Pick ‘n’ Mix Week 1 March 2023
We are really grateful to Trudie Pestell for sharing Pick ‘n’ Mix: a fabulous education initiative that she has been producing for University Hospital Southampton Emergency Department for a while.
Each week we will bring you some clinical pearls to add to your knowledge and understanding with links to other resources as well as an OSCE of the week.
The case of a ‘spotted’ infant
The beginning:
A mother has brought her child to the ED with a four-day history of what she thought was the ‘common cold’. Whilst washing her child she noticed a rash that started on the child’s head and has now extended down to its body.
From the history you know the child is not vaccinated. On examination, you see the rash (shown below) and decide to examine the mouth where you notice tiny white spots inside their cheeks.
OSCE of the Weeks – Dermatological Examination
Introduction
“Hello, my name is Phil. I am one of the medical students”
“Please can you confirm your name and date of birth, while I wash my hands, put on my PPE and ensure we are somewhere private?”
“Are you comfortable? Do you need any pain relief or a drink?”
“I have been asked to see you because of a rash, is that correct? I will need to examine this rash, and also look at your mouth, scalp and eyes.”
“Would you like a chaperone present?”
“I will talk out loud as we go”
“If at any time you want me to stop or you are in pain, let me know”
Brief history
“Briefly tell me about this rash.”
- Recent medications
- Change in cosmetics/cleaning products
- Illnesses
- Foreign travel
- Systemic symptoms
General inspection
“In terms of general inspection, I am assessing…”
Patient’s appearance
- level of comfort
- location of rash: symmetrical or extremities
Observations
- BP
- Resp Rate
- Sats
- Temperature
- Blood glucose
Closer inspection
“I will need to examine your rash…”
- Describe characteristics of rash using SOCRATES (see Chapter 3)
- Examines: hair; eyes; mouth; lymph nodes
- If appropriate comment on the need to examine the genitalia
Close
“Thank you very much the examination is now over.”
“Would you like any help getting changed?”
“In summary my working differential diagnosis is…
“I think we should try, e.g.
- Dry: emollient: weak steroids
- Itchy: antihistamines
- Infected: topical fusidic acid; flucloxacillin
“Does that sound reasonable to you? Do you have any questions or concerns?”