OSCE Pediatric Assessment 4

Question 1

A 2-year-old presents with a barking cough, stridor at rest, and moderate sternal recession. Using the Westley Croup Score, this child most likely has:

Accepted Answer

Moderate croup — nebulized epinephrine and dexamethasone

Answer

Stridor at rest with sternal recession indicates moderate croup, managed with nebulized epinephrine and systemic dexamethasone.

Question 2

During a neonatal examination, a midwife asks you about the significance of a persistently open posterior fontanelle at 3 months of age. What is the most important association?

Accepted Answer

Hypothyroidism

Answer

A large or persistently open posterior fontanelle beyond the first weeks of life is associated with congenital hypothyroidism and warrants thyroid function testing.

Question 3

A 6-year-old presents with a first unprovoked seizure lasting 3 minutes that has now resolved. He is post-ictal but vital signs are stable. What is the first-line management?

Accepted Answer

Perform a full history and examination; investigate appropriately

Answer

After a first brief afebrile seizure that has self-terminated, clinical assessment and targeted investigation guide management before committing to antiepileptics.

Question 4

On auscultating a 5-year-old's chest, you hear a soft, blowing, systolic murmur at the left sternal edge that disappears when the child stands. What is this most likely?

Accepted Answer

Innocent (flow) murmur

Answer

An innocent murmur is typically soft, systolic, localised to the left sternal border, and classically diminishes or disappears on standing.

Question 5

A 4-week-old presents with jaundice. Bilirubin is predominantly conjugated (direct). What is the most important diagnosis to exclude urgently?

Accepted Answer

Biliary atresia

Answer

Conjugated hyperbilirubinemia in a neonate is never physiological and biliary atresia must be excluded urgently as Kasai portoenterostomy is time-sensitive.

OSCE Practice Test

OSCE Practice Test

OSCE Pediatric Assessment 4