Oedema in children: diagnostic approach — OSCE

Station brief (candidate)

• Explain that swelling is oedema — a sign needing a cause, not a final label.
• Interpret dipstick and BP in plain language (nephrotic-leaning pattern).
• Outline bedside checks: threat, distribution, perfusion, weight.
• Describe next tests (albumin, kidney function, formal proteinuria) and likely pathway.
• Teach return triggers: fever, severe abdominal pain, breathing difficulty, headache/visual change, rapid weight gain.
• Avoid blame; use teach-back; do not invent uncited drug doses. [1] [2] [3]

Role-player notes

You are a worried parent who was told it was “just allergies.” You become defensive if dismissed, and cooperative if the doctor explains urine protein simply and offers a clear same-day plan. You ask whether water should be stopped completely and whether this is kidney failure. [1] [4]

Expected candidate performance

• Names nephrotic-pattern oedema as leading working diagnosis without over-promising prognosis. [1] [2]
• Does not call it simple allergy given 4+ protein. [3]
• Mentions infection risk and when to return. [2] [4]
• Explains that treatment follows specialist/guideline pathways rather than home diuretics. [1] [2]
• Distinguishes this from airway angioedema if asked. [5]

Examiner checklist

• Threat-first language [1]
• Correct dipstick/BP interpretation [1] [3]
• Mechanism language (protein loss / low oncotic pressure) [1] [2]
• Clear investigations and follow-up [2] [4]
• Safety-net specific to nephrotic complications [2] [4]
• Empathic, non-blaming communication with teach-back [1]