Dear All

Thank you for participating in the session today.

We concluded our Spring course and reviewed what we have covered together.

• Rapid Random Review: 70
• Interactive Zoom Sessions: 24
• Hotseat: 25
• Blogs with details: 24
• Learning points: 110
• One to One Sessions: 10

AG discussed the NEW OLD MRCPCH Clinical exam.

Clinical exam has come round 360 degrees disrupted due to Covid. The Clinical exam was ‘suspended’ for a period followed by FULLY virtual exam. Face to Face exam without children was next and now the exam has reverted to how it was intended to be – FACE TO FACE WITH CHILDREN.

There is one lasting change in the exam and that is in the DEVELOPMENT STATION. It has now changed to a 22 minutes station. It now has two components: History and Development assessment. It is scenario based with candidate required to get appropriate focused history to elicit aetiology, functioning and support followed by development assessment of a domain. Discussion with the examiner is the final interaction on the station.

Questions on what to read:

• NICE guidelines
• Know all ‘Hypos’, ‘Hypers & Status … conditions you know.
• The above will cover almost all emergencies.
• Note difference in emphasis in history at various stations.

We will start the Summer course with Development station on suggestions by all.

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:

• Jaundice in newborn
• Bilateral hydronephrosis @ 20 Week antenatal scan
• Enuresis in 6 year old

The Video station was of a clip a 16 month old presenting with respiratory distress and a CXR showing loops of intestine in Right hemithorax. Dr P was in the Hotseat and Dr K & Dr P had the examiner hat. Dr P picked up all the clinical signs, had appropriate history questions, examination and good management plan. The examiners made valid comments. Dr MF joined us as faculty and made good advice on approach and how to focus on the task.

Learning points are:

• Be focussed while watching the video clip.
• Develop a differential
• Trust your eyes – give weight to your observation
• Do NOT try to manipulate and box findings into your ‘diagnosis’.
• Be flexible and ready to change following your observations.
• Congenital abnormalities can present out of neonatal period.

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

Anil Garg

Dear All

Thank you for attending the session today.

In RRR we discussed:

• Haemophilia
• Chickenpox
• Respiratory Distress Syndrome – Term newborn

The Video station today was on a new born whose mother was concerned about shape of his head by day 4. DR A was in the hotseat. He picked up the clinical signs. Ad A took over and framed the questions appropriately.

There are some learning points are:

• Develop a differential diagnosis – from initial information and definitely after watching the video.
• DD will direct you to correct questions & examination
• Cephalhematoma / Caput / subgaleal haeamorrhage
• Follow the time line of these ‘condition’
• Neonate – ask about feeding, birth & current weight
• Chickenpox – complications & effect in immunocompromised
• RDS in term – important to think of common conditions first

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Hypoglycaemia in a 2 year old
• Rapid onset Flaccid paralysis on Lower Limbs – causes
• Hearing loss

The History and Management station was of a 16 year with Diabetes presenting general malaise & with HbA1C: 10.5 mmol & a positive Coeliac screen. Dr I took the hotseat and Dr D was in the Role player mode. Dr I covered almost all in relevant history but there were some points that could have been explored better. Comments from the group were appropriate however most failed to take full note of the initial information provided.

Learning points:

• ALL the information given in introduction is IMPORTANT
• DO NOT OVERLOOK and do not ignore
• Be systematic in your history
• Drug / medication history is very important
• Try and get details and spend some time on it
• Chronic conditions with an acute ‘twist’ – try and find relevant history
• Summary – do not repeat all you have gathered as Examiner has also been listening
• Your diagnosis / impression with +ve & -ve supporting facts

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

Anil Garg

Dear All

Thank you for attending the session today and your active participation.

In RRR we discussed:

• Huntington’s Chorea
• Autosomal Dominant conditions
• Congenital Hip Dysplasia

We then had a PowerPoint presentation by AG highlighting What & How to … in the history station. There are different aspects that need to be kept to be covered while taking history at the various stations in the exam – 4 different aspects and aims. How to approach and manage information gathering.

We then had a H&M scenario – 7 year old with increased visits to A&E over past three months. Dr K was an excellent Role Player. Dr D took the hotseat and made a very good attempt at gathering the required information. The others in the group made very positive observations.

The Learning points are:

• Structured to history taking is important
• Do not jump back and forth
• Timeline of the disease is important
• Check co-morbidities & treatment
• Drug history – reasonably detailed is necessary – onset of treatment etc
• Drug compliance is important in case of worsening symptoms
• It could be omitting medication or out growing current dosage
• Offer to discuss treatment with consultant and come back to update RP.
• Open questions to begin – then can use closed questions
• Do not lead RP into answers that you wish.
• Social history is important – do not overlook.

