tip from London School ….

Dear All
Thank you for participating in the session today.

We are scheduling an Intensive Revision Course for the forthcoming Exam on 22-23 January 2022. If you may wish to join please register your interest by replying to this message.

In RRR we discussed:

• Small for dates baby – causes & management
• GI causes for Failure To Thrive
• Coeliac Disease: diagnosis & management. Role of biopsy.

The Video station was of a 7 years old boy with brief episodes absence. Dr F & Dr A took the hotseat and made good attempt at clinical signs & management.
Learning points:

• Obvious easy diagnosis will bring more detailed discussion
• Divide causes in to broad categories
• Do NOT start with Specific conditions
• Life style changes important part of management
• Not pharmacology only
• Do NOT ask for Full systemic examination in what you like to examine!
• Team work is important part of Learning and of our Group

Vist http://www.mrcpchonline.org to add your comments or pints I may have missed.
Anil Garg

Dear All
Thank you for participating in the session today.
In RRR we discussed:

• Genetic counselling – what, how for ie child with Cystic fibrosis
• Bronchiolitis
• Prune Belly syndrome

The Video station was of a 3 year old child with puffy eye and reasonably well otherwise. It was attempted well by Dr S & DR I in hotseats the two sessions.

Nephrotic syndrome / Acute Glomerulonephritis / Angioneurotic – Allergy / Protein losing enteropathy
Learning points:

• Workout a Differential diagnosis of 2-3 conditions
• This will guide your history and examination cues
• Keep it simple
• common things are common
• Do not bring in complicated tests into management as 1st option
• Be systematic
• Be careful of WHAT you say – DONOT dig a hole for yourself.

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

Dear All
Thank you for participating in the session today. We commenced on the Video Station. Following the RRR we had a PowerPoint presentation and a Video station.
In RRR we discussed:

• 4 day old baby is referred for jaundice
• Soiling in in 5 year old
• Screening test for Cystic fibrosis

For the Video Station we had a presentation by AG on how to attempt the Video Station. The do’s & Don’ts. Questions one may ask and examine. How to best present and what if? The video station scenario was of a 4 day old baby referred for review by district midwife. Dr I was in the hotseat and for the second session we had a Dr E take the first description of clinical signs observed. Good discussion.
Learning points:

• Structure to thinking after seeing the introductory information
• Differential diagnosis is a MUST to guide you through the station
• Specific history and examination details
• Do NOT ask for general broad information
• Management in broad categories first – then go to specifics if asked

Visit www.mrcpchonline.org to add your comments or points I may have missed.
We have no session on Thursday 23rd.

Merry Xmas to all and Seasons Greeting.

Anil Garg

Dear All
Thank you for your participation.
In RRR we discussed only one topic:

• Neonatal Resuscitation. Scenario was new born, not breathing and blue. What will you do? Verbalizing What you will do is extremely difficult. Dr S gave an update of current Resuscitation protocol.

Clinical station was a 13 year old boy seen due to painful and swollen knee joints and deformity of one wrist and elbow. Dr I & Dr AJ were in the hot seats and found completing the examination in required time.
Learning points:

• Golden minute in resuscitation
• Brief history for vital cues ie Heart rate
• Effective ventilation
• Practice MSK examination – it takes time and requires practice
• Time management
• In summary – give you diagnosis OR differential if not sure
• Then your cues / signs to support
• Do NOT reiterate the finding examiner has told you a few minute ago.

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

Dear All
Thank you for participating in the sessions today.
In RRR we discussed:

• Neurodegenerative disorder – Developmental regression
• Petechiae in neonate
• Pyloric stenosis

It is important to ‘work out’ a differential diagnosis of 2-3 common causes on reviewing the stem / initial information provided. This will help guide you history and examination.
In the clinical station we saw two presentation on MSK examination. First was brief presentation on the MSK examination by Dr Urmila and second How to actually complete the MSK examination by Dr Siba.
The learning points:

• If confused about the task – Clarify if Not directed: MSK or Neurology as lead in could be similar.
• After introductions ask if can ask Leading questions
• Practice MSK examination – complete in 5 minutes
• Systematic and fluent
• General examination also part of this station
• Developmental regression important and often ignored.
• Practice, Practice & Practice.

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

Thank you for participating in the session today.
In RRR we discussed:

• Clubfoot
• PUO – aetiology
• Recurrent ‘focal’ chest infection – foreign body

We did not discuss a specific clinical scenario instead we had a PowerPoint presentation on the Clinical station discussing various systems:CVS / Respiratory / Abdomen / Neurology: Lower limbs & Upper limbs / Eye

There is more to be covered: MSK examination / Neck swelling etc. that we will cover during the clinical sessions.
Look forward to seeing you at the next session – still continuing with Clinical station.
Visit www.mrcpchonline.org for your comments & Look forward to your feedback.
Anil Garg

Dear All
Thank you for participating in the sessions today.

In RRR we discussed:

• Hearing loss in a 5 year old
• ‘Mile stones’ in hearing in 1st year of life
• Encephalitis / Encephalopathy

The clinical station was with universal cue of healthy 15 year old with longitudinal pigmented scar in RIF and also some circular scar around the umbilicus. Fullness and dullness in RIF.
Dr S & Dr D took the hotseat and made a very good attempt at clinical examination of the abdomen including a general examination. Time pressure was evident in both sessions.
Learning points as noted by all:

• Note universal cues and make a differential
• Systematic, fluent examination
• Introductions important. I have been asked to examine your ….
• Expose the ‘requisite’ part of body
• During this time do the General examination of ‘environment’
• Remain calm and confident – it is difficult in hotseat
• Verbalize your examination – practice, practice!
• Use RIGHT words to describe what you mean and want done.
• Learn about all the common scars and surgical procedures

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

Dear All
I will like to Congratulate Dr Chinnu, Dr Vijay and Dr Sumit who have made us proud at the last UK diet. We wish them all the best for their future career and look forward to them coming back to our meetings to share their experiences and give us tips.
In the RRR we discussed:

• Acute Liver Failure
• Jittery baby
• G6PD deficiency

The Clinical Station was of a 9 year old with h/o fainting on sports day. |universal cues: Ejection systolic murmur, LVH of ECG and Cardiomegaly on CXR. Dr A and Dr S took the hotseat and made very good attempt at the examination.
Learning points are:

• Structured examination is Vitally important
• Systematic approach
• ASK for Cardiology OPINION for ECHO cardiogram. NOT an ECHO. You will not be able to interpret it!!
• CVS exam is NOT complete without checking for ‘Femorals’.

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

Anil Garg

Thank you for participating in the sessions today.
In RRR we discussed:

• 29 weeker twins. Problems of prematurity
• Sudden desaturation of 1 day old preterm on ventilator: DOPE
• Hypothyroid – TSH 400mu/L on 6th day blood test

In the Clinical station we discussed a 4 year old presenting with difficulty in walking and frequent falls. Universal cues were of calf hypertrophy and Gower’s sign. Dr I & Dr D were in the hot seat. Both made very good attempts.
Learning points are:

• Structured examination
• Follow a logical order
• Power check in Group of muscle acting on a joint
• Summary – your DD and supporting clinical findings
• Time management is essential and practice completing exam in 5 minutes
• General examination is part of EVERY clinical systemic exam.

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