Professional Documents
Culture Documents
2001
1.
2.
Developmental history
i.
15 mth old boy with multiple medical history since birth. Premature, intubation for 10 days,
seizure. On Carbamazepine.
ii.
What do you think? Tests/investigations you would like? What will you find on neuro exam?
3.
Surgical 1
i.
14 yo boy with 4 hour history of scrotal pain. How do you assess? If red painful scrotum,
what is your differential diagnoses, what will you tell parents, and what is your management?
ii.
22 month boy swallowed 20c coin. What will you do, investigations, what will you tell dad
(coin is in abdomen on Xray)
4.
5.
6.
Surgical 2
i.
Exompholos
ii.
2001.2
1. Physical examination Gastrointestinal system
2.
Advice giving Anxious mom has just been told her 2 yr old child has had her first febrile
convulsion: she wants to know what it is, complications, what causes it, prevention, what to do
next time; etc.
3.
Surgical station 1 7 yr old falls of wire fence and presents to ED: immediate and further
management of lacerated forearm, possible dangers/complications
4.
Hypospadia: baby history and examination, long term complications, management, when will
you operate?
5.
Pen and paper school age child presents with sore throat: fill out a script for amoxicillin,
choose appropriate formulation, advice to mom regarding script. Child later presents with
morbilliform rash (photo provided). Subsequent change in management?
6.
Clinical scenario 2 yr old presents with lethargy, pallor, eats few solids, drinks copious
amounts of cow milk: interpret FBE, iron studies, management of Fe def, advice to mother.
7.
8.
Acute appearance of lateral neck lump 7 yr old history and examination, diff diagnoses, most
likely cause.
2001.3
1. Respi exam in normal child
2.
3.
4.
5.
6.
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2001.4
1. Lowerlimb ex
2.
Hx on unretractile foreskin
3.
4.
5.
6.
2002
1.
2.
3.
4.
5.
6.
7.
2003
2004
OSCE (4 Child & Adolescent Health)
1. Orthopaedics: Perform a hip examination looking for developmental dysplasia of the hip
2. Immunisation: Address a mothers concerns about vaccinating her child
3. Surgery: Discuss the management of two clinical cases (red lateral neck swelling, bowel obstruction
in a neonate)
4. Growth: Plot a head circumference on a growth chart, and explain some causes of a big head in an
infant, plus additional questions on anaemia
SLIDE QUIZ (6 Child & Adolescent Health)
1. International child health: Discuss measles, and some of the barriers to effective prevention of this
disease in third world settings
2. Renal medicine: Ponder the issues surrounding the collection of urine specimens, and use of ward
urinalysis
3. Surgery: Explain a red swollen penis
4. Respiratory medicine: Comment on bronchiolitis, pneumonia, cough, and asthma
5. Trauma: Describe the management of a child with a fracture near the elbow (supracondylar)
6. Development: Reflect on a young girl who is somewhat delayed in her speech development
Paeds :
-Surgery : neck lump and acute scrotum (2 photos - talk about Dx and Mx)
-Mother with PND and baby with colic - take Hx and advise on Mx
-Child with recurrent infections - take Hx and discuss Mx
-Vaccination - discuss vaccination with and adolescent and do it on a model then.
(can't remember if there was a 5th station)...
2005
1)
Mrs Smith has brought in Jason because he is small for his age. Take a history. Discuss
differential diagnoses. List investigations youd like to order and interpret a CXR.
This station was just an examiner.
2)
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A four year old child with RLQ abdominal pain and fever. What has he got. What is
This baby was born in a country hospital and youre the intern on duty what do you do.
A photo of a baby with exomthalos. What syndrome does might baby have? The
babys blood glucose is 1.6. What do you do.
3)
You have been asked to see this adolescent and give advice. Thats all that was on the door.
The station was that you had to ask him about his asthma and answer his questions.
a.
b.
c.
there were more but I cant remember. The examiner also started writing when I went
through confidentiality.
d.
4)
You have been asked to see Jenny Jones about her son Luke who is two and still not walking.
The door had an extensive birth history, which basically indicated hypoxic ischaemic
encephalopathy. You had to then take a developmental history and describe what examination
and findings youd expect.
