22 May 2012

Communication station (Medical students)

The 'Communications Skills' is one of the stations in the paediatric viva of the final exam. The following scenarios are intended for students to practice communication skills (with one another or with a relative or friend). The interview lasts for 4 minutes. You can speak in English or Maltese.

(1) Introduce yourself, 'Good morning, I am Joseph Mizzi, one of the doctors who is taking care of your child.' (2) You can begin by giving a resume of the information you had been given. 'So you have brought your son John because of fever. He has been vomiting and complaining of headache. When we examined him, we noted that he had neck stiffness.' (3) Answer any questions clearly and honestly. If asked whether meningitis may lead to death or long term problems, for instance, answer: 'Yes, meningitis is a serious illness that may cause death or long-term problems such as hearing loss. However most children recover completely without any complications.' (4) During the conversation refer to the child by his name. (5) As far as possible lead the conversation, but allow the 'parent' to comment and ask questions (communication should be a conversation not a monologue!) (6) Towards the end of the interview ask the parent if he has any questions, 'Is there anything else you would like to know?'

  1. You have examined a 4 year old boy, John, at A&E. You are suspecting meningitis on clinical grounds (fever, headache, neck stiffness). Explain to the parents your diagnosis and the management.
  2. 8 month old baby Julia, had been admitted for investigations for fever. The urinalysis is consistent with UTI. The blood and urine cultures are pending. Explain the result and outline the management.
  3. Baby Mattea was recently diagnosed with cystic fibrosis. The father would like to know about the genetic aspects of the condition.
  4. Six year old boy, Mark, was recently diagnosed with asthma and started on budesonide 2 puffs nocte and salbutamol 2 puffs prn.. At out patients explain to the parent the purpose of the two inhalers and how to use them effectively.
  5. 3 year old, Emma, was admitted to paediatric ward for investigations for fever, tachypnoea and cough. The CXR shows a right sided middle lobe pneumonia. Explain the diagnosis and outline the management to the parent.
  6. A 13 year old girl, Jessica, has been suffering from headaches for the past one month. She was referred by an ophthalmologist for papilloedema. A CT brain was normal. You decide to perform an LP to confirm benign intracranial hypertension. Explain to the parent the result of the CT and what will be involved in the procedure, including the local anesthetic.
  7. During a neonatal examination of baby Karl, you discovered a significant murmur, probably due to a small VSD. Explain to the parent what investigation is required, the follow-up, and the likely outcome.
  8. A 2 year old boy, Kyle, was referred by the community paediatrician with newly diagnosed diabetes. On examination he is 5% dehydrated and is breathing rapidly. Urinalysis shows heavy glycosuria and ketones. Explain briefly to the parent the immediate management.
  9. At paediatric A&E, you examined a 2 month old baby Carla who was brought in with  a one day history of low grade fever, irritability and poor feeding. Explain to the parent why she needs to be admitted and what investigations are needed.
  10. The parent of a 3 year old boy, Mark, came to COP for the results of the investigations taken for abdominal pain, weight loss and diarrhoea. Anti-TTG IgA is positive and total IgA normal. Inform the parent about the diagnosis, further tests and outline management.
  11. My 8 year old daughter, Martha, is obese. I would like to know what factors lead to obesity.
  12. A 4 year old boy, Karl, was brought to casualty with a one-day history of fever and a non-blanching rash. He is alert and in good general condition. His pulse and blood pressure are normal, he is not tachypnoeic and the saturations 96%. What will you tell his parent?
  13. What are the advantages of breastfeeding to the child and to the mother? What are the challenges? When is breastfeeding medically contraindicated?
  14. Explain to a parent how to reduce the risk of cot death.
  15. Explain to a parent how to correctly take the temperature of an infant and how to control fever.
  16. Apart from the routine vaccines given on the national service, what other vaccines are available.
  17. The parent of a 3 week old infant, Martha, is concerned about her persistent jaundice. What questions will you ask the parent?
  18. The parent of a 12 month old child, Luke, who was admitted with a first episode of febrile fit, would like to know more information about this condition.
  19. 8 month old baby, Karl, was seen at A&E, for one day history of fever. He is feeding well and appears well. Temp 38C. No focus of infection is identified. Urinalysis is normal. Discuss with the parent your findings and the management.
  20. The parents of a newborn had been told that their child probably has Down syndrome. One of the parents would like to speak to you about their son, Matthew.
  21. The parent of an 18 month old boy, Timothy, wants to speak to you about his development (he is not saying any words yet, does not point to show interest, avoids eye contact, prefers to be alone and has obsessive interests).  
  22. 2 week old male infant, Dennis, presented with a 3 day history of projectile vomiting following most feeds. He is clinically dehydrated. BW 3.0kg; current weight 2.8kg. You are suspecting pyloric stenosis. Speak to the parent about the diagnosis and management.
  23. 2 week old male infant, Matthew, 3 day h/o projectile vomiting. Clinically dehydrated. BW 3.0 kg; current weight 2.8 kg. You are suspecting pyloric stenosis. Speak to the parent about the diagnosis and management.
  24. You have examined a 2 year old girl, Kate, at A&E for low-grade fever (37.8C), non-bilious vomiting (x1) and diarrhoea (x3). On examination she is mildly dehydrated. You diagnose acute gastro-enteritis and decide to treat her at home. Discuss with her parent.