Leukaemia in Children guidelines for osce PDF

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for final year students
guidelines for osce practice covers lecture material...

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Leukaemia in Children STEM = you are a junior dr in the emergency department at the WCH. You have been asked to see Amy (5 years old) and her parents after they were referred by their GP due to concerning blood test results:

Complete the following tasks: ● Take a brief focussed Hx from Amy’s parent ● Ask the examiner for relevant examination findings ● Explain your preferred diagnosis to the examiner, the investigations you would like to undertake, and emergency management ● Respond to any questions - you are NOT required to explain the diagnosis to the parents! PC = Amy has been very tired and not herself for the past few weeks. Her GP did a blood test and said there was something wrong with her cells and she needed to come here immediately. ● Normally a very bright and active child ● For last 2 weeks, has been a lot less active than normal ● Started napping for 2-3h when she got home from school instead of playing with her sister ● Has not been as hungry as usual for the last week and seemed very weak ● Had the last 3 days off school - too exhausted to attend ● Over last week has come home with bruises - reported getting them after playing at school ● Had a nosebleed 2 nights ago - not normal for her ● No bleeding gums when brushing teeth ● No bone / joint pain ● No chest pain, SOB, abdo pain ● No fever ● Has not been sick recently Antenatal Hx = normal antenatal scans, no infections during pregnancy. No alcohol / smoking during pregnancy. Neonatal Hx = born at 39 wks via NVD. No complications during birth. No resp. Support required. Heel prick and hearing checks normal. Went home next day. PMHx = good health since birth. No medical conditions. Has been growing normally. No concerns re. Development. Is enjoying school.

Meds = NAD Allergies = NAD Immunisations = UTD FHx = older sister (Penny) is well. No medical conditions run in family. No Hx bleeding disorders. Social Hx = lives at home w. 2 parents and older sister. Started school & both parents recently returned to work. Get along well as a family. Happy. No financial stressors. No religious affiliations (eg. Jehovah’s witness). Examination: ● General inspection = appears clingy, looks very pale ● Hydration status = well hydrated ● Vital signs = HR 160, RR 20, SpO2 98%, T 37.6% ● CVS = HS dual, no murmurs ● Resp = no work of breathing. No adventitious breath sounds ● ENT = Tympanic membranes appear normal. Pharynx not erythematous. ● Haem = obvious bruising on legs. Lymphadenopathy in the groin, axillae, and cervical regions ● Abdo = no tenderness, gross hepatoma galy (liver span 20cm) ● Neuro / MSK = NAD Investigations = current findings show pancytopaenia. Consider: ● Repeat CBE ● EUC, LFT’s ● Bone marrow biopsy Immediate management: ● Manage pancytopaenia, eg: ○ RBC transfusion ○ Consider PLT transfusion ● Urgent oncology referral...