Dear All

Thank you for particpating in the session.

In Rapid Random Review we discussed:

• Maternal drugs affecting foetus
• Ambiguous genitalia
• Limp in a 6 year old

Mini Mock CVS was of 6 years old child reviewed inoptpaitents. H/o cardiac surgery with central and lateral sternotomy and a continuos murmur in upper left sternal region. Dr P had the Hot seat with Dt I & Dr P with examiner hats. Dr P made a good attempt in ‘examining’ the case and followed his template. Most points were covered. There was confusion as to identification of the murmur. Discussion was reasonable. Dr P and Dr I picked up the shortfalls. It was noted that on this attempt the time taken was 9 minutes, inspite of some technical glitches – much improved from previous session. 

Learning points are:

• Structured smooth examination 
• Learn to identify more murmurs
• Systolic, Diastolic and Continuous – location with thrill will provide rest
• Do NOT fit your findings into a preconcieved Diagnosis
• Present what you find and be confident of your findings.
• We will discuss and Learn murmurs at next session

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.

In RRR we discussed:

• Brusing – causes
• NAI – history
• Hyperthyroidism – presentation

mini Mock was CVS station – Dr P took the Hotseat with Dr I and Dr P with examiner hats. Dr P made a good attempt. It took 12 minutes to complete and had missed some important aspects – performance needed to improve as points highlighted at previous session were not incorporated into practice.Dr I & Dr P pointed out and mentioned how it could be attempted differently. AG ran through the examination from General physical to auscultation and summary to examiner.

Learning points are:

• Practice what has been discussed
• Write out A4 sheet ‘performa’ to your examination
• Need to be systematic – so as not to omit and be haphazard
• Practice – Pracrtice – Practice.
• 5 minutes to complete your examination – it CAN be done
• Listen to murmurs for: VSD, PDA, AS & AR, PS.

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

Anil Garg

Dear All

Thank you for particpating in the session.

In Rapid Random Review we disussed:

• Hypertension
• Joint problems in ‘Healthy’ children
• Acute Mastoiditis

We started the Clinical stations. Clinical stations now have children return to the exam – only development station does not have children and remains ‘virtual’.

 Ag discussed Do’s, Donn’ts and How to covering General examination and some details for CVS. It is important to have a structured approach while examining, you need to have a smooth flowing techniques. Start with General Observation – examination as that is part of every station – even if not mentioned explicitly. 

The Points to remember are:

• Introduce and build rapport with child & parent
• Seek permission with relevant task
• Hand hygiene – confirm has been done
• If Painful – will stop.
• Practice to finish the examination in 5 minutes.
• Start with General obsvervation – 30 secs
• Move to Exposing the relevant part
• Inspection – start with hands then move closer
• Palpation – Percussion – Auscultation
• Ask child to dress up again – when finished
• Think how findings fit into a diagnosis 
• If you cannot – think of Differential diagnosis
• Presentation – with your ‘opinion’ NOT a repeat of what you noted
• Thank the child and parent when leaving the room.
• Wrtie Examination of each system on an A4 sheet 
• Practice with One system per day when in clinic or ward

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

Anil Garg

Dear All

Thank you for particpating in the session.

In Rapid Random Review we discussed:

• Glasgow Coma Scale 
• Hypoglycaemia
• Acute Liver Failure – causes

The Mini Mock Exam we a scenario of 7 year old with second seizure while on holiday. Dr P was in the hotseat with Dr I Examiner hat & Dr S in Role Player mode. Dr P made a good attempt at taking focused history. Most points were covered. There was some excursion in to Communication mode, some aspects of history points could be covered better. Some of our speaking / talking habits need to be noticed and changed to sound better.

The Learning points are:

• Develop a template for your history exercise
• Have a Differential diagnosis to explore
• Missing a ‘point’ gets 0 mark.
• Getting lot of extra information does NOT get you 2 extra marks
• Cover all major ‘domains’ of history – leave half if needed
• You can always go back if there is time at the end
• Avoid drifting to Communication mode – acknowledge Concern
• Do NOT assume what RP may wish or know
• Inquire – Medication instead of Drugs a child is on.

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

Anil Garg



Dear All

Thank you for paetticpating in the session.

In RRR we discussed:

• Post Uretheral Vlaves
• UTI presentation
• Gastroenteritis – mimiced by ..