Please visit www.mrcpchonline.org to add your comments or anything I may have missed. Videos will be available in next 48 hours.

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Headache in 12 yr old – hypertension
• Cyanosed newborn – 4 hours old
• Recurrent infection – 4 yr old

The History station was of a 21 day old aby with weight loss and serum Na-113 mmol/l. Dr I was a good Role player as father of infant. Dr P took to the hotseat while Dr R & Dr K wore examiner hats – with feedback with observations and as per mark sheet. Dr P made a very good attempt at getting the history and discussing management. Examiners made very accurate observations and Learning points from the group are:

• Have a Differential diagnosis with scenario information.
• This will give structure to your history
• Structure to history taking is essential
• Empathy – demonstrate as appropriate
• Do not ask too many questions together – get answers too.
• Family history can be vitally important do not ignore.
• If a cue is offered – explore – do not just brush over.
• CURRENT ACUTE problem ALWAYS needs to be tackled first.
• Discuss with your consultant
• Consult tertiary intensive care teams – if required.
• In CAH – DD – Sepsis, meningitis, Feeding problems
• 17 Hydroxy progestrone is an important investigation – need not wait for results
• SEPSIS in neonatal period – always consider & Treat as omission can be fatal
• Check if .2%Saline 10% dextrose is still used – my memory is that it was discontinued due to problems with hyponatremia. 10% Dextrose NS is used.

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

Anil Garg

Dear All

Thank you for joining session today.

In the RRR we discussed:

• NEC – management
• Addison’s disease
• Breath holding attack – Non Epileptic Seizures

The clinical station was of a 6 yr old with h/o blood transfusions and hepatomegaly. Dr I took the hotseat and did the exam well but took a little longer than 6 minutes allotted. Discussion was good.

The Learning points are:

• Systematic examination technique should be ‘automatic’.
• Rapport – Inspection – Palpation – Percussion – Auscultation –
• Expose the part following introductions so as NOT to forget
• Scars – DO NOT miss them – be Vigilant.
• Identify scars – some may be due to NON MEDICAL procedures
• Cautery by ‘Local native’ practitioners
•  Time management is essential – practice completing ‘exam’ in 5 minutes
• Conclusion –  give Diagnosis if reasonably sure with supporting findings
• Otherwise – findings with your differential diagnosis

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

Anil Garg

Dear All – please join me in congratulating Dr Steve Pau in Malaysia and Dr Shahnawaz Pathan in Saudi Arabia who have been successful at the last diet and are now Members of RCPCH. Anil

Dear All

Thank you for attending the session today. Exams in UK have completed. The feedback is the exam was fair, mixture of case that were difficult for some and not so for others. Happy to note most of the topics in the exam – we had covered in last three four months. We wait for the results

In RRR we discussed:

• Inflammatory Bowel Disease – Crohn’s Ulcerative Colitis
• Pertussis
• Seizure – epilepsy

There was a demonstration by one faculty of how to complete the MSK ‘station’ in under 6 minutes.

The Clinical Station scenario was of a 3 month old with evidence of a VP shunt, repaired meningomyelocele presenting with vomiting. General and specific examination. Dr K took the hotseat and picked all the clinical signs. Time was short and some specific DD points were discussed.

Learning points are:

• Develop a differential diagnosis
• Obvious signs are important but may NOT be the cause.
• Think laterally also for differential diagnosis
• Time management is very important
• Remember Task is Focused examination
• You will not be able to cover everything in 6 minutes.

Visit www.mrcpchonline.org to add your comment or any point I may have missed.

Anil Garg

Dear All

Thank you for participation in the session today.

In RRR we discussed:

• Cervical lymphadenopathy
• Floppy neonate
• CSF rhinorrhoea

The Clinical station had an option and the group chose to do a MSK station. Scenario was of a 4 yr old with parent’s concern regarding his walk and frequent fall. Universal cues were of calf hypertrophy, Gower’s sign & struggling to climb stairs. Dr N took the hot seat and made a good attempt. Dr A then swapped seats. Most of the points were covered but time management was an issue. In General examination look for Walking assistance aids / wheel chairs etc.

Learning points are:

• MSK & Neurology have some similarities and significant differences
• Do NOT go down the wrong route else you will not get the marks
• MSK & all stations – check for PAIN and say you will STOP if there is discomfort
• This is a good sentence for rapport building
• Important to practice on your own with recording video or front of mirror
• Clear nasal or ear discharge after h/o injury or persistent runny nose
• Predominantly from one nostril – think of CSF
• Easiest test – ??? —   Write in
• Rapid recall is essential in the exam

Next session we will have a demonstration of MSK station.

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

Anil Garg