Dear All

Thank you or participating in the session.

In RRR we discussed:

• Cysic fibrosis features in infancy
• Asymptomatic bacteuria
• Breath holding spells

Mini Mock Exam was a Communication scenario – Baby born with ambiguous genitalia – task explain to parent. Dr A took the hotseat with Dr V as the Role player. Dr A made a good attempt at addressing the situation. Dr AG attempted the station as a candidate with demonstration of how the task could be done differently and likely to score more marks.

The Learning points are:

• Structure your thoughts
• Be aware of What you are thinking & What you are actually saying
• Choose your words carefully
• Avoid jargon
• How can I help – instead of What is your problem?
• Do not blame other team members
• Third gender – be careful in commenting
• Need to be factually correct.

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

Anil Garg

Join us on Tuesday to see how we can work together to satisfy the examiners on the day.

Anil Garg is inviting you to a scheduled Zoom meeting.

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Dear All

Thank you for participating in the session today.

In RRR we discussed:

• T o Fistula – Acute management
• Inflammatory Bowel Disease – diagnosis & management
• Erb’s Palsy

We then had a discussion on how to communicate with a parent whose extreme premature baby – now well and fit for discharge – was being discharged a day before due to need of NICU cot. Hidden agenda and possible pit falls. How to avoid your agenda vs Role player’s agenda.

Mock Video Exam was a video clip of 2 hour old baby, mucusy, with secretions and respiratory difficulty. Dr S took the hot seat with Dr Shishir being the examiner. There were some initial concerns on how to approach such a station, how to formulate a differential diagnosis, how to decide on history questions to ask and what to examine. Discussion was good.

The Learning points are:

• Develop a differential diagnosis
• Do not go in for only one diagnosis
• Ask questions to support or refute your differential
• Remember it is NOT a history station hence targeted closed questions
• Management – describe for the scenario / child under review
• Not Generic management as given in the books.
• Sepsis is an import factor in neonatal care.

Please 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.

We had update on the recent exam by one of our members.

In RRR we discussed:

• Pulled Elbow
• Red eye
• Addison’s

AG gave a brief presentation on Video Station – What to expect, How to proceed, Do’s and Don’ts. Dr Varsha, a recent Member of RCPCH gave tips on how to prepare for the station during normal working hours and interaction with children. For each child think of a differential diagnosis and then relevant questions to ask. It will then become a ‘habit’ and Video station in the  exam will not be ‘scary’. 

Mini Mock Exam Video clip was of a 14 month old with respiratory distress. Dr S took the hotseat with Dr R and Dr v with examiner hats. Dr S picked most of the cues and arrived at a differential diagnosis that could have included more common illness. Discussion was good.

Learning points are:

• One has to sound confident in presentation
• Video station is different from other stations
• Every minute detail matters
• Concentrate on different parts on the frame when seeing it a second time
• You are likely to pick up more cues
• Be focussed and not haphazard
• Common diagnosis are common – remember

Please 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 Rapid Random Reviews we discussed:

• Haematuria in a 5 year old
• Nephrotic syndrome
• ADHD

Mini Mock Exam was Examination of a 5 year old who had features of short stature and some dysmorphic feature. Dr F too the hotseat, Dr R & Dr S had the examiner hats. Dr F had some clarifications on how to proceed when no specific systemic examination is mentioned. Start with General physical paying more attention to growth, facial features and anything else that is obvious e.g. gait or behaviour. Follow up on the cues to examine specifics e.g. auscultation for murmurs. Dr F made a very good attempt at picking up and describing the cues. Presentation was also smooth and succent. A differential diagnosis was offered as a specific diagnosis could not be worked out. Discussion was good. Examiners noted the smooth flow of the description of the process.

Learning points are:

• Systematic approach is a MUST
• Do not panic and lose your chain of thought
• Start with observation and then move closer to the child
• Examine other relevant system i.e. auscultate for murmur, check BP
• Put your findings together and have a differential diagnosis
• Give your reasons supporting your diagnosis
• If you cannot formulate a diagnosis – say it.
• You will get more marks for your systematic approach than blurting out a diagnosis
• Remain calm – remember you know it do not let your nerves disturb your thinking.

