Thank you for participating in the session today.

In RRR we discussed:

• Haematuria – aetiology
• Inflammatory Bowel Disease – Crohn’s Disease
• Child abuse – fractures in immobile infant

The clinical station was assessment of Developmental age of a 3.5 year old child. Do remember at the next diet there will not be a child at the Development station. It is similar to a Virtual station with Examiner being the ‘child’ and you will need to get Dependent cues from them. Role player will be there to get history from. Dr A was in the Hotseat with Dr A and Dr P had the examiner hat. Dr A made a good attempt at assessment. It became apparent Virtual station is more difficult to work through when child is not present. Dr t moved to the hotseat and made a better attempt at the task.

It is important to summarize your assessment – Do NOT just narrate what you have gathered from the examiner instead start with if the development is appropriate or delayed – one domain or more than one – Age – and then give your supporting evidence.

The Learning points are:

• Systematic approach to your examination technique
• General observation at the start – what is the child with and what is he/she doing?
• Directions to ‘child’ have to be clear and simple
• One tool at a time – mention removing it after ‘done’
• Practice Verbalising the assessment examination
• Finish in 7 minutes
• Remember Non Accidental / Unexplained Injury

Please visit www.mrcpchonline.org to add your comments or points I may have missed

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Acute Renal Failure – definition & causes
• Sarcoma – diagnosis & management
• Hoarseness in a 4 year old

In our Clinical session we continued with Development station / scenario from Tuesday. Dr P gave history summary. Dr K took the Hotseat for Assessment of NH, 4 year old. He made a good attempt but there were a few points that could be improved: Rapport with child and General observation. Dr A took the second attempt and improved on managing the assessment. He overlooked a fact – one tool at a time and complete one tool before moving on to next. His summary was good.

The Learning points are:

• There will not be children at this station at this diet
• Examiner will be your ‘Role Player’ giving dependent cues.
• General observation is ESSENTIAL for Development station too.
• Introductions same as in other stations
• Rapport building with ‘child’ with few easy ice breakers
• Observe child’s: ‘Aids’, Posture, initial Interaction, Eye contact
• CLEAR instructions – targeted – child can understand
• Fine motor: Start with ‘handedness’. 
• Select your Tools: Cubes, Paper & Crayon, Book, Beads etc
• Use ONE TOOL at a time.
• Check the task till he cannot demonstrate – Upper functional age limit.
• Remove it from vision once finished with it.
• be Systematic – do not move forward and back
• Summarize with your Assessment of skill level and not list

Dr Shishir joined us and gave vital tips on Developemnt and Communication.

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• Iron Deficiney Anaemia: management
• Hearing loss in 6 year old
• Abdominal malignancy: Symptoms & signs

The Clinical Station was to examine the Lower Limbs and any other relavant examination in a 12 year old girl. She had features of Left hemipresis. Dr K took the hotseat and made the first attempt at the station. Dr K ran out of his 6 minutes. Dr A came to the hotseat next and completed the exam in a structured way though with a little guidance. Comments from all were relevant.

The Learning points are:

• Structured fluent examination is essential
• Inspection of surroundings and ‘child’ is next
• Get down to level of child & kneel to get your eyes at correct level
• 5 Ss are essential in a neurology station:
  • SHOES – give important clues
  • Spine
  • Scars
  • Shunt
  • Squint
• Observe the ‘Whole’ child and not just the legs
• Compare one side with the other
• When offered to ask question to get to aetiology
• “When did parents first concerned of problem?’
• This will guide to time where to explore for more details
• Keep questions – simple.

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In Rapid Random Review we discussed:

• Presentations of severe illness in Children
• Chickenpox – complications
• Liver Failure: Management of child

The Clinical station was examination of 14 years old, Rachael who has come for a routine FU. Task is the examine her Respiratory system. Dr P took the Hotseat with Dr A, Dr L & Dr A taking the examiner hat. Dr P conducted a systematic Respiratory examination with a General physical examination to start with. Most of the clinical signs were noted but some significant findings were not noted. Parts of respiratory system was also missed due to time limitation and not lack of knowledge. Examiners picked up the missed findings. We then had a discussion on findings foloowed by summary and presentation to examiner.

The Learning points are:

• Read the Statement VERY CAREFULLY
• Names: have a good idea of girl’s & Boys name. Should give idea of gender
• Getting gender wrong is virtually a fatal mistake. If not sure – ask & clarify.
• Systematic examination is essential – practice so you can finish in due time
•  Do not jump to conclusions
• If condifient of diagnosis – give that first in summarizing and then support with findings
• Narrating list of findings over 35-50 secs is a waste of your time
• Chickenpox is a common condition – read specially in Immunocompromised.

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear sir, 

Thank you so much for your time and guidance. 

 There are few very important things or points I understood with these 2 sessions that we cannot find in books. Your experience and control over topics are really just amazing. 

Thanks and Regards 

Dear sir, 

It was indeed a good session . I got some very important learning points in the session. How and what effective ways to explain  a parent about a condition made me your fan again.  That  really gave me new perspective to learn and explain in a better way.

  Thank you for your time and valuable advises.

