We had a good and useful 1-2-1 session today.

We started with a Neurology clinical scenario of a 12 year old girl with Left hemiparesis. The signs were evident. After initial attempt we had a PowerPoint presentation with discussion on how to best attempt a Neurology station when asked to examine the Lower limbs. We also covered Upper limbs examination also. General examination is a must for ALL clinical stations. There are a few special points to note and they are 5Ss. 

Squint – Shunt – Spine – Scars & SHOES – most important. Shoes will give you a head start as that is what you should examine almost at the start.

Second – A child with h/o falling and difficulty in walking – Duchenne Muscular Dystrophy – MSK exam is different to Neurology as here you should ask 3-4 screening questions, a smooth fluent technique. After examining gait ASK the child to sit on the floor and Get up. Observe for GOWERs and get it out of the way. Rest is pGALs.

If offered 1-2 question to identify aetiology – start with “When were the Parent’s FIRST concerned about the problem?” This will give you a time line and limit the possible aetiology list.

There were quite a few Learning points:

• Talk to child during examination – keep them informed and entertained
• Jendrassik maneuver
• Systematic approach – fluent
• Try and follow Head to Toe
• Summary – UML or LML – easier for your discussion

Visit www.mrcpchonline.org to a

MRCPCH A to Z ~ OnlineFOP TAS AKP CLINICALS – working together to reach your goalwww.mrcpchonline.org

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add your comments or points I may have missed.

Anil Garg