MORE:
child with middle ear infection
-
supracondylar fracture
oesophageal defet
1)
Jake is an 8 year old aboriginal boy who has been experiencing cough and shortness of
breath, particularly at night for the last four months.
His teacher has also said that he is very disruptive in class and doesnt do his work. He has
been getting into fights in the school yard. She is concerned that he has learning difficulties.
Jake lives with his mum, siblings and extended family in Fitzroy.
Jakes Mum is depressed and was in foster care as a child.
Discuss the organic and social causes. Discuss the organic and social management.
2)
2. A mother calls you from home and says that her two year old has just poured a cup of boiling
noodles over herself. You can hear the child screaming in the backfround.
3)
4)
a.
b.
c.
d.
An 18 month old child presents with abdominal pain and bloody diarrhoea
a.
b.
c.
What is the management of eczema. What are some of the different issues about managing
eczema in an adolescent.
5)
x-ray showing the double bubble and asking what is this and what is it associated with.
6)
7)
Sally is a five year old child who fell out of a tree. She was initially ok but then vomited and
became drowsy. Discuss assessment and management.
8)
Andrew is a 6 month old infant whose mother brought him in following a fit. He now has a
Page 3 of 11
temperature of 39 and he appears floppy and lethargic. Discuss possible causes, history,
examination and management.
9)
Jessie is a nine month old girl brought to your surgery because of concerns raised by the
maternal child health nurse. While Jessies head circumference and length remain on the 75th
percentile, her weight has fallen from the 75th to the 10th.
a.
b.
c.
what examination findings will help you determine if the cause is organic or nonorganic?
d.
1)
Adol has worsening asthma. Poor compliance Take a Hx & he will ask you some questions.
(action plan, SE of steroid :make u fat? Smoking makes u thinner?, do I need a preventer?,
adherence, smoking)
- take a Hx on why compliance is poor and give advice
2)
Take a Hx from a mo of a 23 mo baby with early medical problems (seizures) and determine if
child has developmental delay, if so what, and ?what would you seek on examination to confirm
3)
23mth Developmental delay Hx. 1st mum (Global delay- cant walk, cant wite, cant
build blocks,cant say words, just make noise, not intereact with other child in day
care.) what this child has ?what can u find in phy exam? (neuro signs)
3yo w Recurrent OM & chest infection. Hx, ddx, Ix. See CXR. What advice would u give to
mother who fears immunocompromise
4)
Surg (2 parts:
4 yo with signs of dehydration, cyclical abdo pain, guarding, RIF pain initial assessment and
management, diagnosis, management post diagnosis
neonate with exomphalos born in country hospital, first aid and intitial mx, mx of blood sugars,
considerations for surgical correction
CAH
Smoking and asthma in a teenager
A pale child
Counsel parent about febrile convulsion
Emergency presentation of baby (dont know what that means)
Slide Show
1) Video on Breath holding Spell. A) Whats that? B) Any investigations? What? & why? C) Mx
2) Infant-A)Eczema (pic), red itchy, principle of Mx
B) superimpose of bacterial infection? Mx
C)14 yo later, extra factors to consider for his mx of eczema (treat him not as an infant)
3) Seizure video, describe, what sort (general), what kind (tonic clonic), physical
signs
4) surg-non tender red L scrotum, hydrocele? How to confirm?
5) X-ray (double bubble) Duodenal Atresia. Asso with? Down Syndrome
6) Differentiate pneumonia and bronchiolitis. If acute bronchiolitis, Mx- including time course the
following week.. Mum asked his RF for asthma.
OSCE
5) Adol has worsening asthma. Take a Hx & he will ask you some questions. (action plan, SE of
steroid :make u fat? Smoking makes u thinner?, do I need a preventer?, adherence, smoking)
6) 23mth Developmental delay Hx. 1st mum (Global delay- cant walk, cant wite, cant build
blocks,cant say words, just make noise, not intereact with other child in day care.) what this
child has ?what can u find in phy exam? (neuro signs)
7) Recurrent OM & chest infection. Hx, ddx, Ix. See CXR
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8)
Surg- A)abdomen pain- appendicitis- Hx, exam, Ix, Mx. B) exomphalos, Mx, & mx on
hypoglycemia.
