Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Headache in 12 yr old – hypertension
• Cyanosed newborn – 4 hours old
• Recurrent infection – 4 yr old

The History station was of a 21 day old aby with weight loss and serum Na-113 mmol/l. Dr I was a good Role player as father of infant. Dr P took to the hotseat while Dr R & Dr K wore examiner hats – with feedback with observations and as per mark sheet. Dr P made a very good attempt at getting the history and discussing management. Examiners made very accurate observations and Learning points from the group are:

• Have a Differential diagnosis with scenario information.
• This will give structure to your history
• Structure to history taking is essential
• Empathy – demonstrate as appropriate
• Do not ask too many questions together – get answers too.
• Family history can be vitally important do not ignore.
• If a cue is offered – explore – do not just brush over.
• CURRENT ACUTE problem ALWAYS needs to be tackled first.
• Discuss with your consultant
• Consult tertiary intensive care teams – if required.
• In CAH – DD – Sepsis, meningitis, Feeding problems
• 17 Hydroxy progestrone is an important investigation – need not wait for results
• SEPSIS in neonatal period – always consider & Treat as omission can be fatal
• Check if .2%Saline 10% dextrose is still used – my memory is that it was discontinued due to problems with hyponatremia. 10% Dextrose NS is used.

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

Anil Garg