Thank you for participating in the session and making it interesting and interactive.

In RRR we discussed:

• Neonatal resuscitation
• Neonatal hypotonia
• Central cyanosis in a newborn infant

The clinical case was of a two-year-old with hydrocephalus with difficulty in walking. The universal cues were a large head, scar in the Occiput and cervical area and normal lumbar spine.

The Learning points were:

• Time management – practice to finish examination in 5 minutes
• Opportunistic examination in very young children – try and remain systematic
• Describe the lesion as UML or LML with supportive reasoning / findings
• Do NOT forget 5Ss in examination
• More important to look for Squint than Jaundice in a Neuro scenario
• Precise questions when checking for Dependent cues – ‘horizonal scars in tendon Achillis area’ rather than are any scars visible?
• Test power in group of muscles at a particular joint
• RRR – open with ‘Broad categories’ if possible

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

Anil Garg

Dear All
Thank you for participating in the session today.

The RRR discussed:

• 6/12 old with neuroblastoma – diagnosis
• Hearing loss in 7 year old noted by parents
• Respiratory distress & Respiratory Distress Syndrome

The Clinical station was of a 4 year old with parental concerns about his walking and falling.Universal cues were: Difficulty in getting up, Calf hypertrophy. The diagnosis was relatively easy but there was difficulty in completing the exam in mandated 6 minutes.
Learning points:

• Do NOT say I will build rapport with the child – as you will be asked – HOW?
• This will throw off track. Say what you will actually say.
• Expose fully – do not pull up trousers or shirt.
• If refused – then accept and improvise – what might you see if clothes not there
• General physical examination
• Universal cues need to be ‘described’ in examination
• Time management – practice to finish the exam in 5 minutes
• Learn to use unfamiliar words you will use in the exam
• It is a Focussed exam – you cannot do it like an undergraduate.
• Practice, Practice, Practice

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

Thank you for participating in the session and making it so interesting and interactive.
In RRR we discussed:

• Congestive heart failure in an infant: signs and management
• Brittle diabetic causes and management – can have physiological causes too.
• Recurrent chest infections in a 1 1/2 year old – meconium passage

In the clinical station we had universal cues of a 15-year-old with a G shaped scar in the right Iliac fossa and some others around the umbilicus. Dr S and Dr H were in the hot seat and attempted verbalising the clinical examination.

Learning points were:

• It is important to know the common scars noted on abdominal wall
• You need to be slick and finish the exam in five minutes.
• It is a focused examination so do not follow your undergraduate template do you have to cover all points
• Have a differential diagnoses in the 4 minutes when watching the universal cues.

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

Anil Garg

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

• Eczema. Causes, diagnosis and management. It was a Communication station hence discussed in more than normal details
• Mother asked if she should continue with ‘Chinese herbal’ medicine? Good communication practice.

We only discussed one topic as we were to cover Murmurs in details. What is a murmur, Why a murmur, How to distinguish Innocent and pathological murmur. We had visual as well as audio of murmurs commonly occurring in real life and examination.
Learning points:

• Eczema – important to describe in common language – Communication scenario too
• What is an innocent murmur?
• Why ‘MISSED’ a murmur at new born baby check
• Thrill is VITAL to establish during clinical examination – palpation time
• Ability to identify diastolic murmur
• ASD vs Pulmonary stenosis murmur
• Clearly heard a ‘Ejection Click’ today
• Heard rhythm during SVT episode.

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

Anil Garg

Thank you for your participation in today’s session.

Rapid Random Review were:

• Sickle Cell Disease
• Polygenic Inheritance – explain to Medical student / FY1
• Congenital Heart Disease – explain to Role player

The clinical station was CVS. Universal cues were: Stroller, Webbed neck, median sternotomy, Systolic diastolic murmur, LVH on ECG. Dependent cues were to be obtained while conducting the examination. Dr A took the hot seat and after feedback conducted the examination and summary better.
Learning points:

• General physical examination is a MUST & a part of systemic examination
• Verbalizing is significantly more difficult then examining in ‘real.
• Structured approach is essential
• Be Very careful with your words
• “I will put the child at ease” – question – ‘How? ‘Ask of his favourite TV show’.
• Rapport building: by interacting and asking what he will do at school?
• Think of Dependent cues as you proceed
• Practice to complete the examination is 5 minutes
• Summarize in 30 seconds – max 45 seconds – be precise
• Time management is Essential for scoring marks
• Practice, Practice, Practice.

