Professional Documents
Culture Documents
OSCE station
A. Communica on skill – counselling on acute gastroenteri s
‐ Kevin 2 years old boy was admi ed to the ward due to acute gastroenteri s with moderate to severe
dehydra on. He has diarrhoea and vomi ng. He was given IV fluid and oral rehydra on salt.
‐ This is the first hospital admission
‐ Explain his condi on to the guardian and the management was done on him
‐ DO NOT ask history
‐ DO NOT report to examiner
Sample answer
1. Introduction
‐ introduce yourself; ask the parent’s name, how should I address you? assess knowledge
‐ eg : Good a횦 ernoon, my name is Dr. Ali, I am the one who seeing your child. So are you Kevin’s father/
mother? How should I address you? Are you the one who brought him to the hospital?
2. Explain purpose of the conversation and the child’s condition
‐ So I have examined your child, and i would like to talk to you about his current condi on. As you know,
he has had a few episodes of diarrhea and vomi ng. That has caused him to have lost a lot of fluid from
his body. When he came in, he looked lethargic and very dehydrated. So, we have started him on a drip
to replace the fluid loss. Now, the reason your son is having diarrhea and vomi ng is because he has
acute gastroenteri s. Don’t worry, it’s basically an infec on in the gut and bowel which is caused by
some virus, bacteria or parasite. Usually, it’s just due to a virus (Rotavirus) and will slowly resolve on it’s
own.
‐ always use a calm tone and reassess parent’s response. Reassure if worried
ask whether the parent understand what you just explained
3. Explain the management was done
‐ At the moment, our treatment is to replace the water he lost. He has not enough fluid in the body
hence we give him fluid via the branula. He s ll can tolerate orally, hence we also give him oral
rehydra on solu on which can replace the fluid, ions and electrolytes loss into the stool and vomits.
Since the infec on is normally due to a virus, we do not immediately start on an bio cs as that will not
benefit your son, Kevin. We shall take some tests to confirm the cause and then proceed with further
management. As for now, it is crucial to keep him hydrated.
there is no need to explain to the mother on how to calculate the amount of fluid the child has to take
in a day. It is good to explain what is ORS, why it is given and a simple way to prepare it, however, there
is no need to go in depth on how much ORS is needed to give to the child.
4. Feedback
‐ Do you understand what I am saying?
‐ Do you have any ques ons? So what do you concern about?
5. Reassure
‐ Do not worry so much. Your child will get well soon a횦 er we replace the fluid loss. What can you do
right now is being by his side and comfort him. You can offer him orally if he can tolerate it. Offer him
some plain water, fruits juice or so횦 food like porridge.
6. Others
‐ Ques ons can be asked by parents?
‐ Do my child need an bio cs/ an eme c/ or an diarrhoeal?
· No need an bio cs because like I said the most common pathogen causing acute gastroenteri s
would be virus.
· We won’t give an eme c because it can have bad side effect especially to the brain. The child can
have drowsiness. (an eme c – can caused CNS effect, oculo gyric crisis).
· An diarrhoeal also no need because we want him to pass out stool so all the pathogen can be wash
out/ come out too.
‐ is ORS is medica on? Rather than medica on I would say ORS is replacement of fluids, ions or
electrolyte loss due to vomi ng and diarrhoea.
‐ How long it takes for the symptoms to resolve? Maybe a횦 er 2 to 3 days.
‐ What is in this ORS that you men on?
It contain electrolytes which are substances that is required for the body to func on well/ it contain salt
that is required for the body to func on well. As your son will lose these vital substances through
vomi ng and diarrhea, this ORS will compensate the salt that your son had lost.
B. Wri en – Developmental assessment
‐ Situa on : 24 months old girl who is born at term was diagnosed with meningi s soon at birth. She was
given IV penicillin and Gentamicin. She also had history of prolonged and severe neonatal jaundice and
on phototherapy treatment and exchange transfusion.
‐ Her current developmental is:
· able to kick the ball and climb up stairs while holding onto the rails
· can build tower of 3 blocks
· can imitates housework
· can drink from a cup
· able to say indicates she want something
· do not respond to calling/ voice
· cannot speak
· wasn’t able to ?
‐ Ques ons:
1. Please stated for each component she is delayed or normal
‐ Gross motor skill: normal
‐ Fine motor skill: normal
‐ Social skill: normal
‐ Language skill: delayed
2. What is the most likely reason of her pattern of development?
‐ Hearing impairment: because she has language delayed
‐ Other possible reasons:
‐ Ar cula on problems but not likely in this case because she really cannot turn to voice/ upon calling
and not really common for child to have this problems
‐ Cogni ve impairment: not true because she can imitates housework means she observe and
understand how to do it
3. What are the TWO causes of her underlying problems based on the history?
‐ Gentamicin side effects – can cause hearing loss due to its ototoxicity
‐ Complica ons of meningi s
‐ Severe neonatal jaundice (not necessarily Kernicterus)
SHORT CASES
Ques ons Findings DDx