Dear All

Thank you for attending the session.

We had general discussion and questions and Answers on the Spring session.

We discussed Cyanosis – how to describe cyanosis, detect and explain to colleague.
We have finished the Spring course and will shortly be starting the Summer course after a brief break.

Look forward to your ongoing support and feedback on what specific topics you will like to include in the Summer course.

Anil Garg

Thank you for participating in the session today.

We practised for the exam presentation.

Random Rapid Review:

• Clubfoot – scenario could be explain to mother – her new born baby has bilateral clubfoot
• Persistent Vegetative state
• Brain death – possible discussion with a medical colleague or nurse

Clinical station was on request of Dr D to practice neurology as difficult. We saw a video of 9 year old with upper limbs disabilities.

Main findings were Proximal Muscle weakness.Differential diagnosis could be: Muscular dystrophy / SMA 3 / Myotonic dystrophy or Guillain Barre syndrome.

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

Anil Garg

Thank you for your participation in the session today. We Continued with the development station.

RRR:

• Unilateral Cerebral Palsy
• Aetiology of Cerebral palsy
• Important history points in Development history

Clinical Station: We viewed 2 videos demonstrating Speech and Language assessment. Following which the findings were verbalised and a development age assigned.
Learning points:

• Video helpful in tracking how to attempt the station – write out a format
• Be slick and try and not get fazed by an ‘hyperactive’ ‘non-compliant’ child – move on.
• Receptive and Expressive speech
• Practice with children you see on the ward.

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

Anil Garg

Dear all

Dr C had sent me the Dragon boat podcast link which she had mentioned at the last session. I’ve had a quick look and it seems a very useful resource. One way would be to download the podcast and listen to it when you’re walking around or doing other activities.
https://www.dragonbytespodcast.com/mrcpch-clinical-exam-podcasts
Rapid Randon Review was:

• Aims of management in MDT
• Common Surgical Interventions in Cerebral palsy

The aims for a MDT are:

• Therapies: To promote development of the child to their maximum potential
• Equipment: To provide equipment or support to facilitate participation in home & school activities
• Detection and Prevention of secondary complications.

Most often Specialities help is from: Orthopaedics and Neuro Surgery.
Clinical scenario was of a 3 1/2 years old child whose parents were concerned that the child was ‘slow’ compared to his sibling. Task was to determine the developmental age this 3 1/2-year-old child. There was a 6 minute video clip detailing the examination that was later verbalised by a participant, a summary given and brief discussion on management.
Learning points were:

• ‘Cannot do’ vs ‘Did not demonstrate today’ – import communication note
• Life course approach in MDT so the child can be a participating adult member of community.
• Your assessment supported by what the child DID before the upper age limit by not demonstrating
• Ask relevant history of various domains that CANNOT be checked ‘ demonstrated in exam
• Can child ride a tricycle, feed self,
• Focused history – be aware of time and the domains to be covered.

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

We moved on to Development station today.

Rapid Random Review:

• Work up for a child with severe Developmental delay – after history & examination.
• Gait – abnormal gaits normally encountered in children
• GFMCS – what is – I – V. Read up.

We then had a PowerPoint presentation on the format of the station in the current Covid adaptation.

We then reviewed a 7 minute video presentation of Fine motor development.

The presentation demonstrated how fine motor could be assessed and participants are advised visualize to practice vocalizing the examination.

add your comments

Anil Garg

Thank you for joining the session today.

In Rapid Random Review we discussed:

• CHARGE association
• Tremors – shaking limbs
• HUS – haemolytic Uraemic Syndrome

The scenario for history and management was a 10-year-old boy with poorly controlled asthma. Dr D was in the hot seat and Dr A was an excellent role player. The topic was covered well and the management plan was also appropriate. However a key factor mentioned in the information given was overlooked.
Learning points:

• Read the information provided very carefully.
• Sometimes unpleasant information has to be discussed
• Financial and social issues do contribute to the non-compliance by various ways.
• Although finance for medication is not an issue for paediatric practice in UK it can be in other parts of the world.
• You need to be sensitive to Role players emotions when discussing these issues.
• Time management is very important.
• Summarise at nine minutes and you need not take more than 15 to 30 seconds.
• Read Asthma management with Non pharmacological and pharmacological

Add your comment or anything I have missed

Anil Garg

Thank you for participating in the session today. We covered History & Management.
RRR:

• 10 day old baby with jaundice – yellowish greenish tinge of the skin. DD: Congenital Infection, Biliary atresia, Metabolic. Check for Wt, Stool colour.

Dr K took the quick answering hotseat and managed reasonably well.

A brief PP presentation on salient points for the History station.

History station was a scenario of eight-year-old having constipation and soiling. Dr J was in the hot seat and Dr S was the role player. They both completed their respective tasks. Dr M & Dr S – were in the roles in the evening session.

Learning points:

• In the four minutes not your differential and important questions that need to be checked
• Structure your questioning and keep to time.
• Social history is very important and do not miss it.
• Medication is important to get details off – not necessarily milligrams but the frequency to ensure compliance
• Summarise at nine minutes in 15 seconds – then move on to questions not asked
• Check how Parents are COPING & SUPPORT they are getting.
• DISCUSS with RP / Parent instead of Educating them
• Involve Child in your management planning and explain to them also.
• Dis-empaction regime – know about it.
• Back to basics – read fundamentals

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

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

In the RRR – rapid random revision we covered:

• Inflammatory bowel disease
• Precocious puberty
• Transition tachypnoea of the new born. – GBS sepsis a potentially lethal alternative.

DR P, Dr A and Dr S –  covered the main points of the conditions. It was agreed it would be important to read up these topics and be able to discuss the top three diagnoses on management points.

The video station was of a four-year-old with difficulty in walking and frequent falls. Gowers sign was positive.
Dr s and Dr P attempted it well and covered it in required time. Presentation can be smoother & more fluid.
Learning Points:

• Brush up common conditions and the differential diagnoses e.g. precocious puberty
• Discuss Most common condition first.
• Ask relevant questions to support or refute your working diagnosis.
• Mention group of muscles – NEED to describe how you will do the exam
• Be slick – flexors of thigh – by asking child to raise their leg etc
• Practice verbalisation – it is difficult but can be done
• TIME management has been the most important feedback
• 5 Ss – Speech -Squint – Shunt – Spine – Shoes.

Anil Garg

Thank you for participating in the session today.

In Rapid Random Review we discussed:

• Stridor – Laryngomalacia – web – sub glottic stenosis – Vascular ring
•  Floppy infant
• Intrathoracic mass – Malignancy – Hodgkin’s DD TB. Pneumonia

Dr D, Dr P and Dr K completed the task well.
Clinical station was: 6 year old boy who has come for routine FU. Examine his eyes.Dr D conducted the examination and covered all. He has a very real looking prosthetic eye.
Learning points:

• Keep malignancy is DD of thoracic mass
• Do not ‘blurt out’ diagnosis if you are not sure of what they ‘mean’.
• Watch for verbal diarrhoea – always leads to trouble
• check ‘group of muscles’ flexors, extensors etc
• Eye examination – always start with testing acuity in EACH eye
• Be systematic

Add your comments or anything I may have missed.

Anil Garg