2006
2006.2
1) DDH/ what would you see on history (risk factors), on examination
2)
surgical quiz: 2 clinical cases, what are the pictures, what is the treatment, what would you tell
mum (torsion of testicular appendage/ sternomastoid tumor in baby and adolescent)
3)
on the door, it said: mum complains of 2year old child having seizures and worried about
epilepsy so they wanted one to ask questions, rule out abnormal neurology, then look at a
video which suggested breath holding spells, and have some discussion about it.
4)
perform an ear examination on an 8m child who seems to have a painful ear and fever. (i totally
forgot to interact with the child). Then a picture of the tympanic membrane was shown (red,
effusion, bulging, loss of translucency, etc, etc). How do you manage this?
CAH
Breath holding spells: hx, then watch a video of one and talk about breath holding spells
Sx station: two photos- acute scrotum (DDx and Mx), lateral neck swelling (Dx and Mx; I think it was that
SCM lump)
Otitis media: examine a childs ear plus Mx of OM
Examination of babys hip, then talk about causes of hip dysplasia and Mx
2007
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2007.2
1) Discuss the dx and mx of the surgical scenarios presented. (2 scenarios - abdo pain and
abdominal wall defects.)
2)
3)
4)
Talk to adolescent re. medical problem* (examiner specified inside that a full HEADSS screen
was not required. Teenager had asthma, so take hx regarding recent exacerbation and
possible contributors)
2007.2
1) Examine this childs respiratory system. Explain to the mother using an Asthma Action Plan the
current Mx of this acute episode, prevention of future episodes and use of preventer.
a.
2)
A child with recurrent ear & chest infections mum is worried child make have underlying
immune problem
b.
c.
Say the infx have not been serious, what is ur likely Dx? How would you Mx? Would u
give Atb?
3)
d.
Say the child had serious recurrent chest infx, what are ur Ddx? Ix?
e.
Describe CXR
Developmental Hx of a 2yo child parents worried. Complicated postnatal course with poor
Apgar scores & intubation & PVH haem, suffers from recurrent GOR and seizures
f.
Take developmental Hx
g.
What clinical condition does this child have? At what age is his dev stage?
h.
What signs would u look for in P/E with respect to his past medical Hx? hypertonia,
hyperreflexia
4)
j.
k.
l.
m. What should mum look out for while waiting for Sx? Strangulation (persistent lump,
redness, pain, irritability, vomiting)
1)
Dad presents worried re 2y/o with global developmental delay, Hx of hypoxic ischaemic
encephalopathy at birth. Take a Hx then answer questions re level of development and what
you'd look for on examination (hypertonia, hyperreflexia). Dx: cerebral palsy.
2)
No patient, examiner only. Scenario: mom presents worried re child having frequent URTIs
and ear infx (I think), what would you ask on Hx, likely Dx (?CF), DDx, plot growth
charts (failure to thrive), interpret CXR, discuss FTT.
3)
Surg: neonate plus mom p/w lump in baby's inguinal region, please examine, present your
findings as you go, explain to mom likely Dx (inguinal hernia) and planned Mx incl when
surgery will take place.
4)
Resp exam of patient who had been admitted for asthma attack (10y/o boy), dont forget abdo
and ENT, present findings at the end, explain asthma Mx plan to boy and parent (examiner).
1)
2)
Dev. delay. Interview. You must know the appropriate ages for different milestones and able to
Page 6 of 11
2007 (.1?)
1. Mum brought daughter, 15 month old (a doll) for an eye check. She is concern about her
daughters right eye which has been moving inward (esotropia).
-
What other tests would you do? (Visual acuity- 100s and 1000s, test for ophthalmoplegia,
fundoscopy)
Watch a video of a cover test: Girl has exotropia (diagnosis and Mx)
2.
15 year old adolescent came in for DTP vaccination. Take a history and administer the
vaccine.
Hx: Answer her questions regarding why does she need to take this vaccine? What are the
possible side effects? Would it affect her for the next few days as she has drama practice?
Assure her that though it is painful, itll be a quite procedure and shell be monitored for 15 mins
for any anaphylactic episodes.
Administer vaccine
3.
Mum with a 6 week old child (doll). Mum is concern about her frequent crying episodes
(> 4 hrs a day)
Take a history and answer questions regarding differential diagnosis, examinations, and
investigations.
