NAC OSCE Paediatric Assessment — Questions and Answers
Question 1: What is the 'Paediatric Assessment Triangle' (PAT) and what does it assess?
- A tool for measuring a child's height, weight, and head circumference
- A rapid visual and auditory assessment tool that evaluates Appearance (consciousness, tone, interactivity), Work of Breathing (respiratory effort), and Circulation to Skin (colour, perfusion) within the first 30 seconds (Correct answer)
- A method for calculating paediatric drug doses
- A screening tool for developmental delays
Correct answer: A rapid visual and auditory assessment tool that evaluates Appearance (consciousness, tone, interactivity), Work of Breathing (respiratory effort), and Circulation to Skin (colour, perfusion) within the first 30 seconds
The PAT is a rapid 'across-the-room' assessment performed in the first 30 seconds. Appearance assesses tone, interactivity, consolability, gaze, and speech/cry (TICLS). Work of Breathing assesses respiratory rate, retractions, stridor, wheezing, and nasal flaring. Circulation to Skin assesses pallor, mottling, cyanosis, and capillary refill. It helps categorize the child's severity without touching them.
Question 2: A 6-month-old infant presents with fever of 39°C. Which of the following findings would be MOST concerning?
- The infant is feeding well and playing normally
- The infant has a bulging fontanelle, is inconsolable, and has a non-blanching rash (Correct answer)
- The infant has a runny nose and mild cough
- The infant has a single episode of loose stool
Correct answer: The infant has a bulging fontanelle, is inconsolable, and has a non-blanching rash
A bulging fontanelle (suggests raised intracranial pressure/meningitis), inconsolability (indicates significant illness), and a non-blanching rash (purpura — suggests meningococcal disease) are red-flag features in a febrile infant. This presentation requires immediate IV antibiotics (ceftriaxone), blood cultures, and likely lumbar puncture. Meningococcal disease can progress from well to critically ill within hours.
Question 3: How do you calculate the weight of a child for emergency drug dosing when the actual weight is unknown?
- Use the parent's estimated weight
- Use an age-based formula: Weight (kg) = (Age in years + 4) × 2 for ages 1-10, or use a Broselow tape for length-based estimation (Correct answer)
- All children receive adult doses divided by 2
- Use a standard weight of 20 kg for all children
Correct answer: Use an age-based formula: Weight (kg) = (Age in years + 4) × 2 for ages 1-10, or use a Broselow tape for length-based estimation
When actual weight is unavailable in an emergency, the formula Weight (kg) = (Age + 4) × 2 provides an estimate for children aged 1-10. The Broselow tape is a colour-coded measuring tape that estimates weight based on the child's length and provides pre-calculated drug doses and equipment sizes. Both methods are approximations — actual weight should be obtained when possible.
Question 4: What are the signs of dehydration in a 2-year-old child and how is severity assessed?
- Dehydration is only assessed by measuring urine output
- Mild: slightly dry mucous membranes, normal skin turgor. Moderate: sunken eyes, decreased skin turgor, decreased urine output, tachycardia. Severe: lethargic, very sunken eyes, very poor skin turgor, absent urine, hypotension (Correct answer)
- All dehydrated children need IV fluids immediately
- Dehydration is diagnosed only by blood tests
Correct answer: Mild: slightly dry mucous membranes, normal skin turgor. Moderate: sunken eyes, decreased skin turgor, decreased urine output, tachycardia. Severe: lethargic, very sunken eyes, very poor skin turgor, absent urine, hypotension
Dehydration severity is assessed clinically: Mild (<5%) — slightly dry mouth, normal vitals. Moderate (5-10%) — sunken eyes, decreased skin turgor (skin fold takes >2 seconds to retract), reduced urine output, tachycardia, delayed capillary refill. Severe (>10%) — lethargy/unconsciousness, very sunken fontanelle, absent tears, very poor skin turgor, anuria, tachycardia with hypotension.
Question 5: A parent brings in a 4-year-old with a limp. The child is afebrile. What is the MOST important diagnosis to exclude?
- Growing pains
- Septic arthritis — which requires urgent joint aspiration and IV antibiotics, though less likely when afebrile; also consider Legg-Calve-Perthes disease, transient synovitis, and occult fracture (Correct answer)
- A muscle strain from playing
- Flat feet causing discomfort
Correct answer: Septic arthritis — which requires urgent joint aspiration and IV antibiotics, though less likely when afebrile; also consider Legg-Calve-Perthes disease, transient synovitis, and occult fracture
While septic arthritis is the most urgent diagnosis to exclude (as delay causes joint destruction), in an afebrile child the differential includes transient synovitis (most common cause of acute hip pain in children), Legg-Calve-Perthes disease (avascular necrosis of the femoral head), occult fracture (especially toddler's fracture of the tibia), and malignancy (leukemia can present with bone pain and limp).
Question 6: What are the key developmental milestones expected at 12 months of age?
- Running, speaking in full sentences, and toilet training
- Pulls to stand, cruises along furniture, says 1-3 words (e.g., 'mama,' 'dada'), uses pincer grasp, waves bye-bye, and shows stranger anxiety (Correct answer)
- Sitting unsupported, babbling, and rolling over
- Walking independently, counting to 10, and drawing circles
Correct answer: Pulls to stand, cruises along furniture, says 1-3 words (e.g., 'mama,' 'dada'), uses pincer grasp, waves bye-bye, and shows stranger anxiety
At 12 months, key milestones include: Gross motor — pulls to stand, cruises furniture, may take first independent steps. Fine motor — mature pincer grasp (thumb and forefinger). Language — says 1-3 specific words, understands simple commands. Social — waves, plays peek-a-boo, shows stranger anxiety, uses gestures. Failure to meet these milestones warrants developmental assessment.
NAC OSCE Paediatric Assessment
What is the 'Paediatric Assessment Triangle' (PAT) and what does it assess?