We discussed clinical station – Abdomen – presentation today. Initially a talk on how to approach CS – where the task is to examine Abdomen of a child.

The learning points are:

• Listen to the task VERY carefully.
• Statement has clues likely final diagnosis
• General physical examination is ESSENTIAL part of task
• Note the scars and know associated common surgery
• Transverse abdominal scars – which seems ‘huge’ are likely to be due to surgery in neonatal or early infancy.
• If you see a scar you are not familiar with – mention you are not familiar with it – branding or cautery is practised by ‘Native practitioner’.
• A mark of Zero is awarded in exam if one does not follow the task.

RCPCH has informed cancellation of MRCPCH Clinical examination diet in May in UAE and June in UK.

This very disappointing for all who have been working and practicing hard. On a personal note – Do not lose focus and do not stop your preparations.

we discussed a one day old baby who was jittery irritable very hungry – Neonatal abstinence.

The learning points were:

• Think out in clinical settings
• carefully watch for signs – do not make them
• have a reasonable differential diagnosis
• present findings in a systematic order
• do NOT jump to specific diagnosis and dig a hole for yourself
• Keep your Consultant and Parents in the loop
• i/v Drug user – remember AIDS & Hep B & C
• Appropriate protection for the baby
• Monitoring chart attached – score of > 8 significant.
• Look up local guidelines.

Abstinence Observation Chart

Respected Sir,   First of all thank u very much for these sessions. I look forward to tues/Thurs and Saturdays now .
    Sir, I would like to know if there will be a similar revision course before the June UK exam as well. 
Kindly let me know.
Thanks & Regards Dr RA 17 March 2020

Thank you very much for the session today.It was very good.Regards. Dr FF 17 March 2020

I will share tips from diary kept by one of my colleagues who passed the MRCPH recently ……….

Stations in which there is no pre station reading (Clinicals/development/video): keep your exam paper ready in your hand and jump right into the door, when the bell rings. (Don’t *ram* into it),

Moment the bell rings your time has already started.

for development – go to the beach/mall with a fellow student. Do a visual development assessment for every child there.

These days when you cannot go out and neither your children go to school – practice with them – normal precautions are advised ….. Not advocating but ‘incentives’ can some times do wonders …

Obviously keep a distance. Have development tables with you. 

– breathe Mrcpch as much as you can prior to exams. Communicate in real life for all Medical /non medical scenarios. Counsel friends in a tough time. Even if 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. 

Night before exam mentally prepare yourself at do what you are going to do in each station.

Optimise examination technique using pillow cases plus minus pillows! 

Send us your own tips to help colleagues preparing for the exam.

Following request from some – so as not to lose focus in the ongoing preparations for the examination – we have agreed to reinstate the course from 31st March.

The only sure route to success is:

Practice, Practice, Practice

Continuing with our preparation for the exam, today we discussed at clinical station. In this the task was to examine respiratory system of a 14-year-old girl who had come for the review. Comment on any other relevant findings.

Learning points were:

Stand back and observe the child for 30 seconds.

• General physical observations are expected at every station.

Know common venous access methods

• Have a differential diagnosis

Common things common

Cystic fibrosis vs Primary Ciliary Dyskinesia.

Which to mention first.

Check for Pubertal changes in Chronic disease

RCPCH has cancelled the examination in April in Kathmandu, Nepal. This is due to Corona global pandemic and the travel restrictions and possible difficulties with travel.

India has closed it’s borders to all Tourists.

We will postpone our Intensive Revision Course to a future date to be decided when the examination will be confirmed by RCPCH.

Our regular Interactive Course sessions will continue on Tuesday & Thursday – 4:00 pm and Saturday – 10:00 am UK.

Today we discussed murmurs with visual and audio presentation.

Common murmurs were discussed and their clinical effects highlighted.

Learning point:

• Reinforced murmurs
• Innocent / VSD / ASD / PDA / PS / AS-AR/ AS
• Innocent vs pathological murmurs
• Can differentiate a Diastolic murmur
• Metallic valve – ‘click – click – click’.
• How to locate maximal intensity site of a murmur
• Co-relate child’s condition with the murmur.

What murmur is this?

We discussed a CVS case today in the session.

The learning points are:

• Murmur identification is still confusing
• Look for the scars carefully – have a working knowledge of what surgery may have been done
• Look at surroundings on entering the room – stroller / medication
• Femoral pulse examination is important part – do it OR ask for it
• Do NOT make up signs to fit in with your ‘Diagnosis’.
• DO NOT GO OVERBOARD WITH GIVING A DIAGNOSIS
• Keep it simple
• Interpret into Clinical relevance what you have observed.
• If NOT sure of a sign – ask to recheck OR mention with caveat.

PRACTICE PRACTICE PRACTICE

WHAT MURMUR IS THIS? IS THE TITLE CORRECT?