Dear All

Thank you for participating in the session.

In RRR we discussed:

• Haematuria following URTI
• Willaim’s syndrome
• Intracranial tumor S&S

The Clinical station was a 10 year old presenting following fainting at school sports day. Task – CVS examination.  Dr M had the hotseat with Dr V in the examiner role. Dr M made a good attempt at verbalising the examination but got side tracked by asking to plot Ht & Wt and few other minor points. Dr M corrected most of the clinical steps. Diagnosis presentation and discussion was good but can be improved.

The Learning points:

• After introductions – do NOT forget to request to expose the part.
• Else you are likely to forget and will disturb your flow of examination
• HT and Weight – ask for CENTILES – avoids plotting yourself.
• Checking for scars – ask child to sit on edge of bed, raise arms above head and walk around.
• Practice a system each day to get fluency to your technique.
• Summary – if sure of diagnosis – start with it and then supporting findings.
• Try and avoid undergraduate description- examiner has been observing you.

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

Anil Garg

Dear All

Thank you for participating in the session.

In RRR we discussed:

• Obesity – complications
• Ambiguous genitalia
• Persistent Neonatal Jaundice

In Mini Mock Exam we discussed Video station. Video clip demonstrated a young girl of 12 with evidence of ‘day dreaming’. Dr S took the hotseat with Dr Shishir being the examiner. Dr S picked up the obvious clue and managed the history, examination and discussion well. Dr Varsha gave her suggestions on how it could be improved further.

We are scheduling a Face to Face teaching Course in Bangalore on 26-27 October for those taking the exam in November / December.

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

Anil Garg

Dear All

Thank you for participating in the session with us.

In RRR we discussed:

• Haemolytic Uraemic syndrome – (HUS)
• Acute Epiglottitis
• Acute Leukemia

Mini Mock Exam was H&M. 3 week old baby presented with failure to thrive and  Na 113.Dr M was in the hot seat and Dr M was in the hotseat with Dr Shishir with Examiner hat. Dr M took a detailed history covering major points. There were some omissions that were highlighted by Dr Shishir. Observations were made by  Dr Varsha with practical tips to incorporate in practice.

The Learning points are:

• In 4 minutes
• Develop a differential diagnosis with initial information provided to guide
• Note salient points and time you wish to cover in your questioning.
• Adhere to your template else you will miss important facets in history
• Acknowledge and Park queries from Role player – avoid ‘Communication station mode’
• Brief summary at 9 minutes – you may remember what you have missed
• Brush up management of ALL “Hypos & Hypers’ + ‘Statuses’

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

Anil Garg

Dear All

Thank you in participating in our session.

In RRR we discussed:

• Hypospadias
• Immune function is children – assessment
• Respiratory Distress in Term Newborn infant

Mini Mock exam was a video station. The clip demonstrated skull swelling in a 4 day old infant sent for review by midwife. Dr A took the hotseat and Dr M had the examiner hat. Observation and discussion was good.

Learning points are:

• Watch video carefully and develop a Differential diagnosis
• Common conditions are common – should be first
• Ask history questions accordingly to support or refute diagnosis
• Examination needs to be in keeping with Differential diagnosis
• Discussion will be on diagnosis deemed by RCPCH and same for all

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

Anil Garg

Dear All

Thank you participating in our session.

In RRR we discussed:

• Familial short stature
• Persistent Pulmonary Hypertension of Newborn
• Itching in 5 yr old

Mini mock was History and Management. Dr A was in the hotseat and Dr M was the Role player. 7 year old had frequent visits to A&E following fits. she was found to be normal on each occasions. Dr A managed the station well and was able to get to the cause of the frequent visits – carer unable to cope due to recent family bereavement. Some details were missed as too much time was taken up by neonatal history.

Learning points:

• Plan a structure to your task with Differential in mind
• Divide your 9 & 13 minutes in small chunks so as to touch on most important points
• ‘What were you told at time of discharge from hospital / NICU?’
• You will get all the necessary information without taking up too much time.
• Summary at 9 minutes – brief and to act as reminder on what else to cover

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Neonatal Jaundice – 2nd day baby.
• Proteinuria
• Microcephaly

The Video was of a 3 day old baby in SCBU. Signs of Hypotonia. Dr M was in the hotseat, Dr Shishir with Examiner hat. Dr M picked up the signs and knew the possible causes in great detail. He asked relevant questions, needed some help with specific examination. Good discussion.

