Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Empathy – we talk of it – how?
• Cyanotic Heart Disease – 5Ts
• Ethics: 5 pillars

The clinical station was Neurology Examination of Lower Limbs of a 12 yr old girt with left hemiplegia but extensive physio and occupational support hence difficult signs. Obvious limb discrepancies. Dr V took the Hotseat with Dr U and Dr S with examiner hats. Dr V made a good attempt at the station but took far too long on the initial examination and ran short of time. Examiners picked up the clues and gave useful suggestions.

The Learning points are:

• Have a differential diagnosis – do NOT go with one diagnosis only to start with
• Systematic examination has to be sleek – as if you have done it 100s of times
• Expose the relevant part – ask patient and parent to help
• Kneel down to observe Gait & examine leg bulk, scars
• If is DOUBT – MSK or Neuro examination – ASK examiner – Clarify
• Check power in Groups of muscles acting on a joint: flexors – Extensors

5Ss for Observation at Clinical Neuro Station:

Observe / Comment on:

While standing: check for 5 Ss…

•Squint – Look at eyes … side •coloboma  •colour

•Shunt

•Spine  –Scoliosis / kyphosis

•Scars – Legs / Spine – Tendon release

•Shoes• Extra support: Asymmetrical wear & tear

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

Anil Garg