Pediatric OSCE – History-Taking Essentials

A set of concise Q-and-A flashcards covering key history-taking points, danger signs, differential clues, and hallmark clinical features for common pediatric OSCE scenarios: neonatal jaundice, malnutrition, dengue, ARI, asthma, stridor, suppurative lung disease, congenital and rheumatic heart disease, diarrhea, jaundice, edema, pallor, bleeding disorders, fever with fits, and cerebral palsy.

When does the timing of jaundice onset in a newborn become clinically significant?

Within the first 24 h of life (pathologic causes such as hemolysis) or after 24 h (physiologic and other causes).

Key maternal infections to ask about in neonatal jaundice history

Rubella, TORCH infections, maternal sepsis or fever with foul-smelling liquor.

Why ask about prolonged rupture of membranes (>24 h) during birth history?

It increases the risk of neonatal sepsis, a cause of early jaundice.

Two classic neurologic danger signs of kernicterus

High-pitched cry and poor feeding/lethargy.

Breast-milk vs. breast-feeding jaundice—basic difference

Breast-feeding jaundice = inadequate intake/early dehydration; Breast-milk jaundice = persistent jaundice after day 7 despite good feeding.

Weight-for-height < –3 SD indicates what nutritional problem?

Severe acute malnutrition / Protein Energy Malnutrition (PEM).

Most important first question in a PEM OSCE

“What is the main reason for bringing the child and how long has the problem existed?”

Common precipitating illness for oedematous PEM (Kwashiorkor)

Measles, persistent diarrhea, or severe infection causing catabolic stress.

Two cardinal signs of SOME dehydration in acute diarrhea

Sunken eyes and drinks eagerly/thirsty.

Fluid plan for SEVERE dehydration in a child

Begin IV fluids immediately (Plan C: 100 mL/kg Ringer’s lactate/normal saline in 3 h — infants, 30 mL/kg first 30 min then 70 mL/kg over 2½ h).

Positive Hess / tourniquet test in dengue signifies what pathophysiology?

Capillary fragility and early plasma leakage.

Four WHO grades of DHF (name the grade with ‘only positive tourniquet test’)

Grade I – only positive tourniquet test.

Bleeding red flags to ask during DHF history

Coffee-ground vomiting, melena, epistaxis, gum bleeding, subcutaneous petechiae.

Classical abdominal pain site in DHF plasma-leak phase

Epigastric or right hypochondrial pain due to hepatic congestion or gastritis.

Key environmental questions for dengue vector control

Covered water containers, regular emptying of flower vases, nearby stagnant water, use of mosquito nets/repellents.

Fast-breathing cut-off (breaths/min) for severe pneumonia in 2–12 mo

≥50 breaths per minute.

Three danger signs in ARI history that define ‘very severe pneumonia’

Inability to feed/drink, convulsions, lethargy or unconsciousness with chest indrawing.

Classic trigger provoking exercise-induced asthma

Onset of wheeze or cough after running/playing, relieved by rest or bronchodilator.

Poor day-to-day asthma control is suggested when reliever use exceeds…

2 times per week.

Why enquire about atopy (eczema, allergic rhinitis) in recurrent wheeze?

Personal or family atopy strongly supports a diagnosis of bronchial asthma.

Sudden onset inspiratory stridor while playing and no fever suggests…

Foreign body aspiration.

Drooling, high fever, tripod posture indicate which life-threatening cause of stridor?

Acute epiglottitis (often HiB).

Barking cough + hoarseness + inspiratory stridor

Croup / Acute laryngotracheobronchitis.

Foul-smelling copious morning sputum in a child with chronic cough suggests…

Bronchiectasis (suppurative lung disease).

Which childhood infections commonly precede lung abscess/bronchiectasis?

Severe measles, whooping cough, or recurrent bacterial pneumonias.

Classical relieving posture during a TOF hyper-cyanotic spell

Squatting or knee-chest position.

Two hallmark symptoms of congestive heart failure in infants with large VSD

Poor feeding with sweating and failure to thrive.

Migratory polyarthritis + carditis + fever in a school-aged child suggests…

Acute Rheumatic Fever (Jones major criteria).

Drug of choice for secondary prophylaxis after rheumatic fever

Benzathine penicillin G IM every 4 weeks (or oral penicillin V daily).

Stool description that points toward invasive dysentery

Frequent small-volume stools with blood and mucus.

Most reliable clinical sign of severe dehydration

Lethargy or unconsciousness with very slow skin pinch recoil (>2 s).

Dark urine and pale clay-colored stool are typical of which type of jaundice?

Obstructive (cholestatic) jaundice.

Name two serious complications of acute viral hepatitis in children

Acute liver failure with encephalopathy and coagulopathy, or aplastic anemia (HBV).

Abrupt periorbital edema, cola-colored urine after skin infection

Acute post-streptococcal glomerulonephritis (APSGN).

Key urine dipstick finding in nephrotic syndrome

Massive proteinuria (≥3+).

Protein-energy malnutrition type characterized by bilateral pitting edema

Kwashiorkor.

High-pitched cry, opisthotonus, poor suck in a jaundiced neonate equals…

Kernicterus (bilirubin encephalopathy).

Important transfusion-related infections to screen in chronically transfused thalassemia

HBV, HCV, HIV, malaria, syphilis (VDRL).

Sudden pallor + jaundice + coca-cola urine after fava-bean ingestion

Acute intravascular hemolysis in G6PD deficiency.

ITP typical preceding history

Viral infection or vaccination 1–3 weeks before onset of petechiae/bleeding.

Bone pain, pallor, hepatosplenomegaly and bruises in a child suggests…

Acute lymphoblastic leukemia until proven otherwise.

Simple definition of febrile seizure

A generalized seizure occurring in 6 mo–5 y child with fever, without CNS infection, lasting <15 min and not recurring within 24 h (simple type).

Red-flag features that point to meningitis in ‘fever with fits’

Persistent altered consciousness, focal deficits, bulging fontanelle, neck stiffness, projectile vomiting.

Travel to malaria-endemic area + high fever + seizures

Consider cerebral malaria.

Most common cause of cerebral palsy worldwide

Perinatal hypoxic-ischemic encephalopathy (birth asphyxia).

Feeding difficulty with choking and recurrent pneumonia in CP indicates…

Bulbar dysfunction leading to aspiration.

Primitive reflex persistence beyond expected age suggests what?

Neuromotor impairment such as spastic cerebral palsy.

Key prenatal risk factors to ask in CP history

Maternal infections, radiation/drug exposure, hypertension, diabetes, antepartum hemorrhage.