We continued with our theme of Abdomen and discussed a 4 yr child with recurrent abdominal pain. He looked very well. He had a transverse scar in upper abdomen approx 12 – 15 cm across with a circular 3 cm diameter scar and number of spikey scars along the linear scar. No organomegaly.
Interesting –   discussion. Trying to have a succinct coherent presentation took combined effort. Diagnosis was Surgery for intestinal obstruction in early infancy due to volvulus. Circular scar was by a local healer branding the child.
Learning points were:

• give presentation under: Inspection, palpation, percussion – if, auscultation
• narrow down differential diagnosis to 3 most likely – at times not possible
• Investigations with expected results to help narrow done the Differential diagnosis
• Surgical scars are likely to have surgical DD but think of Constipation.
• Do not go to Coeliac disease – if no other clues
• Missing signs attracts lesser penalty than making up a sign.
• If REALLY in doubt – then mention your dilemma.
• If your examination technique was GOOD – examiner will take that into account

If there are any more points that I may have missed – please add them

Anil Garg