Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Rash – DD – HSP, ITP, Malignancy
• Haemolytic anaemia
• Teratogens – proven

The Clinical station we discussed today was – Video. AG gave a brief PP presentation of the basics, what and how – to do, what to ask, what to examine and how to proceed. Dr S took the hotseat. Video showed a teenage girl having convulsive movement followed by post ictal phase in school with review in A&E. Dr S picked up the clinical signs demonstrated and developed an appropriate diagnosis. Dr Shishir was the examiner. He asked what did Dr S observe – details of the convulsive movements. It was noted the movements were not tonic clonic as first thought but were asynchronous. Differential then also included Non Epileptic Seizure. Discussion was detailed.

Learning points are:

• Always develop as Differential diagnosis even if confident of diagnosis
• Keep an open mind. Get bias out of your thinking.
• Watch the video very carefully.
• Concentrate on different aspect on second look at video.
• Look at the ‘child’ as a whole.
• Note the sequence of events in video.
• Munchausen by proxy – do keep in mind.
• True Epileptic seizure is always associated with abnormal EEG
• Sleep deprived EEG is a common investigation.
• History – work through HEADSS.

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

Anil Garg