Regards

Dr KD India

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• HSP – diagnosis & Complications
• Nephrotic Syndrome – diagnosis & management
• IntraCranial Tumors: symptoms & signs

The Clinical station today was examination of Eyes of a 6 year old who has come to OP for arouitne follow up. Dr A and Dr P & Dr P took the Hotseat. Dr P did a good Eye examination – minor points to improve performance and to shave off about minute from examination. Task of Eye examination also should begin Introductions, General examination and then moving to specific eyes. Acuity of individual eye should be done first.

Learning points are:

• Systematic approach is essential
• Explain to child what you will be doing and what you want them to do.
• Use simple language to explain to child
• Know various specific test well: Eye cover test etc
• Management of a condition is not confined to Drugs only
• General and other supportive care is essential to discuss
• Advice for Dr Sonia – our new faculty: Pracrtice, Practice, Practice

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for your particpation in the session today.

In RRR we discussed:

• Head Injury – Primary & Secondry damage
• Burns & Fire
• Adrenal Insufficiency – features

The Clinical Station was examination and discussion of a 6 year old with h/o of transfusions since age of 2 and a full abdomen. Dr A took the Hotseat and Dr P & Dr P had the examiner hat. Dr T did a systematic general and local examination covering almost all the points in an orderly sequence. His conclusion was succient and to the point. Examiner discussion was brief. Questions were what medications , long term complications and their monitoring. The examiners and others gave important points on management.

The Learning points are:

• Thalassaemia – Iron overload
• Complications of Iron on various organs
• Heart, Liver, Pancreas
• Penicillin prophylaxis after spleenectoy
• Following Head Injury – detection of CSF leak
• Check clear fluid with Dextrostix: CSF will be +ve
• Pain control is first management in Burns.
• Mention any other obvious abnormality in examination

Please visit www.mrcpchonline.org to add your comment or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Enuresis – how to manage
• Feacal Soiling
• Cong Adrenal Hyperplasia – management

The Clinical station – we discussed another CVS case. 7 year old refered for a murmur. Dr P took the hotseat and Dr A & Dr P wore the Examiner hat. We had some hiccup in technology, audio was lost at crucial momnet when the murmur was played. It took about 5 minutes to sort it our and get audio to the particpants. Dr P was calm, systemic and covered most of the points. Summary at tend of examination could be improved to make presentation as that of a post graduate. Improvement in flow of eaxmination was pointed out by the  examiners.

The Learning points are:

• Have a Script of examination in your mind
• Involve the child – explain what you will be doing
• How can they particpate – help
• Important to be Systematic and fluent in exam
• General Physical Examination is a MUST for every station
• Follow Inspection – Palpation – Percussion – Auscultation
• Summarize with you Imperssion / Diagnosis first
• Support your Diagnosis with finding +ve & -ve
• Murmur can be discribed as advised in books
• Remeber Common is Common
• Concentrate on Child in front of you and not all possibilites
• Keep to time – try and finish examination in 5 minutes

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg

Dear All

Thank you for your joining the sessions today.

In RRR we discussed:

• Acute Upper Airway obstruction: causes & management
• Gastro-Enteritis: conditions mimicking GE
• Blood spot test / Gutherie Test

Clinical station was CVS examination of a 6 year old seen in OPD for a routine Follow Up. Dr S took the hotseat with DR P & DR A taking the examiner hats. Dr S made a good attempt however examination was not structured and fluent. Identification of the murmur was an issue for all. It was evident that we need to spend more time in practicing clinical examination of various systems.

The Learning Points are:

• Systematic examination technique is a MUST.
• Expose relevant part at the start – so as not to miss.
• Examination should be sequential.
• Basics: Observation – Inspection – Palpation – Percussion – Auscultation.
• General examination is essential for all stations
• Check for Medication, Aids, Obvious features
• Upper Airway Obstructions: DO NOT Examine throat
• Arrange for back up support in case of Respiratory arrest
• Reassure and be confident with child
• You should revise Emergency management of common conditions

Please visit www.mcrcpchonline.org to add your comments or points i may have missed.

Anil Garg

Dear All

Thank you for particpating in the session today.

In RRR we discussed:

• ALL – Symptoms & Signs
• Delayed Puberty
• Acute Abdomen – abdominal pain

The clinical station was of a 6 year old whose parents are concerned that she is clumsy. You are asked to do a MSK examination. Dr A took the Hotseat. He started well with screening questions, then moved to gait and inspection and followed the pGALS instructing the child. He overran and completed the examination in over 9 minutes. Dr P attempted the station after some feedback from all and did the examination in 6 minutes but missed a few minor points.

Remeber – you may be asked to demnstrate a sign or technique of doing a particular test i.e. detection of effusion in knee.

The Learning points are:

• Prepare a DD of 3 for any given scenario
• Do not go in with only 1 diagnosis
• pGALS can be done in any order – complete all.
• Expose the parts – legs and arms in this instance.
• Be systematic in your exam and slick
• Spine – a mild scoliosis is ‘physiological’ when upright – check when touching toes
• Practice finishing the exam in 5 minutes
• Investigations – mention with expected results

Please visit www.mrcpchonline.org to add your comments or points I may have missed.

Anil Garg