Thank you for participating in the session today.

We discussed Extended Clinical Station examination and what to expect and how to proceed with time line. It is important to practice and have a structured approach to the examination as without that life can be very difficult.

Rapid Random Review:

• Non Accidental Injury – multiple bruising in 11 month old
• ITP – diagnosis and management
• Acute Renal Failure: Urine output <0.5 ml/kg/hr

Dr C, Dr S & DR A Dr V discussed Non Accidental Injury, Renal failure and ITP with good clarity. Be very careful of words you speak – need to be very specific. Describing common conditions is difficult and hence it is worth practising them.

Clinical scenario was of a 5.5 year old. IUGR, neonatal and stress related hypoglycaemia, growing along 2nd centile, biggish head, clinodactyly 5th finger. Silver Russel syndrome. Dr K made a good effort at History and examination – all can do with more practice to feel  and have ‘fluid’ technique

Learning points:

• Be systematic and do not ‘jump’ about
• Development – always ask at least ONE question
• 30 sec rule & Hot seat have strange effect on thinking!!
• Summary has to be VERY brief – positive & -ves. Diagnosis if you have or DD
• Review basic paediatrics
• Learn common syndromes – make a chart with main features
• Start noting and linking cues with a diagnosis or Differential diagnosis in 4 minutes

Add your comments or points I may have missed.

Anil Garg

Thank you for participating in the session today.

We discussed clinical examination and what to expect and how to proceed in the various systems. It is important to practice and have a structured approach to the examination as without that life can be very difficult.

Rapid Random Review:

• Hypothyroidism – one of few preventable causes of severe learning difficulties.
• Croup

Dr C, Dr M, Dr S & DR A discussed hypothyroidism and croup with good clarity. The learning point was that thyroxine does not cross the placenta. Describing common conditions is difficult and hence it is worth practising them to.

Clinical scenario was of a 12 year older and task was to examine her lower limbs at a neurology station. She had evidence of central sternotomy, left side hemiparesis with shortening of limbs and a hemiplegic gait. Dr K volunteered to be in the hotseat and made a good attempt. Dr S did the station well proving practice does improve performance.

Learning points:

• If a Name is given – USE it – do not address as Child or Kid
• Be systematic. DEVELOP your own template for each system.
• Need to be fluent – as if have done it a hundred times.
• Do NOT forget to check the room for ‘appliances & aids’
• Lower limb discrepancy – how to confirm & where to measure
• True length: Ant Sup Iliac Spine to medial malleolus
• Apparent length: Umbilicus to medial malleolus
• Describe lesion as UMNL / LMNL and then go further
• Learn about Support available to a child with various disabilities
• Thyroxine does not cross the placenta
• Hypothyroid feature difficult to detect in first few months.

Add your comments or any points I may have missed.
Anil Garg

Dear All
Thank you for your participation in the session. RRR are proving to be popular as they seem to meet the need for broad paediatric review with real time recall as essential for the exam.

Random Rapid Review:

• Anorexia Nervosa
• Failure to thrive in 1 year old: Group causes: Inadequate intake / absorption, Excessive use / Emotional

Dr A, Dr P, Dr M & Dr V attempted the rapid review and covered most of the points. With practice we will get the structure to our presentations.

The clinical station was of a 14-year-old who had come for her outpatient review. The queues were finger clubbing, porta Cath, evidence of delayed puberty and insulin pump. Dr S & Dr M as we had connectivity issues with Dr A who had volunteered first, took the hotseat and made a very good attempt, being systematic at finishing the examination in 8 minutes.

Learning Points:

• Combine different cues and work out a unifying diagnosis
• Chronic Suppurative Lung Disease – Cystic Fibrosis is one of them
• Diabetes associated with Cystic Fibrosis is NOT Diabetes Mellitus Type 1.
• CF related diabetes requires very low dose insulin
• Port a Cath – semi ping-pong ball size ‘device’ inserted subcutaneously for venous access
• Structured thinking and approach is MANDATORY and will come by Practice, Practice, Practice.
• IRT for Cystic fibrosis screening is valid for first 3 months of life only.
• Do not forget to examine for Nasal polyps
• Do NOT forget 30 seconds rule while speaking.

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

Thank you for participating in the session today.

Random Rapid Review:

• Septicaemia – causes, clinical reasoning of hypovolemia
• Management of Meningococcal shock
• Febrile child – common aetiology and management

Dr A & Dr K – Dr V & Dr S took the hotseat for recollecting and presentation.

Hypovolemia is due to maldistribution of fluid due to capillary leak into third space and NOT due to Dehydration.

Ensure Airway by way of intubation if have to give resuscitation fluids more than 30-40 mls/kg. (Check current guidelines)

Common causes of Seizure in a febrile 2 year old:Febrile seizure,Meningitis, Encephalitis

In the Clinical station – scenario of a 9 year old girl with clinical findings of Neurofibromatosis-1 seen for yearly review. What all will you examine.Dr C & Dr V took the hotseat and covered most of the points. Very brave to step forward – remember June & September are not far away.

Learning points:

• If diagnosis is obvious – Say it and be prepared for ‘more detailed’ discussion
• Have a Differential diagnosis following Universal cues
• How to approach clinical station – Have a system in your mind to proceed, Dr V & Dr S
• Systematic approach is mandatory
• Can give a very brief ‘Over view’ of what you wish to examine
• Do NOT just a list what you want to do to examiner
• Ask and wait for reply to your query
• Use other Specialists to help in management
• Hotseat is Stressful like in the Real Exam but you do NOT forget afterwards.
• 30 second Rule – DO NOT forget with EXAMINER also!!