Mum has been upset and angry Post partum blues/ PND
4.
a)
A 6 y/o child cut his hand while trying to saw some wood with a rusty saw. Now presenting in
ED.
Shown a photo of the cut (deep cuts on boys fingers, he has tingling sensation, pain and
wouldnt let you examine his fingers)
If the Plastic surgeon is running 4 hours late, what would you do in the mean time?
b)
2007.?
1) immunization: adolescent comes in with because of a missed DTPa booster. tell him why
immunization needs to be done, address his concerns, and give him an injection
2)
do a cover test on an 18m old child (doll), interacting with mum. watch a video and give your dx
(?esotropia). Causes of squint.
3)
take a hx from mum who has PND, explain infant colic (irritable, inconsolable crying), what
are ur strategies to cope w this. tell the examiner what a newborn checkup involves. what
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surgical station:1) scenario of boy cut by old rusty saw, given picture of a hand with laceration
over 2nd and 3rd finger. how would you examine the hand? asked more questions about the
hand. 2) intussusception scenario, talk to mum and tell her about the natural hx of this, and
explain it in laymans terms
Page 8 of 11
2008.1
1) 6 month old child presenting with fever and vomiting. Half the time was for
taking a history from Mum (no examination). Then they asked what
differential diagnosis would be (4 were asked for) and what tests would you
order as well as other management. We were then given vitals for the child
(had fever, capillary refill of 4 seconds and tachycardia) as well as results for
urine dipstick, LP and MSU MCS and asked to interpret.
2) DDH Station- 4/52 w. mum for 6 week checkup. You had to talk to Mum
about doing the exam, what it involved. Examination was performed on a
dummy and observed by the examiner. They then asked what were the risk
factors. What on physical examination would lead you think the child had
DDH? Short station, finished with time to spare
3) Febrile convulsions- 2.5 year old kid who has had his second febrile
convulsion in the last year. He's been previously well with no past
developmental or medical history. The child's conveniently asleep so you need
to talk to Mum and answer her questions about febrile convulsions. She asks
questions more than once on occasion but it went quite well (if you knew your
facts, a lot of people didn't revise this and struggled immensely). It was a good
station though, Mum actor was quite genuine and the interaction was an
interesting one.
4) 28 week premature baby presents at 3 months: measure head circumference,
plot on charts, examine eyes, examine motor development, what on physical
exam suggests cerebral palsy, if cerebral palsy, will the baby have a big/small
head? (small)
Developmental station- growth chart featured in this. Mum came in with Bubs
who was an ex-28 weeker and was now 3 months old. Bubs is a doll in this
case. They gave you a rather complicated history but none of it was actually
relevant to the task. So you had to begin by demonstrating how you measure
head circumference and then plot it on the chart. You had to correct for age of
course. They also gave current weight, birth weight and current length and
asked you to comment. He was doing fine. They then asked how would you
assess vision in a child. She stopped me once I pulled out my toy and did fix
and follow as well as examination using a pen torch (mentioned reflexes here
as well). She then asked me to demonstrate how I would assess gross motor
function. The trick was to put him on the bed apparently (some people
examined the doll in Mum's lap). I was then asked what gross motor signs
would you expect at 6, 12, 18, and 24 months. They asked about reflexes (to
name 4- grasp, rooting, Moro and suck). And that was pretty much it.
2008.2
1. With consultant - spot diagnosis - gastroschesis or exomphalos. What is your
immediate management? (There was another bit to this that I've forgotten)
2. This man has brough in his sick kid (not present) to ED. Take a history (some
already provided) - pooing a lot. What would you like to examine (hydration, etc.).
Now, you've assessed the child and he's ok to go home: viral gastro. Counsel the
father (there's a good speil on this on the RCH website) - e.g. keep fluids up
(gastrolyte or pedilyte), will be off food - that's ok, notify creche / child-care. Bring
back if worried, persistant, gets worse.
3. Eye examination. Do it. Watch video and do spot diagnosis. What's the possible
Page 9 of 11
complicaton (amblyopia)
4. Counsel girl for immunisation and do it. Remember the anaphylaxis bit - check for
adrenaline nearby and keep pt for 15 mins after.
