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Paeds Casesrheumatology-musculoskeletal-and-sports

Paeds Cases · rheumatology-musculoskeletal-and-sports

Explain acute osteomyelitis management to a family — OSCE

OSCE communication and shared decision-making station: explaining the diagnosis and management of acute haematogenous osteomyelitis to the parents of a three-year-old boy, addressing the role of magnetic resonance imaging, the intravenous-to-oral antibiotic strategy, the need for blood cultures before antibiotics, and the plan for follow-up and early switch to oral therapy.

osce communication and shared decision-making3 min readVerification in progress

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
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Study tools

Target exams

MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
The parents of a three-year-old boy are in the emergency department after he developed three days of fever and stopped walking, holding his left leg still and crying when it is touched. The registrar has made a diagnosis of acute haematogenous osteomyelitis based on a high C-reactive protein and a magnetic resonance image showing marrow oedema in the distal tibia. The parents are frightened, they think the limp is from a fall at the playground two days ago, and they do not understand why their child needs a bone infection treated with antibiotics in hospital when he has never been this unwell before. Counsel them.

Candidate brief

You have eight minutes to counsel the parents of a three-year-old boy who has been diagnosed with acute haematogenous osteomyelitis of the distal tibia. The diagnosis is confirmed by a magnetic resonance image showing marrow oedema. Blood cultures have been drawn and empirical intravenous antibiotics have been started. Use a structured, honest, empathic approach that explains the diagnosis in plain language, addresses the parents' fears and the playground-injury theory, outlines the intravenous-to-oral antibiotic strategy, and builds a shared plan for the hospital stay and the outpatient follow-up. [1] [4]


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References4ShowHide
  1. [1]Woods CR, Bradley JS, Chatterjee A, et al. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Journal of the Pediatric Infectious Diseases Society, 2021.PMID 34350458
  2. [4]Gornitzky AL, Kim AE, O'Donnell JM, et al. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Reviews, 2020.PMID 33006465
  3. [6]Yagupsky P. Diagnosing Kingella kingae infections in infants and young children. Expert Review of Anti-infective Therapy, 2017.PMID 28918656
  4. [12]de Graaf H, Sukhtankar P, Arch B, et al. Duration of intravenous antibiotic therapy for children with acute osteomyelitis or septic arthritis: a feasibility study. Health Technology Assessment, 2017.PMID 28862129
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