Thank you for participating in the session today and sitting through our trial of ‘new’ technology for us – breakout rooms in zoom. IT did not go as I expected but it did give an opportunity to more hotseat experience and discussion beneficial to all.
Learning points:

• Good introduction / opening statement: ‘We are meeting because your daughter has a problem tell me more ….’
• ‘Why are we here today?’ … sounds grating to ears – even though correct.
• I would say what I information I have and then build on it.
• “I have letter from your GP mentioning Deborah, your daughter, has a problem with her phoo. Can you tell me more…’ Then keep quiet. OR words to this effect.
• Read up common conditions.
• Differential diagnosis and key question points in the 4 minutes while ‘reading & waiting’.
• Ask relevant questions.
• Remember examiner has been listening so DO NOT make up later. Admit you forgot to ask.
• Management plans need to be suitable to scenario.
• Be aware of treatments used and also a reasonably well informed of drug actions.
  
  add your comment or any point I may have missed.

Anil Garg

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