NAC OSCE Paediatric Assessment

Question 1

What is the 'Paediatric Assessment Triangle' (PAT) and what does it assess?

Accepted 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

Answer

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?

Accepted Answer

The infant has a bulging fontanelle, is inconsolable, and has a non-blanching rash

Answer

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?

Accepted 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

Answer

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?

Accepted 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

Answer

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?

Accepted 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

Answer

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).

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE Paediatric Assessment