Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Antenatal screening
• Obesity
• Cong Hypothyroidism

The Clinical station – we covered a Video Station scenario. 6 month old with Spina bifida & VP shunt presenting with vomiting for 24 hours. Dr A & Dr P had the examiner hat – Dr j took the hot seat and made a very good attempt. He identified the clinical signs present. History and examination dependent cues were important. In history & examination- What can be deducted by clinical exam to help support or refute diagnosis is the key.

Learning points:

• UTI, Gastroenteritis, Meningitis – common causes.
• Video station – concentrate on Acute problem
• Do not go into detailed past medical history
• Develop a differential diagnosis of 3 to work through
• DO NOT get stuck with ONLY one diagnosis
• Simple things first
• A complicated diagnosis may not be causative of presentation
• Targeted questions as opportunity to ask only 2-3
• Focus and be structured
• Antiemetics and NOT give routinely in UK practice
• Regular use only in association with Chemotherapy
• Antibiotics – do not delay after culture sample taken
• Involve your consultant

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

Anil Garg

Some feedback following exam:

Exam Done

Thanks for your help

Your tips were very helpful

One confusing discussion was with a surgical registrar who was arrogant and closing the discussion with himself with allowing for senior input! Very annoying actually

We agreed a way forward and to re-connect after further tests and consultant input

Other stations were okey !

Thank you so much Dr Garg for all your help. They were invaluable – Thank you so much Dr Garg for all your help. They were invaluable

Here were my cases

Meant to say your teachings and tips were invaluable

DR W & Dr J

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Seizure – Differential diagnosis
• Poisoning
• Raised ICP

The clinical station was of a 13 year old boy presenting with joint swellings and joint deformity. Task was to do a MSK examination. DR A took the hot seat and made a very good attempt at MSK examination. There was confusion between neurology vs MSK examination. Although there are some similarities between the two tasks there are significant differences. It is vital not to mix the two. We then saw a video of MSK examination.

pGALS – look up and know well.

The Learning points are:

• MSK: Joint functionality and muscles
• NEURO: Muscle power – Tone – reflexes.
• TM – joint & Spine
• Mentally jot down the points you have to work through
• Be Systematic
• Poisoning – 3 types
• Inform your consultant before contacting others.

A number of our colleagues have written the exam in the past two week. We anxiously await the results.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Upper / Lower Motor Neurone Lesion
• Spasticity
• Constipation – visible healing anal fissure

The clinical station showed a 9 year old with evidence of left Hemiplegia. Dr R took the hotseat. Dr J, Dr J and DR P had the examiner hat. Verbalizing the exam is quite a challenge and in my opinion more difficult than having a child in front of you. It is very easy to overrun and not complete the exam in 6 minutes.

The Learning points are:

• Remember it is a Focused examination
• Systematic
• You will not be able to cover ‘ALL you wish’.
• Genral physical and looking around room – 1 min max.
• Comment on any ‘abnormal’ finding – cue
• Splints / aids / medications
• General health – mention
• Examine without ‘splint’ if shown wearing
• GAIT – start when child standing
• Follow by Sitting on floor and getting up
• Conclude with your impression: UML lesion / LMN lesion

Please visit www.mrcpshonline.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:

• Lymphadenopathy – hodgkins
• Addison’s disease
• Chronic tonsillitis

The Clinical station was – OTHER. 6 year old has come for regular follow up. Task was to examine his eyes. Universal cues were: Normal looking boy, decreased movement of left eye. Dr D took the hotseat and made a good attempt at the examination. Dr D, DR J and DR W were with Examiner hat. Examiners picked up the good points and things to improve. There was definite room for improvement.

The Learning points are:

• Eyes check: Start with Acquity of vision
• Test EACH eye separately
• Colour vision can be checked asking to name colours in a picture
• Check movement in each group / muscle as appropriate
• Field of vision by confrontation test
• When discussing investigations – mention with expected results

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

Anil Garg

Dear All

Thank you for joining the session today.

