MBBS OSCE · Paediatrics
OSCE — Croup
Eight-minute OSCE station on Croup: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Croup.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Croup (acute laryngotracheobronchitis) is the most common cause of acute upper airway obstruction in young children, peaking at 6 months to 3 years, caused mainly by parainfluenza virus type 1 and 2. Presentation: barking seal-like cough, harsh inspiratory stridor, hoarse voice, low-grade fever, worse at night. Most are mild and self-limiting over 3 to 7 days. Severe croup: stridor at rest, marked retractions, cyanosis, altered mental state. Treatment: oral dexamethasone 0.15 to 0.6 mg/kg single dose for all children; nebulised adrenaline 1:1000, 0.5 mL/kg max 5 mL, for moderate to severe with stridor at rest; observe at least 2 to 4 hours after adrenaline for rebound.
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Stridor at rest, marked retractions, cyanosis, altered mental state - severe cro |
| Safety | Drooling, dysphagia, muffled voice, high fever, sitting forward tripod, no cough |
| Safety | Toxic child, high fever, purulent secretions, rapid deterioration - bacterial tr |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.