Please 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.

In RRR we discussed:

• Kasai’s operation: Indication & complications
• NAI – history and features
• Anorexia Nervosa

Mini Mock Exam was: 6 year old presents for routine review – to examine eyes. Dr I took the hotseat with Dr Shishir and Dr F had the examiner hat. Dr I made a good attempt at the task. There was some confusion as to the order of examination and also how to specifically do particular tests. Dr F gave a good feedback – Dr F then ran though the scenario examination again. It was done well and in time. Dr Shishir took the presentation and follow up discussion. Child had a prosthetic eye.

Learning points are:

• Be systematic – do not rush
• Check for glasses / visual aids in General examination
• Visual acuity in EACH eye is first step
• This will eliminate significant error
• Refresh basic eye examination process
• Field of vision vs range of movements
• Differential – Craniosynostosis, Hyperthyroidism

Please 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. We had a double session so as to be able to cover aspects of this station better.

In RRR we discussed:

• Radiological investigations of UTI
• Cephalhematoma
• Haemolytic anaemia

Dr AG gave a brief update on the Development station. It is still a ‘virtual’ station i.e. there are no children at the station. Do’s and Don’ts of history to emphasize, How to conduct assessment of ‘child’ during the exam.

Mini Mock – Dr F was in the hotseat with Dr R and Dr I with examiner hats and Dr AG Role played the examiner. Dr F conducted a fluent systematic examination picking up most of the clinical findings. Examiners picked up a few points that could have been done differently.

The Learning points are:

• Set the scene – arrange a table and two small chairs
• Observe General surroundings and child or the video clip provided
• Sit on the floor at the level of the child – say how you will proceed with the exam
• Use ONE TOOL at a time
• Remove tool / toy after you have finished – out of sight
• Start with ‘handedness’ of the child
• Demonstrate what you will like the child to do  – ‘draw a circle’ he may not understand
• Demonstrate and then observe what child does
• Recall development salient points for the age give on the child
• Examine / ask what child is able to accomplish – till he cannot
• Check Hearing and Vision in the history time i.e. any concerns

Please 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:

• Temper tantrums
• Non organic failure to thrive
• Septicemia

The Mini Mock Exam today was based on History & Management Station. A 16 year old presenting with recent onset headaches and one sided weakness. Dr R took the hotseat, Dr F was Role player and Dr S & Dr Shishir Examiner. Dr R took a detailed history and completed the task in time. Most points were covered but some that were missed were picked up by the examiners. Dr Shishir gave suggestions on how to prepare a skeleton of the history in the four minutes while reading the information provided. This ensure significant points are not overlooked in the ‘heat’ of the exam interaction with RPs.

The Learning points are:

• Have a systematic plan for History gathering
• Not & Explore points mentioned in the information provided
• Have a differential diagnosis of 3 even if one diagnosis stands out
• Systemic screening review is essential
• HEADSS for teenagers + Menstrual history
• You cannot cover every detail of history
• Do not Slip into Communication mode – acknowledge and park queries
• Summary at 10 minute knock – 4-5 sentences only

Please 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:

• RSV prophylaxis
• ADHD
• Febrile seizure

The clinical station was a Lower limbs examination of a 12 year old girl with asymmetry of Rt and Left Upper & Lower limbs. There was evidence of abnormal gait. Dr F took the hotseat with Dr S and Dr R having the examiner hats. Dr F did a fluid systematic examination – General Physical and Lower limbs examination. She completed the full task but slightly over ran the six minutes. She was able to corelate sternotomy scar with diagnosis on Upper Motor Neurone (UML) to the pathology noted. Examiners noted the smooth flow of the technique and suggested little more practice to complete the examination in required time.

The Learning points are:

• Remain clam
• Be reassuring and encouraging to the ‘patient’
• Give specific instruction to ‘patient’ of what you would like them to do.
• Be logical and systematic in examination technique
• Sitting down before moving on to couch – Gower’s
• Practice, Practice & Practice.

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

Anil Garg