Thank you for participating in the session.
In RRR we discussed:

• Febrile Neutropenia. Chemotherapy is the most common cause. Read management.
• STI in young person. Consider safeguarding as an important issue. Gillick / Frazer competence.

The above scenarios can present in various guises hence read and be prepared to consider more than ‘face value’ information.
Video scenario was of a young person – 14 years presenting with ‘seizure’ like activity.

Learning points:

• Being systematic is mandatory
• Non Epileptic Attack Disorder – read up.
• How to differentiate True seizure activity – remember what you have observed.
• Be confident of your observation skills and MENTION your ‘gut feeling’.
• Do not fit observed clinical signs into ‘pre thought’ diagnosis.

Visit www.mrcpchonline.org to add your comments or points I may ahve missed.
Anil Garg

Dear all

Thank you for participating in the session today.

Random Rapid Review:

• ABCDE … 10 year old following RTA in A&E
• Monitoring for raised Intracranial pressure
  

Video scenario was of a 6- year old with evidence of generalised rash, involvement of mucosa and  progressing to flaccid bullous eruption. Toxic Epidermal Necrolysis – a rare condition but can be fatal hence should know about it.
Have your DD: TENS / SJS / SSS.

Learning points:

• Need to be systematic
• Think on broad lines and use umbrella terms for initial diagnostic evaluation
• Differential is essential to formulate a plan for history and examination questions
• Mindful of time – need to be slick.
• It may seem familiar but still hold true.
• Pay attention to TASK set.
• Do NOT spend your time in not asked for but other equally important
• Mention ABCDE and move to task asked. Else you will not generate any marks.

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

I found the sessions useful as it makes one think in a broader way which is required in the exam.

Most of the time we get a clue from universal cues but still thinking of 2/3 differentials open in mind is important which I learnt. I was looking forward for some short clinical stations. 

Dr P. UK. 30 April 2021

Thank you for participating in the session today. We started on the video station.
After the RRR  we had a video scenario.
Dr A & Dr S attempted the rapid reviews.

Random Rapid Review:

• Stridor: 2 year old
• Development regression 3 year old
• Limp in 5 year old

Video scenario was of a 2-old old newborn baby who was fitting. The differential diagnosis could be birth asphyxia, metabolic- hypoglycaemia and sepsis. Dr S & Dr V were in the hot seat. It was a interesting station.
Learning points:

• Need to be systematic
• Think on broad lines and use umbrella terms for initial diagnostic evaluation
• Differential is essential to formulate a plan for history and examination questions
• Mindful of time – need to be slick.

Please visit www.mrcpchonline.org to add your comments or anything I may have missed.
Anil Garg

Thank you for participating in the session today. We started on the video station.

After the RRR there was a brief presentation on the video station what is expected and how to attempt it and then we had a video scenario.
Dr C & Dr P attempted the rapid reviews.

Random Rapid Review:

• Foreign body in the respiratory tract – CXR may not identify ‘non radio-opaque’ toys or parts
• Weakness in a five-year-old Myasthenia gravis; Tenison test.
• Precocious puberty in a three-year-old male. Twenty times less common in males. Tumour most likely. Consider: Trauma / Infection in DD.

Video scenario was of a 24-hour old newborn baby who was noted to be jittery irritable. The differential diagnosis could be drug withdrawal, birth asphyxia, metabolic- hypoglycaemia and sepsis. Dr P was in the hot seat with Dr Ji and Dr S being the examiners. It was a interesting station in that the most likely diagnosis is not very common in Asian countries
Learning points:

• Learn of conditions seen is UK
• Think on broad lines and use umbrella terms for initial diagnostic evaluation
• Differential is essential to formulate a plan for history and examination questions
• iv drug users – consider as ‘infected’ unless evidence to contrary – protect new-born
• Mindful of time – need to be slick.

Add your comments or anything I may have missed.
Anil Garg

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

The rapid random review RRR were:

• Space Occupying Lesions: Red flags,
• Bruising – ITP – Steroids are not used – Immunoglobulins if required. When Bone marrow appropriate
• GOR / GORD – important to differentiate between the two. Diagnosis with pH monitoring in Oesophagus.

Dr C, Dr A, Dr P, Dr V & Dr S tackled the subjects with questions from colleagues. All were very well attempted.
Clinical station was with queues of a six month old increasing in weight from 58 to 91st centile and having symptoms off throwing out his arms with some head movement. DD was Over feeding with GOR and Infantile spams. Dr A took the hotseat. Dr A & Dr V kept their cool but got fixated on only one diagnosis – which most often can lead to problems.
Learning points:

• Universal cues – take NOTE of every word – literally
• Keep an OPEN mind. Do Not panic.
• Have a Differential diagnosis – 2-3 – even if you are sure of the diagnosis
• Probe with history & examination findings to confirm one and rule out others
• Need to show Examiner you are checking mile stones – if required – seeing in Universal cues not enough
• Diagnosis – reached now – support with findings.
• Common and SIMPLE things first – unlikely to have very rare conditions
• Be Confident & Fluent.
• Divide your time appropriately – DO NOT spend on one ‘point’ only
• Infantile Epilepsy vs Infantile spasms – use broader umbrella term.

Add your comments or any points I may have missed.
Anil Garg

Thank you for participating in the session today.