In RRR we discussed:

• Ambiguous genitalia
• Haemophilia
• Tuberous sclerosis

The clinical station showed a 6 year old with h/o repeated transfusions. Task was examination of Abdomen. Dr P took the hotseat and was soon Dr N swapped the hotseat. There were number of points which could be done different and we struggled for time. These were picked up and pointed by DR R, Dr W and DR J who wore the examiner hat.

The learning points are:

• Note the cues present watch carefully
• Be systematic – EXPOSURE – Inspection, Palpation, Percussion & Auscultation.
• Do not be ‘haphazard’.
• Time management is vital
• Slick examination technique is a must
• Verbalize your examination
• Confirm cues observed by your examination questions
• Consider examiner has not seen the video cues.
• You have to get Dependent cues. Don’t ask – Don’t get.

Please visit www.mrcpchclinicals.org to write your comments or points I may have missed.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRRs we discussed:

• Fragile X Syndrome
• Pulled Elbow
• Dehydration assessment

For Clinical station – AG first presented Do’s & Don’ts of the Clinical stations. What to do and what should be done differently. DR U then reviewed a CVS station and summarised. It is very easy to get into difficulty by going into details that are not required and not being systematic.

The Learning points are:

• Watch the video cues very carefully
• Concentrate on different ‘signs’ besides one you have noted in first view
• All signs shown have relevance – note and mention
• General physical examination is part of EVERY station
• Spend 30 – 45 sec to look around and note any splints / medication
• General well being / growth / any obvious abnormality
• PAIN – be aware and check at start of examination
• Practice to verbalize your examination
• Offer a differential diagnosis if cannot narrow down to a single
• Mention investigations with expected results
• Do NOT just give a list of investigations.

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. Some of our colleagues are going to be in the real ‘hotseat’ tomorrow and in the following few days. We wish all of them Best of Luck and nerves for the exam. We are confident you will do well.

In the RRR we discussed:

• Neuroblastoma – LL paresis in 6 month old
• Pyloric stenosis
• Shock – types

The Video was of a 2 day old baby having a seizure. Dr A took the hotseat and picked up most of the clinical signs demonstrated. History questions were relevant and examination made useful points. However it is important to have a differential diagnosis to work through.

The Learning points are:

• 2-3 differential diagnosis after completing video watching
• Watch video carefully and focus on different signs
• Do not get locked into most obvious finding
• Common differentials
• Questions to support or refute your differential
• Do NOT ask vague broad questions – likely to get vague reply.
• ALWAYS ask for Br weight and Current Wt in newborn or weight loss
• Management – top 3-4 bullet points
• Acute problem – sort out first. Convulsion – stopping is top priority.

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

Anil Garg

Dear All

Thank you for participating in the session.

In RRR we discussed:

• RSV prophylaxis
• Meningococcal sepsis
• Syncope / fainting in 5 year old

The History station was of a 21 day old baby admitted with poor feeding and lethargy for 1 week with a Na:113. Dr A took the hotseat and Dr N was a very good Role Player. There was fair bit of time left at the end of Dr A’s history taking and we had candidates taking the exam in a next few weeks take supplementary question for 2 mins each. Dr A then summarised well. Discussion on how to manage the condition and advice to parents.

The learning points are:

• Have a Differential diagnosis based on information provided
• Write down heading of history points on your sheet
• Open questions first – do not interrupt
• Go through the history systematically
• Closed questions to ‘close’ the ‘session’ / task
• Even if diagnosis ‘obvious & in your face’ – cover other DDs
• Linked questions to get information for drugs
• Sick day plan
• Birth weight & current weight are MUST for neonate
• Probably more important than Vital signs – as likely to forget.
• Treat Emergency first before calling others – if appropriate
• Brain block can happen – do NOT panic

We will cover Video Station at next sssion.

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

Anil Garg

Received, thank you. 

Will do accordingly Sir

Wish if i could join your classes lil earlier .

The guidance and classes are extremely good .

Thanks 

Dr NJ – 4 Sept 2022