We discussed a scenario of 6 month old presenting with vomiting. there was evidence of a repaired meningomyelocele and insertion of VP shunt. We covered how to develop differential diagnosis in this case. And …
14 year old with universal cues of hemiplegic gait, shortening on left limbs but generally very well.

The learning points:

• approach to a child with vomiting and ‘VP shunt’.
• VP shunt examination for obstruction
• CT Shunt series of head for quick assessment for ‘broken’ shunt
• MRI is not appropriate as it takes long and will require sedation
• Good brief description / summary of universal cues
• Focused history questions
• Specific examination: Neurological exam: Muscle bulk / Power / Tone / Reflexes – Augumentation
• MSK examination: range of movements is more appropriate
• Exam is a ‘Performance’ Write your own script for each station & PRACTICE, PRACTICE, PRACTICE

Add your comments or anything I may have missed.
Anil Garg