In the Random Rapid Review: Dr C, Dr S, Dr M & Dr H took the hotseat and covered most of the points. Dr Akruti looked at the literature and provided brief summary with relevant investigations.

• Cushing syndrome: Low & High dose Dexamethasone suppression test. Alternate day to reduce side effects.
• Fragile X : second most common cause of severe learning disorder after Down’s syndrome.
• Brusing  – rare non concerning cause: 4 month old sucking vigorously on the fore arm.

Extended clinical station. Universal queues were bilateral papilloedema and a CT scan showing deleted ridiculous system and identified lesion on one side. The lesion was more likely to be incidental due to its side and the dilated ventricles suggesting hydrocarbons which were more likely to be due to I said he better tumour. Dr J |& Dr A took the hot seat and did justice to the history taking but clinical examination overran the time.

Learning points:

• Systematic and fluent – MUST
• A FULL neurological exam cannot be done in 6 minutes
• Learn the screening ‘exam’ as explained – 2-3 minutes maximum.
• Examiner can then lead you to where further time needs to be spent.
• Gait, walk heel to toe, Romberg’s, shake hands, ask to squeeze fingers both hands
• Practice, Practice, Practice!!!

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

Thank you for participating in the session today.

We discussed Extended Clinical Station examination and what to expect and how to proceed with time line. It is important to practice and have a structured approach to the examination as without that life can be very difficult.

Rapid Random Review:

• Non Accidental Injury – multiple bruising in 11 month old
• ITP – diagnosis and management
• Acute Renal Failure: Urine output <0.5 ml/kg/hr

Dr C, Dr S & DR A Dr V discussed Non Accidental Injury, Renal failure and ITP with good clarity. Be very careful of words you speak – need to be very specific. Describing common conditions is difficult and hence it is worth practising them.

Clinical scenario was of a 5.5 year old. IUGR, neonatal and stress related hypoglycaemia, growing along 2nd centile, biggish head, clinodactyly 5th finger. Silver Russel syndrome. Dr K made a good effort at History and examination – all can do with more practice to feel  and have ‘fluid’ technique

Learning points:

• Be systematic and do not ‘jump’ about
• Development – always ask at least ONE question
• 30 sec rule & Hot seat have strange effect on thinking!!
• Summary has to be VERY brief – positive & -ves. Diagnosis if you have or DD
• Review basic paediatrics
• Learn common syndromes – make a chart with main features
• Start noting and linking cues with a diagnosis or Differential diagnosis in 4 minutes

Add your comments or points I may have missed.

Anil Garg

Thank you for participating in the session today.

We discussed clinical examination and what to expect and how to proceed in the various systems. It is important to practice and have a structured approach to the examination as without that life can be very difficult.

Rapid Random Review:

• Hypothyroidism – one of few preventable causes of severe learning difficulties.
• Croup

Dr C, Dr M, Dr S & DR A discussed hypothyroidism and croup with good clarity. The learning point was that thyroxine does not cross the placenta. Describing common conditions is difficult and hence it is worth practising them to.

Clinical scenario was of a 12 year older and task was to examine her lower limbs at a neurology station. She had evidence of central sternotomy, left side hemiparesis with shortening of limbs and a hemiplegic gait. Dr K volunteered to be in the hotseat and made a good attempt. Dr S did the station well proving practice does improve performance.

Learning points:

• If a Name is given – USE it – do not address as Child or Kid
• Be systematic. DEVELOP your own template for each system.
• Need to be fluent – as if have done it a hundred times.
• Do NOT forget to check the room for ‘appliances & aids’
• Lower limb discrepancy – how to confirm & where to measure
• True length: Ant Sup Iliac Spine to medial malleolus
• Apparent length: Umbilicus to medial malleolus
• Describe lesion as UMNL / LMNL and then go further
• Learn about Support available to a child with various disabilities
• Thyroxine does not cross the placenta
• Hypothyroid feature difficult to detect in first few months.

Add your comments or any points I may have missed.
Anil Garg

Dear All
Thank you for your participation in the session. RRR are proving to be popular as they seem to meet the need for broad paediatric review with real time recall as essential for the exam.

Random Rapid Review:

• Anorexia Nervosa
• Failure to thrive in 1 year old: Group causes: Inadequate intake / absorption, Excessive use / Emotional

Dr A, Dr P, Dr M & Dr V attempted the rapid review and covered most of the points. With practice we will get the structure to our presentations.

The clinical station was of a 14-year-old who had come for her outpatient review. The queues were finger clubbing, porta Cath, evidence of delayed puberty and insulin pump. Dr S & Dr M as we had connectivity issues with Dr A who had volunteered first, took the hotseat and made a very good attempt, being systematic at finishing the examination in 8 minutes.

Learning Points:

• Combine different cues and work out a unifying diagnosis
• Chronic Suppurative Lung Disease – Cystic Fibrosis is one of them
• Diabetes associated with Cystic Fibrosis is NOT Diabetes Mellitus Type 1.
• CF related diabetes requires very low dose insulin
• Port a Cath – semi ping-pong ball size ‘device’ inserted subcutaneously for venous access
• Structured thinking and approach is MANDATORY and will come by Practice, Practice, Practice.
• IRT for Cystic fibrosis screening is valid for first 3 months of life only.
• Do not forget to examine for Nasal polyps
• Do NOT forget 30 seconds rule while speaking.

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