Paeds OSCE

Question 1

What are the heart rate ranges for ages:

• <1 year
• 2 - 5 years
• 5 - 12 years
• >12

Answer 1

• <1 year = 110 - 160
• 2 - 5 years = 95 - 140
• 5 - 12 years = 80 - 120
• >12 = 60 - 100

Question 2

What is a left parasternal heave indicative of?

Answer 2

Right sided ventricular hypertrophy

Question 3

Talk through a cardiovascular exam on a child

Answer 3

1. Introduction
   
   1. Who have you got with you today? chaparone
   2. Exposure
2. Inspection
   
   1. Bed: O2, fluids running
   2. Patient: well / unwell, dysmorphic features, comfortable speaking, obvious cyanosis
   3. PEWs?
3. Hands
   
   1. CRT
   2. Clubbing
   3. Splinter haemorrhages
4. Arms
   
   1. Radio-radial delay
   2. Radio-femoral delay
   3. Pulse rate and rhythm
   4. BP
5. Face / neck
   
   1. Eyes - jaundice, anaemia
   2. Mouth - cyanosis, dentition, moist
   3. JVP
6. Chest Inspection - scars, RR?! central lines
7. Chest Palpation
   
   1. CRT
   2. Apex beat
   3. Heaves
   4. Thrills
8. Auscultation
   
   1. 4 areas WITH palpation
   2. 2 manouvres MS and AR
9. …while upright: back
   
   1. sacral oedema
   2. lung bases
10. Hepatomegally
11. Ankle oedema
12. Offer:
    
    1. BP
    2. femoral pulses

Question 4

What is the extra test you should do in a LMN exam on children?

Answer 4

Gower’s test - lying flat to standing upright - walking up their body is a sign of proximal muscle weakness

Question 5

What would you like to do at the end of EVERY examination on a child?

Answer 5

Plot weight and height on a growth chart!!