OSCEs for Medical Students, Volume 3 Second Edition

122 OSCEs for Medical Students, Volume 3AnswersCommentThe key to all paediatric examination is good observation. From a distance look fortachypnoea, distress and hyperexpansion (seen best from the side) or asymmetricalexpansion. Auscultation is usually best in babies if they are quiet, but in olderchildren expansion, percussion should take place first. Always explain to the child andexaminer what you are doing. Never forget the peak flow and weight. Also, if you aredoing something, be prepared to say why (there is little point percussing or elicitingvocal fremitus in a child with equal and normal breath sounds).Common conditions in OSCEs are CF, asthma, chronic lung disease (ex-prem) orpossibly a baby recovering from bronchiolitis. In CF there will probably be a mixtureof inspiratory crackles and expiratory wheeze (many have asthma too) and may beunderweight. Those with chronic lung disease often have some degree of chestdeformity and scars on their hands from repeated cannulation.