Explaining invasive fungal disease and central-line removal — OSCE

Candidate instructions (8-minute station)

You are the paediatric registrar on the oncology ward. A 7-year-old boy with acute lymphoblastic leukaemia, on day 12 of induction chemotherapy, has been profoundly neutropenic with a central venous catheter in situ. His blood cultures, drawn because of persistent fever, have grown Candida. The oncology team has decided to remove the central line and to start an intravenous antifungal. His parents are frightened: the fever was hard enough, and now they are being told their son has a "blood fungal infection," that his line must be pulled, and that he will need weeks of a new intravenous medicine. They are worried the line removal will derail his chemotherapy. [14]

Your tasks are: [2]

1. Explain in plain language why a child with a central line and low immunity developed a fungal bloodstream infection, and why the line itself is part of the problem and must come out. [2] [14]
2. Explain what the intravenous antifungal does, why it is given through a drip rather than by mouth at this stage, and what the team will watch for (kidney function, electrolytes, drug levels). [2]
3. Explain why the ophthalmology team will examine his retinas, and what the two-week minimum duration means in terms of repeated blood cultures and follow-up. [14]
4. Address the parents' worry about the chemotherapy, and explain how the team will protect the next cycle with prophylaxis. [1]

You are not expected to give exact antifungal doses to the parents; explain the plan in plain language and flag that any decision is made by the oncology and infectious-diseases teams with the parents' consent. [14]