Learning points:

• Develop a differential diagnosis of 2-3
• Microcephaly: check if without Developemntal delay (familial) or with delay
• Hypotonic neonate – antenatal h/o foetal movement
• Infection: prenatal, postnatal
• One history question should related to one DD
• Exam – deep tendon reflexes, ventral suspension
• When watching Video clip – concentrate on different parts of the frame
• Do not concentrate on what you have already noted.

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Failure to thrive
• Limp in 5 year old
• Medical problems of Prematurity

The Mini Mock Exam MRCPCHCLINICALS –  Scenario: Lady has gone into premature labour at 29 weeks and expected to deliver. The task was to speak to lady & her partner and explain medical problems of a premature baby born at 29 weeks. Dr Shishir was in the Role player & examiner seat. Dr Anil Garg was also with examiner hat. Dr M made a very good attempt at addressing the concerns. However got entangled with details of Respiratory problems getting into CPAP, Surfactant and Ventilators which grew progressively complicated. DR Shishir gave a very formative suggestions and feedback on how to introduce and state problems at start and then give Role Player’s questions and agenda. 

The Learning points are:

• Introduce and Welcome greeting to parent
• Avoid jargon
• Keep points simple
• Avoid frightening the RP BUT be honest
• Focus on initial problems first
• Later problems can be addressed as and when required
• To many details will only confuse and frighten
• You have to be reassuring doctor
• Summarize at 6 minutes
• ‘What else’ can lead after summary
• Remain calm

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

Anil Garg

MRCPCH Clinicals Onlineworking together to reach your goalwww.mrcpchonline.org

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Dear All

Thank you for participating in the session.

In RRR we discussed:

• Haematuria in 5 year old
• Delayed puberty
• Correcting Gestational age in premature infants

Mini Mock was a Video station of a 7 year old with prolonged hospital admission following a flu like illness with signs of unsteady, high stepping gait with proximal muscle weakness – inability to jump. Dr a took the hot seat and made a good attempt at picking up clues and developing a differential diagnosis. Dr S completed on points that were missed. Good discussion.

The Learning Points are:

• Listen to the Question carefully – do NOT get confused
• If not sure – clarify!! e.g. Delayed puberty vs early puberty
• Differential diagnosis – think of cases you have seen in clinic / practice
• Do Not develop your differential from text book list
• Common thing first
• Remain calm and do not get confused
• If you have not never seen it – it is unlikely to be relevant

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

Anil Garg

Dear All

Thank you for participating in the session today.

In RRR we discussed:

• Fragile X – 2^nd most common cause of genetic severe learning disorder
• Diabetes mellitus: Long term Aims of treatment
• Assessment of dehydration

The Mini Mock exam was on Video Station. Clip was of a 14 year old presenting with progressive spreading rash on her trunk. Dr A took the hotseat with Dr S and Dr AG as examiners. Dr A made a ‘spot’ diagnosis of the diagnosis but could not think of other possible causes or why such a rash was present in a 14 year old. This affected the History questions and points for Examination. Dr M made good observation. The subsequent discussion was good.

The Learning points are:

• If you Do Not know – admit and say so – Do Not waffle – Examiners ‘know’.
• Watch the Video clip very carefully – focus on different aspect on second watch
• Diagnosis – work out 2-3 differential diagnosis
• Diagnosis – if ‘irrefutable’ – work on aetiology of cause for diagnosis
• Consult other specialists and Professional in care – you alone are not responsible
• Inform your Consultant and seek their advice
• Know broad management guidelines

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

Anil Garg

Dear All

Thank you for participating int he session.

We would like to congratulate two members – Dr Fua Sin Yuan from Malaysia and Dr Ibrahim Ghazi Oudah from Iraq for satisfying the examiners on the day and are now Members of the Royal College of Pediatrics & Child Health, UK.

In RRR we discussed:

• Oral Ulcers
• Seizures – aetiology
• Acute headache

Mini Mock Exam was a Video station. Dr S took the Hotseat with Dr V with examiner hat. Dr S made a good attempt at identifying the clinical signs shown. However Dr S missed the line and did not include the diagnosis in his differential. When given the diagnosis he managed the discuss as expected. HE scored full marks for discussion but would have lost marks for identification of signs. Points to consider while watching the were discussed.

The Learning points are:

• Watch the video carefully
• Have at least two or three differential in mind
• Ask history points to support or refute your differential diagnosis
• Do not lose your nerve as you can score points with discussion.

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

Anil Garg