ACEM example: A rashy child OSCE added anonymously 

You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.


A five year old is brought in by mother, with a new onset rash

View attached:  Attachment 1

Instructions for the candidate

A 5 year old child is brought in by mum with a rash to the torso. (See photo)
You are required to take a history from the mother who is a nurse.

You will then be given the examination findings by the examiner.
You will then be required to present your findings to the mother including a likely diagnosis, differential diagnoses and your intended management.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Professionalism
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You are the mother of a five year old child who has developed a rash today.
You are working part time as a nurse. You live with your husband who is an ofice worker and this is your first child.
Your child spends time in pre-school on days when you are at work.
Immunisations as per schedule.
no medication, no allergy, previously well apart from usual URTIs.

Child was well yesterday but today developed a fever and a rash. Temp at home 38.0
The child has had a mild headache but no vomiting or neck stiffness.
Slight runny nose, slight cough, but not dyspnoeic or tachypnoeic. Mild conjunctivitis.
Fine erythematous macular rash covering the face, chest abdomen and back.
No petechiae or ecchymoses.
Child looks reasonably well but is irritable. Fever has improved with paracetamol.
No history of overseas travel, no apparent exposure to other sick children.
Tolerating fluids well but has decreased food intake today. Apparently normal urine output.

Examination findings. T 37.4, P 120, Well perfused, active but irritable
RR 14, Pharynx sl red with no tonsillar exudate
A few cervical lymph nodes, no neck stiffness or photophobia
chest clear, abdo soft
The rash blanches, with no petechiae.

For the examiner

You are to observe the candidate as they take a history from the mother.
The candidate will then explain to the mother the likely diagnosis, differential diagnosis, intended investigations and disposition.

Domains Assessment Objectives

Medical Expertise
Candidate must take a history looking for possible serious causes of a rash in this child.
Should consider meningococcus, Henoch Schonlein purpura, Kawasakis disease, measles, erythema multiforme.

Prioritisation And Decision Making
It is none of these. The candidate should recognise that the child is not unwell and has no findings to suggest a serious cause.

The candidate should take a relevant focused history in view of the differential diagnosis and should conclude that as all findings are negative the child can be discharged with no tests. Should suggest LMO review if not improving or urgent ED review if patient deteriorates.

The candidate should interact with the mother in a professional way.

Other Assessment Notes

The image used comes from DermNet NZ. Published online at:

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