Today we saw video of a 16 month old child who was seen for severe respiratory distress. Chest x-ray showed loops of bowel on the right side of the chest.

The discussion was very useful. Most of the clinical signs were picked up and presented. The loops of bowel in the chest x-ray were not commented on initially but later formed important point of discussion.

The learning points were:

• See the video till the end before coming to conclusions or shutting your mind.

• Diaphragmatic hernia or even eventrations can present late and need not be at birth

• Management plan mention important things first which will change how you provide care

• Chest x-ray, blood gases and other relevant investigations

• Blood gases: type one and type two respiratory failure were discussed.

• Read up on blood gases as a normal PCO2 in a child with tachypnoea needs urgent action

• The following phrases can guide the examiner to your discussion: The following phrases can guide the examiner to your discussion:

• Supportive care, safe intervention, relevant investigations.

Discussed two and a half years old girl admitted with multiple bruises. Provisional diagnosis – Non Accidental Injury.

Learning point:

• We are hesitant in mentioning NAI as a cause.

• Do not beat around the bush.

• Depersonalise and say it is the Law – child has to be in a place of safety.

• Do not be afraid to mention Social service / Police if required

There is a good scenario online I have done on how it could be attempted.

Visit: http://www.mrcpch.in .    OR       www.mrcpchonline.org

We are scheduling a five day revision course for preparation of the April exam.

2 hour sessions for each station and a mock.

End of March / beginning of April – Exact dates to be published shortly.

Anil Garg

Intensive Revision Course

We discussed presentation of a 15-year-old with type 1 diabetes and recent weight loss.

The learning points were:

• Social history to be taken soon after presenting complaint and their details

• Drug history for current medications should be in detail

• Check for compliance and side effects. Lipodystrophy in this case.

• Complications of the disease

• In teenage girls important to check for menstrual history in chronic disease

There are a lot of things we know we should do but thought block while in the hot seat happens and can only be improved with practice.

Dear Dr. Garg

Yes, I find it very useful, Wish I found this earlier.

Thank you very much. I will contact you for my quarries and  I will update reg. my exam and out come.

Thanks again

Dr KP UK. 20 Feb 20

Today we discussed a Critical Incident of Drug error – 12 year old given a wrong drug.

The learning points are:

• Do NOT use jargon. We all know it – but it happens! Life.

• We know it but mind shifting from Medical to Lay person ‘lingo’ needs to be instantaneous.

• Avoid use ‘Come to tell you…..’  to  ‘Have come to discuss……’

• Listen to Role player very carefully and respond to their concerns.

• Do not stick to your own agenda.

I find the course useful in that it puts me in exam like situation , and will probably help in overcoming nervousness during exam . Also ,it pushes me to do more reading and practice ..

Dr DS – Doha, Qatar 17 Feb 2020

I would like to wish colleagues who have been in our learning group and and are taking the clinical exam in the week beginning tomorrow:

VERY BEST OF LUCK. KEEP NERVES UNDER CONTROL.

REMEMBER EXAMINERS ARE THERE TO ‘PASS’ YOU – UNLESS YOU DO SOMETHING UNEXPECTED.

In our session today we Discussed at the cardiovascular station: murmurs are very important And it is expected that the candidate will be able to identify common murmurers heard in the paediatric setting. My experience is that murmurs cause a lot of anxiety and concern.

We discussed the following murmurs in context Of the exam with visual phonographic reinforcement to help remember:

• Ventricular septal defect

• Atrial septal defect

• Pulmonary stenosis

• Patent Ductus Arteriosus

• Aortic stenosis

• Aortic regurgitation

• Aortic stenosis and Aortic regurgitation combined

• Innocent murmur.

Also discussed basic physiology for Clinical reasoning in the exam.

We discussed increased visit to accident and emergency for convulsions in a seven year old girl with developmental delay.

Learning points were:

• Think of a differential while reading the information outside

• This will guide you in your questioning but be open to change track if the information provided so demand.

• Remember the broad headings for history and try and cover them all, this may limit your ability to go in great depth in all.

• Check the current issues and the social impact on the child and family.

• Social history is very important and usually has the clues to how to proceed

• Be empathic, do not use jargon

• A brief summary at nine minutes with the open question of is there anything you would like to tell me that I have missed.

SOCIAL HISTORY IS VERY IMPORTANT IN CHRONIC DISEASE AND IT’S MANAGEMENT.

TAKE IT AFTER PRESENTING ISSUES.