Discussed Neurology – Lower limb examination of a 4 year old boy with finding in keeping with Right side hemiplegia.

Good discussion and a easy to follow flow chart for Gait:

• Gait – Normal or Abnormal. i.e. Y or N
• Wide based Gait – both limbs to be affected
• Leg – Side affected: Left or Right
• Tone: Increased or Decreased on affected side
• Reflexes: Increased – easy to be sure. If Difficult to elicit – Jendrassik manoeuver

Child with a Limp – painful joint will not want to run. Guide you to MSK.

Learning points were:

• General examination is part of all stations.
• Stand back for 30 seconds and observe child and surroundings
• Upper limbs and face – not to miss
• Ask parents to expose legs – keep observing the child during this
• Do not make up signs – reflexes to fit your ‘mental’ diagnosis

Dear Sir ,

Today’s class was very informative, every time something new to learn.

Few days back I had come across one of the scenarios in a Malaysian clinical exam.I do not have a video.

11 yr old girl *

Back pain, to examine back and MSK system of upper and lower limbs * Girl with scoliosis and pes planus*

Her height is at 50th centile*median sternotomy scar.

 
The candidate gave differential diagnosis of ehler danlos , marfans less likely and got full marks.

What puzzles me was where beightons score was incorporated when we’re doing the normal pgals.

the only clue I could think of was while examination of spine ask to touch the floor .

Whenever there is time , I would like if shared with class.Just something I came across ,hope it benefits.

Thank you

FF 

I would like to thank Ram who joined us today and gave us his experience of the stations on how he had approached the 2 stations and managed them.

The point I noted was that in spite of not getting the diagnosis as a first opening statement he was able to secure full marks by discussing his clinical findings and his reasoning to the differential.

I wish to thank Akruti as well who has been joining us and giving us a perspective of the stations from your eyes though with slightlu less anxiety now.

• The learning points were:
• Keep the patient in mind when discussing your findings.
• Practice to finish exam in 5 minutes – you really do have to be quick.
• Gowers sign in female patients is RARE.
• Bilateral atrophy / reduced muscle bulk in a child who is walking – be careful.
• Scar on back – DO NOT miss.

Name: Ram Mohan

Email:rammohan664@com

Comment: I attended Dr Anil’s intensive course before my MRCPCH exams. I found it to be a very comprehensive course. This station amongst others was something that is necessary for all exam goers . Learning this live on an online platform was necessary for me as I have not come over various post cardiac cases in my training. Sir’s gentle expalnation coupled with an immediate rapid, random individual questioning helped me here. Would advice anyone undergoing the exam to join this course. Thank you Anil sir

1 April 2020 Chinnai

Name: Ram Mohan

Email:rammohan664@com

Comment: I attended Dr Anil’s intensive course before my MRCPCH exams. I found it to be a very comprehensive course. This station amongst others was something that is necessary for all exam goers . Learning this live on an online platform was necessary for me as I have not come over various post cardiac cases in my training. Sir’s gentle expalnation coupled with an immediate rapid, random individual questioning helped me here. Would advice anyone undergoing the exam to join this course. Thank you Anil sir

2 April 20 . Chennai, India

Today we discussed a boy of 4 years with difficulty in walking and frequent falls. Clinical signs evident were calf hypertrophy and positive Gowers sign.

Diagnosis and identification of Gowers sign was useful. How to approach such a child and how the discussion regarding management should be directed.The main learning points are;

• Practice giving instructions to children in SIMPLE language. Not easy as it seems.
• Management – ideal – Gold standard as in UK protocols but then mention what is available in your own practice.
• Observing muscles, legs, gait be at a level to clearly see child – kneel.
• Do NOT walk in front of child or by his side – you will not be able to observe any signs.
• We will see a video at next session.
• General physical examination is EXPECTED at ALL stations.
• MDT – composition and role of each member – important to know.
• Expose body part in question. Trousers and socks.

Sir ,
Thank you very much for the podcast, highly informative and lot of nuances to note.
The approach by Udy and the way the CNS presentation was led forward is something to be learnt,to present the findings as they are,say the possible differentials – why and why not they fit in.
Vision and hearing in development-often missed during stress
How to not waste time during development station by Akruthi.
The valuable point you shared about missing findings is less detrimental to committing to findings not present to fit into a diagnosis-is another message to be remembered during the examination.
Thank you Sir,Udy and Akruthi for all the time and effort to help us. Dr FF – UAE

Dr

We had an excellent session today discussing Neurology scenario at the Clinical station.

There is often confusion between Neurological examination and MSK – MusculoSkeletal Examination at a station. It is very important to listen to the task statement as you are introduced by the examiner.

Gait examination is common to both and a starting point for both – the exam separates from there on. One needs to follow through as per task and findings.

We had 2 colleagues at the recent exams giving how they had approached the Neurology and development station.

We will post a shortened video of the session soon.

We discussed clinical station – Abdomen – presentation today. Initially a talk on how to approach CS – where the task is to examine Abdomen of a child.

The learning points are:

• Listen to the task VERY carefully.
• Statement has clues likely final diagnosis
• General physical examination is ESSENTIAL part of task
• Note the scars and know associated common surgery
• Transverse abdominal scars – which seems ‘huge’ are likely to be due to surgery in neonatal or early infancy.
• If you see a scar you are not familiar with – mention you are not familiar with it – branding or cautery is practised by ‘Native practitioner’.
• A mark of Zero is awarded in exam if one does not follow the task.