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

Dear All

Thank you for participating in the session today. We practised A development scenario of a 4 year old with developmental issues – mentored b Dr P.

Dr S & Dr M took the hotseat and covered focused history and the examination respectively. The emphasis on history in this station is to identify the Aetiology that may have caused the presenting symptoms. Do NOT waste time in not necessary details that may be relevant in a different scenario. You can waste upto six minutes of history time without having a clue to what causative aetiology might be. Examination – follow a sequence and IMAGINE the child in front of you.

The Learning points are:

• Focussed history to elicit aetiology
• Open questions will get Role player to offer a lot of important information.
• WHEN DID CONCERNS FIRST NOTED – gives a good point to spend more time.
• Do screen for birth and related history BUT do not spend TOO much time.
• COMORBIDITIES – always ask and DONOT forget.
• Can check to compare ‘how child is comparing with a sibling’ if appropriate
• Social history is important
• How is ‘mother’ coping, affecting other family members
• What help is available – DLA etc – check document on .gov website
• General physical examination is a MUST for every station.
• Sequence in examination is essential: check with & without aids / orthosis
• Sit – stand – walk – run – Ball. Check if Normal or different / abnormal
• If a child cannot walk steadily – do not ask to tip toe – be cautious.
• Small ball vs Big ball. Defines level of control & dexterity of child.
• SAFETY of child is MOST important – show you are taking precautions

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

Anil Garg

Dear All

Thank you for attending the session today. I would like to thank Dr P for extending the session to a Double session keeping needs of participants who are sitting the exam in the next 2 weeks.

The information was useful for those of us who have a little longer to prepare for the exam.

Dr P gave a comprehensive presentation on the Do’s & Don’ts of Development station. There are two distinct parts – History and clinical assessment. Focus of history is on determining the aetiology of condition, severity, management and support available to the family. Assessment is to determine the age of child for the task set.

Dr N was in the hot seat and made a very good attempt at the task set of fine motor assessment.

There are a number of learning points:

• Time management is very important
• Problem oriented history
• Rapport with Role player & child
• Verbalize the exam – more difficult than you would assume
• Systematic approach is important.

Visit www.mrcpchonline.org to add your comments or add points i may hve missed.

Anil Garg

Dear All

Thank you for attending the session today and making it so interesting.

In RRR we discussed:

• Preventing UTIs in children
• Chronic Fatigue Syndrome
• Asthma – diagnosis

The Video was on a young boy looking unwell. Inflamed lips, rash with flaccid blisters. Dr J took the hotseat and identified all the clinical signs. History had appropriate questions but Drugs were missed due to stress of the hotseat. Differential diagnosis also good.

Remember PAIN is one thing we can alleviate and is the kindest action.

The Learning points are:

• Toxic Epidermal Necrolysis is an EMERGENCY.
• Deterioration is very rapid and can be fatal.
• Nikolski sign – can ask directly.
• Acknowledge it – escalate to Consultant, Dermatologist.
• Plan for transfer to a burns unit as urgency.
• PAIN relief is urgent – before other treatment modalities: fluids, antibiotics etc
• Differential diagnosis is Steven Johnson Syn – milder spectrum of same disease process / Scalded Skin Syndrome are the top three – Mycoplasma to keep in mind
• Look up details, complications of this rare but common exam condition
• “What will you tell parents?” is a common management question in many conditions.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Thrombocytopenia in Newborn – causes
• Tumour necrolysis syndrome
• Broncho-Pulmonary dysplasia

The Video scenario was of a 3 day old bay with features of hypotonia. DR S took the hot seat and identified all the clinical signs present. Putting up a differential diagnosis was a bit of a struggle and hence the questions for history and examination. Management was appropriate.

Learning points:

• Develop a Differential diagnosis – a MUST
• Common causes are common – so they should be first
• How to approach the video station
• How to approach a Hypotonic baby – central vs peripheral
• RRRs are important to think and read about.

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

Due to limited time and topics we can cover in our regular sessions if there are any specific topics that bother you and you wish to practice or clarify – contact me for 1-2-1 sessions.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• SCID
• Persistent Pulmonary Hypertension of Newborn (h/o Birth Asphyxia)
• Shock – what is and stages

The Video station was on a young man admitted for ongoing treatment. There were two iv access plus few other signs. Dr M took the hotseat and managed the clues well and good discussion. There is always room for improvement till we are in the actual exam.

When you see a ‘child with a particular signs’ close your eyes for a moment and think of the last time you admitted or managed a similar patient. This will help you decide what next.

The Learning points are:

• Watch the video carefully and take note of initial information provided.
• How to approach a child with chronic illness.
• ‘What medications is the child on? or is taking is a softer statement.
• Learnt how to approach the Video station.
• Got to know various access methods – all depend on length of time access required
• Peripheral iv – Peripheral long line – Central line – Hickmann line – Porta Cath
• Renal catheters – pigtail per cuteneous
• Cyanosis in newborn
• Malignancy is a better opening diagnosis than ALL.
• Features of ‘Chemotherapy’ are evident in treatment of all malignancies
• Remember – a Lot of diagnosis are possible – you HAVE to think of 2-3 common ones.

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

Anil Garg

Dear All

Thank you for joining the session today.

In RRR we discussed:

• Acute cholangitis in children
• Mastoiditis
• Acute Liver Failure in children ( remember Paracetamol overdose!)

We started the Video Station today. AG gave a PowerPoint presentation of What & How of the Video station, how you are assessed and how to get ask relevant questions, answers and get maximum marks. Dr N took the hot seat and noted the clinical signs but there were points that were missed but are essential to note in the exam.

The Learning Points are:

• Read the initial introduction information VERY carefully.
• Each word / sentence has been carefully chosen to give information
• After noting a clue / sign – do not ‘watch’ it again, note it, look for OTHER signs
• Reading the information backwards – can help overcome ‘blind spots’.
• Analyse all information gathered.
• Develop a differential diagnosis: Common things common.
• Try and avoid ending up with ONLY one diagnosis.
• If Examiner ‘suggests a different diagnosis’ – accept it for further discussion.
• Present succinctly with supporting evidence of your decisions.
• Paint picture with ‘Broad’ categories first before come to finer points

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

Anil Garg