Dear All

Thank you for attending the session today and your active participation.

In RRR we discussed:

• Huntington’s Chorea
• Autosomal Dominant conditions
• Congenital Hip Dysplasia

We then had a PowerPoint presentation by AG highlighting What & How to … in the history station. There are different aspects that need to be kept to be covered while taking history at the various stations in the exam – 4 different aspects and aims. How to approach and manage information gathering.

We then had a H&M scenario – 7 year old with increased visits to A&E over past three months. Dr K was an excellent Role Player. Dr D took the hotseat and made a very good attempt at gathering the required information. The others in the group made very positive observations.

The Learning points are:

• Structured to history taking is important
• Do not jump back and forth
• Timeline of the disease is important
• Check co-morbidities & treatment
• Drug history – reasonably detailed is necessary – onset of treatment etc
• Drug compliance is important in case of worsening symptoms
• It could be omitting medication or out growing current dosage
• Offer to discuss treatment with consultant and come back to update RP.
• Open questions to begin – then can use closed questions
• Do not lead RP into answers that you wish.
• Social history is important – do not overlook.

Please visit www.mrcpchonline.org to add your comments or anything I may have missed. Videos will be available in next 48 hours.

Anil Garg

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

Dear All

Thank you for joining session today.

In the RRR we discussed:

• NEC – management
• Addison’s disease
• Breath holding attack – Non Epileptic Seizures

The clinical station was of a 6 yr old with h/o blood transfusions and hepatomegaly. Dr I took the hotseat and did the exam well but took a little longer than 6 minutes allotted. Discussion was good.

The Learning points are:

• Systematic examination technique should be ‘automatic’.
• Rapport – Inspection – Palpation – Percussion – Auscultation –
• Expose the part following introductions so as NOT to forget
• Scars – DO NOT miss them – be Vigilant.
• Identify scars – some may be due to NON MEDICAL procedures
• Cautery by ‘Local native’ practitioners
•  Time management is essential – practice completing ‘exam’ in 5 minutes
• Conclusion –  give Diagnosis if reasonably sure with supporting findings
• Otherwise – findings with your differential diagnosis

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

Anil Garg

Dear All – please join me in congratulating Dr Steve Pau in Malaysia and Dr Shahnawaz Pathan in Saudi Arabia who have been successful at the last diet and are now Members of RCPCH. Anil

Dear All

Thank you for attending the session today. Exams in UK have completed. The feedback is the exam was fair, mixture of case that were difficult for some and not so for others. Happy to note most of the topics in the exam – we had covered in last three four months. We wait for the results

In RRR we discussed:

• Inflammatory Bowel Disease – Crohn’s Ulcerative Colitis
• Pertussis
• Seizure – epilepsy

There was a demonstration by one faculty of how to complete the MSK ‘station’ in under 6 minutes.

The Clinical Station scenario was of a 3 month old with evidence of a VP shunt, repaired meningomyelocele presenting with vomiting. General and specific examination. Dr K took the hotseat and picked all the clinical signs. Time was short and some specific DD points were discussed.

Learning points are:

• Develop a differential diagnosis
• Obvious signs are important but may NOT be the cause.
• Think laterally also for differential diagnosis
• Time management is very important
• Remember Task is Focused examination
• You will not be able to cover everything in 6 minutes.

Visit www.mrcpchonline.org to add your comment or any point I may have missed.

Anil Garg

Dear All

Thank you for participation in the session today.

In RRR we discussed:

• Cervical lymphadenopathy
• Floppy neonate
• CSF rhinorrhoea

The Clinical station had an option and the group chose to do a MSK station. Scenario was of a 4 yr old with parent’s concern regarding his walk and frequent fall. Universal cues were of calf hypertrophy, Gower’s sign & struggling to climb stairs. Dr N took the hot seat and made a good attempt. Dr A then swapped seats. Most of the points were covered but time management was an issue. In General examination look for Walking assistance aids / wheel chairs etc.

Learning points are:

• MSK & Neurology have some similarities and significant differences
• Do NOT go down the wrong route else you will not get the marks
• MSK & all stations – check for PAIN and say you will STOP if there is discomfort
• This is a good sentence for rapport building
• Important to practice on your own with recording video or front of mirror
• Clear nasal or ear discharge after h/o injury or persistent runny nose
• Predominantly from one nostril – think of CSF
• Easiest test – ??? —   Write in
• Rapid recall is essential in the exam

Next session we will have a demonstration of MSK station.

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

Anil Garg

Dear All

Thank you for attending the session today.

In RRR we discussed:

• Diabetic Keto Acidosis: assessment
• Pneumonia – 3 yr old
• Convulsion in 2 hour old.

We then discussed MSK & Neurology examination: what are the similarities and what are the differences. Important to keep in mind at the examination.

The clinical station was of a 12 year old with evidence of Left hemiplegia. Task was to Examine the Lower Limbs and else needed. Dr P was put in the hotseat. She made a good attempt at the station. Dr W took the seat for a shorter period after.

The Learning points are:

• SYSTEMATIC approach is VITAL.
• Start with INSPECTION – a lot can be gathered
• TIME MANAGMENT
• 6 mins is a short time and will FLY by in the exam
• Practice, practice to complete the examination in 5 mins.
• Keep 1 minute for nerves.
• Test Power in Group of muscles acting on a joint: Hip, Knee, Ankle
• Reflexes: Normal Brisk or Diminished
• Put your findings together – do not overtly worry about diagnosis.
• Lesions in Neurology is: UMN or LMN.
• Remember: 5S: Shoes, Scars, Spine, Shunt, Squint

Good wishes to all who are sitting in the over the next few days.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Floppy larynx
• Pulled elbow
• Hearing inattention in 6 year old

The Clinical station was CVS. Presentation was of a 14 year old universal cues of central thoracotomy, multiple peripheral emboli, ejection systolic murmur. Dr S took the hotseat and made a very good attempt at describing the clinical examination. There were some obvious omissions and learning points. Dr W and Dr P gave their summary and Dr S presented very important tips to follow in the  exam.

• Looking for ‘Safe’ registrars who can diagnose and categorize urgency of children
• Exam is to check you have clear understanding of basic knowledge.
• 8 out of 10 diagnosis can be deducted from universal cues.
• 4 mins- note name / task / cues when watching

Other Learning points are:

• Tiem management – is the most IMPORTANT
• Universal Cues are IMPORTANT – need to be picked during EXAMINATION
• Work on examiner has not seen universal cues – describe in your technique
• Practice to finish exam in 5 minutes
• Summarize in 3-4 sentences – max.
• Do NOT narrate back what examiner has just told you.
• In With children scenario: your diagnosis supported by your findings

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

Anil Garg

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

Best of Luck for the exam.

Luck plays a significant role in spite of all your preparations and effort. Keeps finger crossed.

Keep in mind The Exam is like a cricket match – 10 wickets.

In the match even if the first wicket or subsequent wicket falls unexpectedly – do not panic – the runs / marks can be scored in the other wickets.

Keep your cool and wish you again. Have a good sleep night before the exam.

Anil Garg