Pallor in children: diagnostic approach — viva

Opening

Examiner: How do you start? [1]

Candidate: I assess stability — appearance, work of breathing, perfusion and consciousness — before debating colour. I ask what changed from the child’s baseline and treat caregiver concern as data. I examine mucosae and palms in good light, knowing facial colour alone misleads across skin tones. [2] [5]

Branch A — Well toddler, dietary clues

Examiner: High cow’s milk intake, microcytic anaemia, low ferritin, normal other lines. [1]

Candidate: Problem representation is dietary iron deficiency. I treat iron, fix milk excess and diet, safety-net, and recheck response. I still explain that iron deficiency is a mechanism label needing cause correction. [1]

Branch B — Microcytosis, normal iron studies

Examiner: Ancestry risk, high RBC count, normal ferritin. [3]

Candidate: I consider thalassaemia trait, arrange appropriate haemoglobinopathy testing, and avoid indefinite unnecessary iron. I counsel without stigma. [3]

Branch C — Fever, bruises, bone pain

Examiner: Same-day threat? [4]

Candidate: Yes. CBC with film now, senior review, do not trial iron at home. Low reticulocytes with multi-lineage cytopenias push marrow failure or infiltration pathways. [4] [7]

Close

Examiner: Disposition line? [6]

Candidate: Named follow-up, expected response, and clear return advice for worse pallor, dark urine, bleeding, fever or breathing difficulty. [6]