Dear all

Thank you for joining the session and making it so interesting.

In the RRR we discussed:

• Unsteadiness due to Cerebelitis
• Chronic active hepatitis
• Guillian barre syndrome

The cardiovascular station was a scenario of 15-year-old with central sternotomy scar and a murmur. Dr P and Dr J took the hotseat and were good at getting the clinical findings.

We had the following Learning points:

• Systematic examination is a must.
• General examination is MUST for all stations
• Do NOT spend more than 1 min on introductions & General exam
• Do not forget inspection palpation percussion auscultation.
• Expose the part.
• Sit child on edge of couch with arms up to look for scars.
• Also moved from periphery to central i.e. fingers to the chest
• Localise the apex beat feeling on both sides – Left & Right.
• Check for THRILL – this will give site of maximum intensity of murmur
• Do not want to miss Dextrocardia
• Listen to the members carefully and be able to differentiate common ones
• Take 10 seconds to organize your thoughts before presenting
• Avoid going back & forth as it seems poorly organised technique

Visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg