Dear All
Participating in the session today. We covered a history station.

A 16-year-old had presented with worsening headaches for the past 2 to 3 months. Dr P did an excellent role play and was too good to offer a lot of information not requested. Dr A was in the hot seat. Most of the points in the history were covered but some important points were missed. As a whole group all was mentioned and covered.
Mistake was made of moving from H&M to Communication mode. Presented Power Point on History & Management.

Learning points:

• Work our differential while viewing the information and differentiating questions in 4 minutes.
• HEADSS
• Social & family life
• Detailed current medication / drug history / compliance
• DO not move to Communication mode.
• Brief summary with + & – ve points to support your first diagnosis
• Important DD offer for discussion
• Management is a Team – effort – you do not need to manage all options
• Discuss with Consultant
• Hemiplegic Migraine is a diagnosis of exclusion by Paediatric neurologist
• Imaging with Chronic is an almost must. Can delay it till discussion with consultant.
• Do not go to Psychiatry before ruling out space occupying lesion – it may be the cause!
• Not neurological exam – does not rule out a Space Occupying Lesion
• Head smart card – check put.

Visit www.mrcpchonline.org to Add your comments or any point I have missed.
Anil Garg

Thank you for your participation in today’s video station session.

We looked at two clips one was of a six-year-old with rash with Toxic Epidermal Necrolysis (TENS) and second of a 12 yr old with Generalised seizure like activity (NEAD). Dr A, Dr Y and Dr S – took the hot seat as there were some internet connection issues. Findings were discussed. Discussion was very generally good.
Learning points:

• Watch a few videos of True Epileptic seizures so you are sure of what a generalized seizure looks like!
• Know the management well.
• Be confident of your observations.
• Do not ask for information already given.
• Some noted the clinical signs but did not mention as not sure
• NEAD is a frequent symptom and needs to be tackled appropriately
• Learn how to address Functional disorders
• Do NOT forget the 30 sec rule
• When asked ‘What will you do?” – Do NOT mention What you will NOT do!

Anil Garg

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

We reviewed two video clips one of a nine month old baby with respiratory distress and the second of a thin looking 12-year-old boy with a gastroscopy and a central venous access and alopecia.

Dr DS and Dr S took the hotseat. Observation of clinical signs was good and discussion followed smoothly hence we were able to see 2 scenarios.
Learning points:

• See the video clip carefully – sequence of clinical signs is very important
• Sequence will affect management of the case.
• Do NOT use abbreviations when describing. Very easy to mis-hear on the net and lead to confusion.
• History and examination pointes have to be very ‘crisp’.
• Do not ramble in your presentation.
• Acute asthma – check BTS guidelines
• Sudden significant deterioration – think of pneumothorax
• Avoid painful stimuli / tests if possible in respiratory compromised children till help is available.
• Saturation monitors do NOT substitute for Electrical heart monitoring.

Visit www.mrcpchonline.org to add your comments or points I may have missed. Video of session will be available for 2 weeks.

Anil Garg

Thank you for participating in the session today. My apology that the breakout rooms did not work as I had planned and will check with our IT guru and learn where I went wrong.
We saw Video clip of a 14 year old girl with a rash. The distribution of the rash was consistent with Shingles.
The learning points are:

• Keep mind open during FULL video
• Do not get biased by only one point – very likely to miss other significant clues.
• If a diagnosis is ‘barn door’ obvious. Do not need to work on a differential
• Instead be ready to support your diagnosis with clinical findings
• Neuropathy and Neuralgia and not interchangeable.
• Gabapentin is used in Neuralgia – post herpetic in this case
• Key words are very important in describing the findings
• Learn various types of venous access – how they look.

It you will like to add any other points or comments – you can do it here.

Anil Garg

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

The video clip was of a two day old baby who was noted to have abnormal movements. Dr A was the first in the hotseat. He got most of the clinical signs. Few clues not picked up were – no movement of right upper limb, HIE due to difficult delivery with meconium and ? fracture of clavicle. Discussion was a little more tricky.

Causes & management of neonatal convulsions is something done by all but under spotlight we tend to wilt a little.

Learning points:

• work out a DD while watching the video and noting signs
• Watch the whole clip – do not shut your mind after first few signs
• DD should guide your history and examination questions.
• Keep things simple – common conditions are seen more frequently
• Be brief and specific with your questions. Ideally closed questions.
• Speak slowly – this need a lot of practice – start now.
• Read NICE guidelines for common conditions.

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

Thank you for participating in the session today.

We started on the video block with a PowerPoint presentation of what to expect in the exam and how you will acquire marks. The videos clip was of a full term baby referred for appearing jaundiced. Dr S and Dr F Dr V & DR A took the hot seat into discussions which were very useful.

The landing points are:

• Watch the video clip carefully – try and ‘focus’ on different aspect each time you see it
• In the video station after seeing the clip and identifying the clinical signs …
• You are expected to ask 1-2 focused history and examination questions to help you build full picture
• If you do not ask – examiner will not tell you
• Starvation and dehydration are important causes in neonatal jaundice
• Read up neonatal jaundice as it is a common topic and can be asked.
• You need to be fluent with the first 3 to 4 courses of jaundice in a newborn
• Be prepared to discuss physiological jaundice how and why?
• Family history of previous siblings with jaundice: ABO & Rhesus – still important
• Common things common – mention them first before moving to rare causes
• Keep it simple
• Practice – Practice – Read – Read – Practice – Practice

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