Dear All

Thank you for participating in the session today.

Dr S joined us to share her experience of the recent exam. She felt the exam was straight forward and there was enough time at each station to complete the examination at clinical stations and tasks at other station. Children in UK get very good supportive care hence it is difficult at times to identify a lesion e.g. spastic diplegia with minimal signs due to good physio & occupational therapy support.

Clinical station was a 8 year old admitted previous evening with breathing difficulty – to do a respiratory system examination. Dr Shishir was the examiner. Dr S took the hotseat. He made a very good attempt at the clinical exam. There were some parts missed and Dr N took the hotseat for another attempt. Working diagnosis of the case was: Asthma exacerbation. Other members gave their input on how to complete the examination. Summary needs to be brief and ‘post graduate’.

The Learning points are:

• Have a differential diagnosis
• Systematic, fluent examination
• General physical examination is essential at every station.
• Review growth – check centiles
• Respiratory system includes ‘Upper airway’ nose, pharynx, larynx
• Check for polyps – look up the nose – show and mention. Rhinitis.
• Look at skin for eczema – as a cue for asthma.
• Respiratory effort and respiratory rate.
• Give your ‘diagnosis’ / impression first then mention supporting findings.
• Not the other way round when you list findings first.
• Management of Asthma: Stepwise’ and as per BTS guidelines
• Inform consultant in case of deterioration
• Arrange for support from ICU / anaesthetic colleagues

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

Anil Garg