Peds OSCE this is pediatric osce book

Peds OSCE Pack Nick Graham Nic Todd Zak Peters

Standard Pediatric History and Physical: History: • ID: age, sex, nationality, home, CC • HPI: • PMHx: • PSHx: • Pregnancy: prenatal care, U/S, complications (GDM, HTN, infections, rash, fever, bleeding), meds, smoking/EtOH/drugs, IUGR • Delivery: gestation, G#P#, route of delivery, presentation, birth wt, apgars, complications (induction, bleeding), neonatal problems, NICU stay, LOS • Nutrition: formula type, amount, frequency, solid foods, growth concerns • Development: GM, FM, social, speech • School Performance: grades, friends • Immunizations: routine, special (HepA, PCV, Mengugate, VZV) • FHx: genogram, pertinent familial diseases • SHx: martial status of parents, family unit, finances, school/peer relations, HEADSS, health care plan, family support, effect of illness on family • All: drugs, food, environmental • Meds: drugs, supplements Physical: • Appearance: dysmorphic feats, resp distress • Vitals: T, HR, BP, RR, Sats, GCS • Growth: wt, ht, HC • H+N: dysmorphic feats, fontanelles, vision, red reflex, strabismus, hearing, MMM, TM, lymphadenopathy, neck mass, PERLA, conjunctiva, nasal secretions, nasal flaring, cyanosis, pharynx, palate • CVS: S1/S2, S3/S4/ES/murmurs, PPPx4, cap refill, BP • resp: AE, crackles/wheezes, tracheal tug, intercostal/subcostal indrawing, cyanosis, clubbing • GI: BS, tenderness, masses, hernias, peritoneal signs, hepatomegaly, splenomegaly • MSK: rashes, hips (Barlow, Ortolani), scoliosis, L-spine (hair, sinus tract, pigmentation) • Neuro: CN exam, gait, limbs (power/tone/sensation/DTRs), coordination, primative reflexes • Hydration: MMM, irritability, HR, BP, tearing, cap refill, skin turgor, sunken fontanelles • Special Tests:

Anemia Definition: • Hb/Hct 2 SD below mean for age and sex History: • ID: nationality (SEA – thalassemia, African – Sickle cell) • HPI: duration, onset • Anemia S/S: pallor, SOB, fatigue, syncope • Nonspecific S/S: irritable, decreased PO intake, increased sleep, decreased exercise tolerance, HA • Bleeding S/S: bruising, bleeding, epistaxsis, UGI bleeds (hematemesis, melena), LGI bleeds (hematechezia), menstuation • Constitutional S/S: fever, wt loss, bone pain • PMHx: transfusions, chronic disease, hypothyroidism • PSHx: splenectomy • Pregnancy: ABO/Rh, IUGR • Delivery: gestational age, jaundice • Nutrition: milk, # feeds, iron containing cereals • Development: • Immunizations: when, what, where • FHx: nationality, anemia, transfusions, splenectomies • SHx: lead paint in home • All: • Meds: sulfa drugs Physical: • Appearance: pallor, jaundice, cyanosis • Vitals: tachycardia, tachypnea • Growth: dropping off if chronic • H+N: conjunctiva (pallor/jaundice), lymphadenopathy (infiltrative disease) • CVS: CHF, flow murmur, cap refill • Resp: • GI: hepatosplenomegaly (infiltrative disease) • MSK: hands, nails, bruising/petechiae, edema • Neuro: altered LOC • Hydration: • Special Tests: DRE, FOBT Investigations: • CBC/d • peripheral smear, retic count, hemoglobin electrophoresis • serum Fe, TIBC, ferritin, iron sat Differential: • Microcytic • Fe deficiency, ACD, thalassemia, lead poisoning, sideroblastic anemia • Normocytic • Increased reticulocytes: bleeding, hemolysis (Sickle) • Normal/Low reticulocytes: aplastic, malignancy, ACD, transient erythoroblastopenia of childhood, erythroid aplasia, bone marrow infiltration, ?sepsis • Macrocytic • B12/folate deficiency, liver disease, EtOH, hypothyroidism, aplastic, Fanconi’s anemia Treatment: • Treat cause

• Ferrous sulfate 6mg/kg/day divided TID for 3 months • side effects: stained teeth, dark stools, constipation

Asthma General: • Definition: IgE mediated reversible obstructive airway disease • Spirometry only if greater than 6 years old History: • ID: • HPI:

• • • • • • • • • • •

• Presentation: wheeze, cough, onset, duration, frequency • Red Flags: fatigue, unable to speak full sentences • Control: ER visits, admissions, intubations, night-time symptoms >1/wk, ventolin >3/wk, exercise limitation, many exacerbations, absenteeism • Triggers: exercise, dust/pollen, URTI, stress/anxiety PMHx: eczema, allergic rhinitis, ASA sensitivity, nasal polyps PSHx: Pregnancy: Delivery: Nutrition: Development: Immunizations: FHx: asthma, eczema, allergic rhinitis SHx: environmental history All: environmental, dust, food Meds: B-agonists, oral/inhaled corticosteroids, anticholinergics, others

Physical: • Appearance: level of comfort • Vitals: decreased O2 sats, tachycardia, tachpnea • Growth: • H+N: • CVS: pulsus paradoxus • resp: cyanosis, pursed lip breathing, nasal flaring, tracheal/intercostal/subcostal indrawing, barrel chest, audible wheeze, AE, wheezes, crackles, percussion • GI: • MSK: • Neuro: GCS • Hydration: • Special Tests: spirometry, PFTs Mild Asthma

Clinical Features

• nighttime cough • SOB w exercise • + B-agonist use

Moderate Asthma • abbreviated speach • SOB at rest • ++ B-agonist use (>q4h)

Severe Asthma • • • •

altered LOC difficulty speaking laboured resps persistant tachycardia • no relief w B-agonists

Near-Dea

• exhauste confused • diaphore cyanotic • apnea • decrease effort • failing he

O2 Sats

>95%

>92 - 95%

35 1/200 Clinical Features: • Head: brachycephaly, small low set ears, epicanthal folds, Brushfield spots, flat nasal bridge, macroglossia, micrognathia

• Chest: short neck with excess skin, C1C2 instability, hypothyroid, cardiac murmur (50%), Extremity: single palmar crease, clinodactyly, syndactyly • Syndromes: Alzheimers, developmental delay, leukemia, short stature, CHD (ASD, VSD, PDA, TOF), duodenal atresia, hypotonia Diagnosis: karyotype, amniocentesis, ?blood test

FAS Criteria • Evidence of growth failure (pre or post natal) • Characteristic facies: flat philtrum, thin upper vermillion border, midface hypoplasia, short palpebral fissures, narrow forehead, small eyes, ptosis, microcephaly, cleft palate/lip • Behavior/intelligence: IQ 50-70, hyperactivity, learning disorder, aggressive, lack impulse control, fine motor problems, social maladaption • Strong evidence for maternal drinking during pregnacy Associated Medical Problems: • FTT, seizures, eyes (strabismus, poor visual acuity), VSD, ASD, horseshoe kidney, abnormal ureteric insertion, fused RU joing, C-spine fusion, scoliosis, speech pathology EtOH Withdrawal Sx:(NEED TO DOUBLE CHECK) • disturbed sleep/wake, irritable, hypertonia, hyperreflexia, disordered sucking

Foreign Body Aspiration History: • acute presentation: choking event, stridor, increased WOB, cyanosis • chronic presentation: recurrent wheeze, chronic cough, persistant pneumonia, persistent atelectasis • risk factors: