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Paeds Casesgenetics-dysmorphology-and-metabolism

Paeds Cases · genetics-dysmorphology-and-metabolism

Counsel an adolescent and her family on a new Turner syndrome diagnosis — OSCE

OSCE communication and shared decision-making station: explaining to a 13-year-old girl and her parents what a new Turner syndrome diagnosis means, what the karyotype found, what the growth-hormone and oestrogen management involves, why the aortic surveillance is lifelong, what the fertility implications are, and how the family can support her — while addressing the parents' grief, the adolescent's anxiety about being different, and the temptation to defer fertility and cardiac conversations because she is young.

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
A 13-year-old girl and her parents attend following a karyotype (45,X) that confirmed Turner syndrome after investigation of short stature and absent puberty. The parents are grieving and anxious, and feel guilty that they missed the diagnosis. The adolescent is withdrawn and has asked her mother whether she is 'not a real girl' and whether she will ever have children. The parents are reluctant to discuss fertility or the heart because 'she is too young.' Counsel them.

Task

Counsel the family. You have five minutes. Demonstrate an organised, empathic, and accurate explanation that addresses the five questions a fellowship communication station rewards: what the diagnosis means and what the karyotype found, what the medical plan is, why the aortic surveillance is lifelong, what the fertility implications are, and how the family can support her. The framework follows the 2017 international Turner syndrome guideline. [1]

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References4ShowHide
  1. [1]Gravholt CH, Andersen NH, Conway GS, et al. Clinical practice guidelines for the care of girls and women with Turner syndrome. Eur J Endocrinol, 2017.PMID 28705803
  2. [2]Sybert VP, McCauley E. Turner's syndrome. N Engl J Med, 2004.PMID 15371580
  3. [4]Hadnott TN, Gould HN, Gharib AM, Bondy CA. Outcomes of spontaneous and assisted pregnancies in Turner syndrome. Fertil Steril, 2011.PMID 21496813
  4. [8]Trolle C, Mortensen KH, Hjerrild BE, et al. Clinical care of adult Turner syndrome--new aspects. Pediatr Endocrinol Rev, 2012.PMID 22946288
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