREyes:
   * pallor of conjunctiva: anaemia
   Mouth:
   * central cyanosis
   * dry mucosal surfaces
3. PalpationTrachea position
   * deviation = tension pneumothorax
   Lymph nodes
   * signs of infection
   * metasteses
   Central CAP refill
   * press on sternum for 5 seconds
   Chest expansion
   * poor: asthma
   * asymetrical: pneumothorax?
   HepatomegalyOedema
   * pretibial
   Apex beat
   * check medisatinal shift
   * tension pneumothorax
4. Auscultate (first as percussion is unsettling for child)16areas - front(6), back(6), axilla (4)Noises (see image + see below)
   * harsh breathing sounds - upper airway problem (foreign body, allergic rxn, viral/bacterial URTI) crackles fine: bronchiolitis
   * indicates small airway collapse due to loose secretions coarse: pneumonia
   * excess fluid in lungs
   * Dullness: consolidation
5. Further investigations/exams:
   * ENT
   * Peak flow
   * Sats
   * BP
   * CVS
   * Abdo