The Hsitry station was of a 15 year old, with Diabetes type 1 since 4 years old. Presenting with weight loss, lose stools and crampy abdominal pain. Dr I was in the Hotseat with Dr P in Role player mode. Dr S & Dr P were with examiner hats. Dr I made a good attempt at gathering history but as it was the first ime in the hotseat panicked a little and lost control of the timing. Too much time was spent on one specific complaint and could not quite get the ‘family photograph’. Dr S & Dr P completed the blanks and summrised.

The Learning points are:

• You need to be orgnaised and structured
• Have your history template and note down bullet points
• Develop a differential daignosis of likely casues or complications
• Develop a mental time line so as to cover ALL points noted
• missing specific points will lose marks – touch all bases
• Need to develop sucicent questions to your quries
• do NOT get into Communication mode
• Acknowledge and park the queries
• Summarize at 9 mins – briefly

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 – RRR – we discussed:

• Anaphylaxsis
• Fragile X syndrome
• Achondroplasia

The history Mini Mock was 7 year old with increased visits to A&E in past 3 months. Dr P was in the Hotseat with Dr S & Dr P had co helpers of the hot seat. Dr P made a good attempt and covered most of the points in history that were required. Good introduction,asking for details with open and closed questions. More time was spent on getting history around delivery and neonatal care. Some points were overlooked – medication in details, social history and details of care being provided for the child. Dr S picked up those points and Dr P gave useful suggestions. Summary presentation to Examiner – Dr Shishir was good.

The Learning points are:

• Develop a template of bullet points needed in history
• Define time to spend on each bullet point
• This will give structure to your history taking exercise
• Remember you can always go back to the point – if time remaining
• Important to cover all important bases and not omit any.
• Have differential diagnosis with initial information provided
• DD will guide your history to an extent.
• Compliance – not RP will admit to not taking medicine at first
• Explore with more searhing details – essential
• Do NOT forget your communication skills – empathy
• Remember you are a ‘to-be-Registrar’ – use other seniors
• MDT – local support networks in your community / hospital

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 Rapid Random Review we discussed:

• ALL – Therpay objective
• Nephrotic syndrome
• Congestive Heart Failure – symptoms in infant

We started on History & Management station today. 

History taking is a very important skill needed in all the exam though with different and acquiring different details. History skill set can be compared to the skill set a player in cricket needs and uses differently in different formats of: test match – One day – T20 games. Dr AG discussed the ins & outs of the various stations and information one has to get with the help of a Power Point presentation. There was good discussion following the presentation with a question answer session with Dr Shishir.

The Learning points are:

• Adapt to the situation
• Develop a Differntial diagnosis
• Skeleton history with Time line to follow – at start
• Open ended questions to begin – will get you more information
• Different to ‘History’ in indian exams
• Communication skills are tested
• Body Language is essential to ‘monitor’ and be aware of
• Queries from RP – handle tactfully and Park – do NOT ignore
• Act like a doctor and not a robot
• Stressful inside- but need to demonstrate clam
• Social hisotry very important
• Summarize to the RP at 9mmins – brief and check for what else

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.

In Rapid Randon Review we discussed:

• Supraventricular Tachycardia
• Chickenpox complications
• Anaemia in children – causes

The Mini Mock – Dr P had the hotseat with Dr P & Dr S in supporting Roles. The clip was on a 18 month old boy in paediatric ward. H/o of fever for 3 days. He had a runny nose, was irritable, miserable with erythematous rash, rad lips and palms. Dr P picked all the clinical signs and developed a differential diagnosis of: Kawasaki – Measles – Scarlet fever – Meningococcal. History questions were focussed and examination good to reach the diagnosis with particpation of supporting Role ‘doctors’. Management was discussed well. One point of discussion – throbmocytosis – seen towards end of first week of illness – will we see in after 3 days of fever? Well the prodrome has been on for a few days prior to fever developing hence – important to mention it.

The learning points are:

• Keep it simple
• Do not think ‘too’ much and devle too deep in minutiae
• Knowing too much can be a disadvantage 
• Remeber you are a ‘ Senior SHO’ not a Consultant for the exam

We have completed Video station and I can see the progress. We will not move to History & Management station.

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

Anil Garg