Paeds OSCE

Question 1

Paeds 1: a mom has a baby who’s been dx with a UTI. Explain what this means, how it’s treated, and further management necessary and answer her questions. You needed to know about AB therapy plus the necessary scans (US, MCU etc)

Answer 1

Treatment

• ABx (oral cephalexin bd) or IV penicillin +/- gentamicin

Scans
- bladder and kidney U/S
- “DMSA” scan to look at kidney function and any possible damage to the kidney, and/or
- Micturating Cysto Uretherogram (MCU)- a bladder x-ray called an ‘MCUG’ (contrast passed through catheter to fill and void bladder to see if Vesicoureteric reflux is present)

Kidney function
- BP as HTN is an indicator of kidney damage
- Urine Analysis - proteinuria + bacteria
- DMSA scan (nuclear tracer injected and kidneys scanned 3 hrs later)

Question 2

Paeds: Repeat from previous years. Grandmother concerned about her 8yo granddaughter’s reduced growth (falling off her growth curve in the last few years). The girl was also getting bullied at school because of her height. Tasks: Take a history and explain results. Notes about station: All of the results were randomly placed around the desk in front of you – results included Blue Book entries, bloods, genetic testing and bone scan. Blood tests and bone scan were more or less normal – hence was normal growth delay

Answer 2

Counsel grandmother that puberty begins from 8-13 years of age –> growth spurt is from 10-14yrs of age so she has a while

Look at:
- bloods see if normal (no reason for failure to thrive),
- genetic testing for downs, turners etc
- bone scan -> growth plates closed yet
- referral to child psycologist as bullying can be traumatic for the girl
- reassurance and can always check in a couple of years time

Question 3

An 18 month old boy has been brought into ED with high fever and irritability. 6 The ED consultant wants to do a lumbar puncture. Explain the procedure to the boy’s parent (there will be a diagram in the room that you can use). Will it hurt? Is there a risk of nerve damage?

Answer 3

**Indication **
- The procedure is done to see if there is infection of the fluid in the spine and brain
- It can also determine what kind of infection, whether bacterial or viral, and whether there is any bleeding in the brain as well
- Meningitis is a life-threatening condition and therefore requires urgent diagnosis and treatment

Procedure - see attached pic

**Contrainidications **- coagulopathy, raised ICP, SOL, infection on skin, anatomical variability

Benefits - confirms diagnosis and guides therapy based on specific infection

**Risks **
- Anaesthetics risk – allergy
- Procedure – failure, damage to local structures
- Headache – can last up to several days
- Backache
- CNS infection
- Bleeding from site of needle insertion
- Brain herniation or coning (rare)
- Leg pain, weakness, or numbness (rare)
- Risk of not getting it will lead to misdiagnosis or treatment may not be targeted or effective

**Alternatives **
- Blood cultures – not as good
- Empirical antibiotic therapy – not targeted