Add your comments or anything I may have missed.
Anil Garg

Thank you for participating in the session today.

We discussed a CVS scenario: 18 month old seen for parental concern. Universal Cues were: Cyanosis, clubbing, median sternotomy, stoma bag and a murmur clip. Dependent cues had to be ascertained. Dr M & Dr S took the hot seat and covered most of the clinical signs. Discussion was fair.

Random Paediatric Review:

• Mendellian inheritance & Cystic fibrosis
• Coeliac disease
• Arrhythmia
• Hepatitis

Learning points:

• Read common topics
• Common topis are also difficult to explain – contrary to what we think
• Verbalise and be systematic
• Speak slowly and remain calm
• Brief summary with +ve & -ve points – Do Not repeat the whole examination

Do read up the topics from Random Paediatirc Review so as to know the details and also make Neuronal Links for rapid recall – a necessary skill for success in the exam.

Add your comments or points I may have missed.
Anil Garg

Thank you for participating in the session today.

In the random paediatric review we covered:

• Oesophageal atresia & TOF
• Diabetes Mellitus – How is affects adolescence
• Staph & Strep infections – Local and Toxin mediated effects
• ALL – presentation & side effects / complications of treatment
• Evidence Based Medicine

Clinical Station was CVS. 7 year old with Pink, webbed neck, median sternotomy a murmur in URSA – systolic and diastolic. Good attempt by Dr A who completed the examination in under 6 minutes and all points were covered by team effort. Dr S took the hotseat when all other  ducked below the parapet – brave effort.

Learning points:

• Timing is very important
• Universal cues – watch carefully – ‘Everything’ is shown for a reason
• Practice how to communicate our thoughts effectively
• Need more practice with murmurs
• Need to vocalize the exam – practice – practice

Add your comments or anything I may have missed.

Anil Garg

Thank you for participating in the session today.

We have started a new 15 to 20 minutes component to our zoom sessions incorporating quickfire random paediatric topics. This we would like to try out as review of recent results suggests that basic paediatric knowledge was lacking. We will practice talking on 2 to 3 topics picked at random from a basic paediatric book and discussing some of the various aspects of the topic that comes up. 

The aim is to learn from each other and also to improve rapid recall of knowledge we already have under stress especially in the exam.

Today we came across and discussed:

1: What affects sugar levels in diabetic children

2: Ambiguous genitalia

3: URTI – Blocked nose, Croup, epiglottitis, tracheitis

4: Myocarditis.

5: Short stature

6: SVT

The session was approved by all present with suggestion to continue and have a fuller evaluation in a few weeks.

Anil Garg

Thank you for participating in the session today.

Scenario was of discussion with FY1 results of a 6 weeks old baby admitted with diagnosis of Pyloric stenosis with dehydration, metabolic alkalosis,  Hypochloremia and hypernatremia.Dr S and Dr P were excellent role players and Dr A, Dr P, Dr N and Dr S took the hotseat.It was well attempted.

Learning points:

• Clarify the agenda if in doubt. Check with role player
• If you spend all your time on the wrong track – there are NO marks
• Be careful & aware and specific about terminology
• Metabolic alkalosis is not caused by blood.
• Communication is a DIALOGUE not a MONOLOGUE
• Do not give a ‘lecture’ – remember 30 seconds Rule
• Speak slowly.

Add your comments or anything I may have missed.
Anil Garg

Thank you for participating in the session today and making it so informative. The scenario was of a 15-year-old diabetic who has microalbuminuria and needs to be started on a new medication. Dr K & Dr H were role players (RP) and was very good – ideal patient. Dr H & Dr S were in the hotseat and remained calm and addressed the concerns and tackled the given task.
Learning points:

• Appropriate introductions: If you ‘know’ the ‘person /RP’ introduce accordingly
• Not like a unknown stranger – it will seem odd.
• Rapport building and then mention the task
• Do Not forget 30 sec rule
• Bad news – PAUSE – keep quiet for 5 secs – let RP come in ask a question / comment.
• Keep it SIMPLE but AVOID baby talk
• Jargon – if used – explain what it means and in context
• Summarize at 6 minutes – do not need to say ‘I am now summarizing’
• Summarize in 30 sec.
• ‘Failure’ of treatment – commonest cause ‘NON Compliance’ even if denied at first – check & confirm.
• Compassion & empathy – keep in mind and demonstrate
• Do not confuse Communication & History & Management
• Pick up ALL information of concern and signpost appropriately & Stick to Task.

Please leave your comments or any points I may have missed.
Anil Garg

Thank you for all for participating in the session today.  The scenario was of a 12 year old given Adrenaline by error. Task was to inform and explain error to parent. Dr D & Dr D took the hotseat in the two sessions and Dr B and Dr V were excellent role players.
The scenario and task was felt to be difficult but a huge learning opportunity.

Learning points:

• Simple language
• Be aware of ‘What you say & How you say “
• Speak slowly and let Role player finish before responding.
• Stay calm and follow the 30 seconds rule
• Appropriate apology but do not over do the apology
• Busy in ‘Clinic’ sounds better than busy in ‘Meeting’ – if waiting to meet ‘Consultant’.
• Accept ‘Human error’.
• Errors can never be ‘completely eliminated.
• Medications vs drugs
• PALS / Datex / Incident Reporting form / Error Reporting / Root Cause Analysis
• Understand the concept of above
• Hot seat and Examiner perspective are very helpful in understanding the approach

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