We discussed scenario of constipation and encopresis. It is a very common clinical problem in paediatrics but seems enough attention is not paid to it by trainees. It is worth reading it and discussing or explaining to a colleague.
Learning points were:

• While reading the information ‘outside’ think of 2-3 causes
• Check for presenting ‘concerns’ or worries’.
• Focus should be on events in previous 3-6 months
• Important to get information on diagnosis and treatment
• The Differential diagnosis should help you structure your questioning
• Be focussed. You do not have time to get history of everything as in ward clerking
• Summarise at 9 minutes with your understanding of the positive and negative points

leave a comment of other learning points I may have missed.
Anil Garg

Thank you for participating in the session today. We moved to FH&M after covering Clinical Station.

Scenario was of a 8 year old who had starting soiling for past 2-3 months and hiding her ‘pants’. Seen in OP Clinic with parent.

Hiren was our role player and FM offered to take the hot seat. Thank you. Always a stressful place to be. FM completed the take in the required time and rest of the participants filled in with the questions she had overlooked. Not many.

Discussion was good and we rotated it round all to add.
Learning points were:

• Think of a differential in the 4 minutes
• Write out bullet points of history to be taken.
• Rapport building is an essential part of the opening of this station also.
• Ask what ‘brings’ them to the clinic / consultation?
• This will give their agenda and you need not follow yours.
• Address their concerns.
• Staying at home for a parent need not mean they are home makers and do not work.
• Do NOT assume facts – clarify – if important to your decision making.
• Management – break in broad headings and then can explore one by one.
• Remember you do not have the TIME to ask EVERYTHING you wish.
• Be selective else task cannot be completed.

Add you comments for points I may have missed.

Anil Garg

We always think that MRCPCH is part 1,2,3. 

It’s not like that.

If you’ve passed TAS,FOP, AKP. That means you have enough theoretical knowledge for Mrcpch. 

It is likely that exams may be round the corner hence we will add a tip from Dr RM – who has been there, done with the exam and has come through with flying colours.

Communicate in real life for all Medical / non medical scenarios. Terrific practice and improve your skill set.

Counsel friends in a tough time. Even if an enemy is having a tough / good time counsel them.

Let them talk, but finish in 6 min then repeat what you’ve discussed and arrange a further meeting. 

It is likely that exams may be round the corner hence we will add a tip from Dr RM – who has been there, done with the exam and has come through with flying colours.

Anurag discussed details of a child he looked after 2 days ago.

A 6-7 year old child admitted with chest infection. She was diagnosed soon after birth with cystic fibrosis presenting with meconium ileus, delayed passage of stools confirmed by IRT. Parents could not afford the treatment and child was seen intermittently.

On presentation she was febrile, small, failing to thrive, deeply cyanosed 55% saturation – improved with O2 to 100% saturation. Lung infiltration and dilated cardiac outline. No hepatomegaly. She was treated appropriately with positive pressure ventilation but died 24 hours later. Results came as Covid 19 +ve.

Carrying on with the theme we discussed optimum care for children with cystic fibrosis: MDT care, physiotherapy, regular medication – pancreatic enzymes, antibiotics, prevent colonisation.
Monitor for growth failure, diabetes. Annual blood tests.

Learning points:

• Good to see ‘all’ the findings of a young person with CF.
• Pubertal delay, clubbing, diabetic monitor and insulin pump, Hickman line.
• If ‘sure’ of diagnosis – mention it and then give supporting signs.
• Interpret the signs with reference to child you have examined.
• Know the support available in UK and put in perspective with local facilities.
• All the respiratory exam can be done in 5 minutes
• If one decides to be ‘choosey’ – may run the risk of disorganised examination
• Examination technique get 2 marks at each clinical station.

Add any other points I may have missed or to add your comment.
Anil Garg

– breathe Mrcpch as much as you can prior to exams – days, weeks and months.

It is likely that exams may be round the corner hence we will add a tip from Dr RM – who has been there, done with the exam and has come through with flying colours.

First was of a boy with difficulty walking, abnormal gait and +ve Gower’s sign. Second was a 4 year old boy with a swelling in the neck in the region of the thyroid gland. Discussion was done well.

Introduction, exposure of part, observation, muscle bulk, sitting and getting up, 5 Ss and then closer examination for tone and reflexes. While in the second scenario associated examination – pulse, eye signs, looking in the mouth, tremors, sitting and getting up for myopathy. Good differential and discussion.
Learning pointes:

• associated examination points for swelling in the neck
• Eye signs, pulse. Mention reflexes in thyroid swelling
• Non invasive relevant investigation before invasive test are better e.g. isotope scan.

Please leave any other comments.
Anil Garg

We discussed a 6 year old girl with concerns regarding her walking. Seen for FU. She had ‘Normal gait’, reduced muscle bulk in Left leg, some possible increase tone, reflexes defficult to elicit during the exam and almost equal power. There was a transverse scar, 8-10 cm in sacral area covered by her pants. This could be easily missed.
Points to examine: 4Ss, ask cahild to stand or hop on each leg, ALWAYS carefully examine spine.
Learning points:

• Do not regurge your clinical findings like an undergraduate
• Give your impression and why – supporting clinical findings
• Have a differential diagnosis
• In this case – likely Tumor, Meningomyelocle, Trauma – causing scar
• Examine fluent and structured. Repeat till you can do it in your sleep.
• Do the 4Ss before taking the child to couch.

Visit www.mcrcphonline.org to leave comments or to check the video of the session.

Teacher addresses a student and asks: “How many kidneys do we have?”
“Four!”, The student responds.
“Four? Haha,” The teacher was one of those who took pleasure in picking on his students’ mistakes and demoralizing them.
“Bring a bundle of grass, because we have an ass in the room,” the teacher orders a front bencher.
“And for me a coffee!”, the student added.

The teacher was furious and expelled the student from the room.
The student was, by the way, the humorist Aparicio Torelly Aporelly (1895-1971), better known as the “Baron de Itararé”.

On his way out of the classroom, the student still had the audacity to correct the furious teacher:
“You asked me how many kidneys‘ we have. ” ‘We have four: two of mine and two of yours. ‘We have’ is an expression used for the plural. Enjoy the grass”.

Exam demands much more understanding than knowledge.

If NOT sure – ask and reconfirm. Also is the reason to clarify the role and task with patient or Role Player. .

This station somehow causes concern but if one proceeds in a systematic way – it can be completed satisfactorily. We had a presentation on how one can attempt the station.

The Do’s and Don’ts.

Be focused on the task given.

Lower limbs – most common task we discussed today.
Inspection / observation is the most important part of this station and a lot of information can be gathered by meaningful observation and asking the child / young person to do some basic tasks – walking, talking, sitting and standing.

Examine 4 Ss. SQUINT / SPINE / SHUNT / SHOES.

Learnings points were:

• Expose part
• Be systematic
• General physical part of the task – must
• 4 Ss
• Presentation – succinct & slick

If I have missed a point please visit add.
Anil Garg

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