Tuberculosis in children — OSCE assessment and communication station

OSCE \u2014 Assessment and communication station

Candidate instructions

You are the paediatric registrar. You have 8 minutes per station. ^[1]

Station A (classify, investigate and treat). A four-year-old boy is brought in thin, with a cough and intermittent fever for six weeks. His uncle was diagnosed with smear-positive pulmonary tuberculosis two weeks ago. His chest radiograph shows right paratracheal lymph-node enlargement without cavitation. Classify the child on the TB spectrum, outline the investigations, and explain the treatment plan to his mother through a trained interpreter. ^{[1] [7]}

Station B (TBM override and the contact). You are asked to review a two-year-old sibling of the same family who presents febrile, irritable and drowsy, and to counsel on an asymptomatic eight-month-old household contact. Recognise the emergency, outline immediate management, and explain contact screening and presumptive preventive therapy. ^{[6] [1]}

Examiner brief and marking domains

Domain 1 \u2014 Classification (Station A). Correctly places the child on the exposure-infection-disease spectrum as TB disease (symptoms plus a compatible radiograph), classifies the disease by site as intrathoracic and by severity as non-severe (lymph-node, non-cavitary, smear-negative pattern), and explains why the contact history is the most specific finding. ^{[1] [3]}

Domain 2 \u2014 Investigation (Station A). Outlines two to three early-morning gastric aspirates (or induced sputum) for Xpert MTB/RIF Ultra plus culture and susceptibility, a TST or IGRA to support infection, an HIV test, and a chest radiograph read for the lymph-node pattern. States clearly that a negative Xpert does not exclude disease and that treatment proceeds on a compatible picture. ^[5]