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

Anil Garg

Thank you for participating in the sessions today.
Rapid Random Review were:

• Coeliac disease in 2 year old – DD
• 2 year old admitted with Burns. Assessment & management
• Hypsarrhythmia – significance

Clinical Station – Dr AG gave a brief presentation on the essentials of Virtual Clinical Station. The timeline, how it will be presented in the virtual platform. Universal and Dependent Cues. How to note and work through to get the examination to get Dependent Cues from the examiner. How to summarize and present to examiner. We then covered a scenario of 7 year old requiring CVS examination.
Learning points:

• Sanitize hands, Introduction & consent
• General physical examination is essential prior to systemic examination
• Ask to expose part early on so you do not forget
• Structured clinical examination
• Sleek
• Time management mandatory
• Approach child – start with hands – less intimidating – better rapport

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

Thank you for making the session so interesting.
In RRR we discussed:

• Atopic dermatitis
• Glasgow Come Scale
• Reluctance to walk and move Right leg

The video clip was of a 9 month old with Respiratory distress. Child looks tired and towards the end of video seems very tired. Discussion was on differential diagnosis and management. Dr I & Dr S were in the hotseat.
Learning points:

• Watch the video very carefully
• Formulate a differential
• Ask relevant history questions per your DD
• Differential diagnosis – also consider importance / seriousness of condition
• If ‘sign’ is not clear – can ask examiner to clarify your confusion

We start on Clinical station from next session.
Visit www.mrcpchonline.org to add your comment or any points I have missed.
Anil Garg

Thank you for participating in the session today.

The Rapid Random Review were:

• Down’s syndrome – feature & genetics – inheritance
• Arrhythmia in children – SVT
• Bruising in 5 years old – ITP? management

The Video scenario was of a 14 years old seen in A&E following a seizure recorded by teacher. Evidence of asymmetrical limbs movement. Dr S & Dr I were in the hotseat.
Learning points:

• Note details in introduction – each word has been looked at carefully
• Observe the Video very carefully
• Structured approach
• Tonic clonic seizures are symmetrical
• ITP – refresh management guidelines – do not say ‘ No Treatment’.
• Be confident of your observation
• In Communication – Do NOT keep on apologizing
• Before ‘intervention’ mention why i.e. referral for counselling.

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

Anil Garg

Dear All
Thank you for your participation in the session today. We met two new members.
RRR – Rapid Randon Review:

• 2 yr old with sino pulmonary infections
• Antenatal diagnosis – modalities
• Haemophilia A

The Video scenario was on a 14 year old with a rash – clinically Shingles. Dr I & Dr A were in the hotseat.
Learning points:

• Consider possible differential diagnosis in 4 minutes with information available
• OBSERVE the video very carefully
• Note clinical signs and check how they relate to your differential diagnosis
• IF diagnosis is OBVIOUS – need not work on differential
• Consider questions on aetiology, complications, management.
• History questions should be related to your differential
• Targeted examination – relevant to above
• Summarize with your diagnosis supported by clinical observation

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

Thank you for participating in the session today. We had our Rapid Random Review which were:

• Jittery baby
• Toxic radiation to CNS in ALL relapse treatment – Learning disability
• Cerebral dysfunction in Newborn – signs

This was followed by a PowerPoint presentation by AG on the radio station and how to attempt the presenting scenario.Video clip was of a two day old baby who was showing evidence of seizure activity. Hotseat was taken by Dr I & Dr K. Examiners were Dr A & Dr A – Dr D & Dr S

Learning points:

• You are allowed to use a paper to make notes
• Think of differential diagnosis (DD) in 4 minutes with initial information
• Observe the Video carefully and note the signs
• Work out questions to ask in history on your DD
• Relevant examination on your DD
• If examiner suggests a different Diagnosis – Do Not argue!
• Support your diagnosis
• Aetiology in BROAD categories first
• Management in Broad principles first.
• If an ‘Emergency’ – deal with that first e.g. seizures

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