OSCEs for Medical Students, Volume 3 Second Edition

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Paediatrics Answers 131STATION 1.7Neurology examinationAssessment Good Adequate Poor/not done1 Appropriate introduction (full name androle)Answers2 Explains purpose of examination3 Candidate washes their hands using thealcohol handwash provided (no marks ifcandidate only expresses the need towash if handwash is provided)4 Looks and comments on posture5 Briefly looks at child overall (blindness,syndrome, gastrostomy, failure to thrive)6 Asks child to take toy and commentson ability7 Feels tone of upper and lower limbs8 Examines power and reflexes competently9 Looks for contractures and scars fromtheir release10 Assesses primitive reflexes (grasp,plantars)11 Asks child to walk and run if appropriate
132 OSCEs for Medical Students, Volume 3AnswersCommentNeurology cases in paediatric OSCEs will almost always be children with cerebralpalsy. Other possibilities include: spinal muscular atrophy (lower motor neuroneweakness only) and Duchenne muscular dystrophy (boys only, predominantlyproximal weakness, occasional pseudohypertrophy of calves).The paediatric neurology examination is fairly similar to the adult format. As before,observation is key. From the end of the bed look for an upper motor neurone or ahypotonic posture. Look also for associated defects, such as blindness, failure tothrive and deafness. The rest of the examination identifies the type of defect(UMN/LMN), its location (mono-, di-, hemi- or quadriplegia) and the extent to whichthis is limiting function. Arm function can be assessed with toys or writhing and legfunction by walking.Hypertonia tends to develop over time after the insult that caused the cerebral palsy,and affected children are often hypotonic in infancy.
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OSCEs for Medical Students, Volume 3 Second Edition

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