CAH
1) Strabismus examination of an actual child
Perform a cover test Eye exam of 10 yo child (Must bring your own toy)
Questions:
Look at a video of a girl with strabismus (the video that was shown in Lectures) and explain
what type of strabismus she has
What other eye examinations would you do on a child? E.g visual fields, visual acuity,
ophthalmoscope
What would you look for with an ophthalmoscope e.g. retinoblastoma
List the important features of a Paediatric History with particular reference to a child with
Strabismus
2) Surg Mx of exomphalos and acute abdo pain just the examiner and you
Run through the immediate (first aid) Mx, include informing the parents
List the elements of Hx and Ex that you would look for to help your Dx
3) Counselling of a Mother of an 18 month child with gastro with a female actor
Advice about what to feed the child, what fluids are appropriate
What to look out for and when she should come to hospital
Counsel her as to why immunisation is a good idea (eg prevent you getting
sick, herd immunity, good thing to do for your community to protect those
who cant be immunised or those who immunisations dont work etc)
Take a pre immunisation Hx (e.g any allergies, do you have a fever today)
Give her the injection (on the fake arm next to her), (syringe was already
drawn up, needed to swab, inject into deltoid, hold pressure on the site etc)
talk through the procedure with the actor.
Mention that she should hang around for about half an hour in case of
anaphylaxis
2009
OSCEs
1. Jo (real-life child) has been referred because of a murmur. Asked to do a cardiovascular
exam. At end, was asked what simple investigation you would do (CXR) and asked to interpret
it (normal CXR). Asked most likely diagnosis (innocent murmur) and what would you explain to
mum. [Station comprised of just examiner and child.]
2.
Mother worried her 2 year old son might have seizures. Asked to take a history. At end, asked
what the most likely diagnosis (breath-holding spells) is and what features on history suggest
that.
3.
Ear exam on a 10 month old child (doll). Examiner asks what else you would do in exam
(pneumatic otoscopy). Given a photo of ear drum and asked what you see (Acute otitis media).
Asked what your management is for first 48 hours, and subsequently if no improvement. Really
short station. [Had a bit of difficulty with this one, as the dolls ears dont actually have a canal,
so cant exactly insert the speculum properly.]
4.
Trauma station, talked through with examiner. Boy fell from bike, complaining of abdominal
pain. First asked what youll like to ask on history. Immediate management (primary survey,
ABCD, analgesia, etc.).Secondary survey shown a picture with bruise on left side of chest.
Asked what possible injuries (ruptured spleen, tension pneumothorax, etc.). Whats most
appropriate investigation (CT)? Then shown a CT abdo scan and asked what you see. Setting
in rural hospital, so what else would you do? Call trauma team at paediatrics hospital, arrange
for PETS to transfer him, communicate to parents whats happening.
Slide Quiz
Page 10 of 11
1.
Development. Shown a video of the 2 year old (from CD-ROM) copying circle. Asked what
developmental skill shown, when 90% of normally developing children can do skill. Asked what
neurodevelopmental skills required to complete skill. Asked what 2 things indicative of a
preverbal childs cognitive ability (receptive language, play).
2.
Burns. Asked what your management priorities. What you would specifically do for the burn?
3.
Video of child in respiratory distress (taken from the acute respiratory problems video you get
in the library; its the chubby child with croup). List the signs you can observe. List three
differentials. What would you do if child deteriorated?
4.
Video of girl in respiratory distress. [Asthma] List three signs you observe (wheeze isnt one of
them). Management if she deteriorated. As the story goes, she was admitted and recovered,
then asked what your discharge plan would be (2 marks for this part).
3 month old child with non-tender transilluminable scrotal lump that you can get above.
Diagnosis? (hydrocele) Does it require urgent operation? (no) Embryological origin? (patent
processus vaginalis)
5.
6.
Pelvic x-ray (taken from Medical Imaging CD-ROM). [DDH] Describe what you see. Describe 2
clinical screening tests done earlier that would have detected the problem (5 marks). At what
age should these tests be done? Risk factors for condition (4 marks).
7.
Photo of hypospadias. Identify condition. List three cardinal features. Name one associated
anomaly.
8.
9.
6 year old boy present with sore throat and high fever. Photo
shown of his throat.
List 4 differentials. What makes it more likely on history and exam
that it is of a bacterial cause (4 marks)? Name 3 complications if it
was a bacterial infection. What would your management be?
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