Video clip of a 2 day old floppy baby with nasogastric tube in place.

Differential diagnosis –

neuromuscular disorder

Birth asphyxia

Sepsis.

Interesting discussion on how to present differential diagnosis and management.

Keep the differential diagnosis – broad / general – unless absolutely obvious. Support you differential diagnosis with signs you have noted on the video clip. Mention investigations with what results you are expecting to confirm or refute the diagnosis.

We discussed Video scenarios today – 9 month old with breathing difficulty. Important message – watch the whole video till the end and DONOT close your mind early. Missed deterioration of the child towards the end. This caused the participants to miss the correct management step of: ensure securing the airway by calling the anaesthetic and ENT help. Also call for help from out of the department after discussing with your OWN consultant. If an emergency – then inform your consultant as soon there after.

Scenarios practised were:

1: Critical incident: Needle stick injury and request from parent for a further blood sample. Father already upset at difficulty in getting blood and cannulation at time of admission. – Not a happy father!!

2: Ethical Dilemma: Discuss with a student nurse why information about a diagnosis in not given to a 10- year old boy.

Good attempts and very good feedback and contributions from participants. 

Learning point was to try and summarise following 6b minute knock ending with an open question – very likely role player will reveal important information or accept the discussion.

We had two scenarios And a PowerPoint presentation on the video station.

The scenarios were 1: Infantile spasms, 2: Diabetic ketoacidosis

The learning points were:

• Read up acute Management of common emergencies like diabetic ketoacidosis, severe dehydration, status epilepticus, state assessed medicals, anaphylaxis.
• Why are you watching the video keep thinking of the likely diagnosis and two other differential diagnosis if applicable.
• Describe the salient points to the examiner and do not go into too much detail
• Support your differential diagnosis by your observation

An important point In diabetic ketoacidosis management is the role of pH in determining if a bolus rehydration is required. there are other factors also like blood pressure pulse.

Practice Clinical stations

4min plan to practise system examination in wards was the best learning point for a beginner like me.

Dr DB

We had a quick revision of how to run a scenario.

Communication station is essentially Putting a good performance And providing all the information accurately relevant to the patient/role player.

My advice for this is:

• Read the task carefully, note the name of the role player And use it when you go in and introduce yourself.
• Do not always ask “What shall I call you”?
• Arrange for a quiet place and an Escort, possibly ward sister if appropriate.
• Speak in short sentences and clarify the task.
• Summarise that six minutes and then carry on with whatever comes up for the next two minutes.

The main learning points today:

• Reduce worries of the role player
• If explaining an abnormality it is always better to briefly explain what normal is. It is then easier to put the abnormal in perspective.
• Do not rush to the treatment going steps as otherwise the role player is likely to interact with a query with you you may not be able to answer.
• Do not oversimplify the explanation.
• If discussing Central cyanosis then you need not talk about good blood and bad blood instead mention pink, oxygenated blood coming from the lungs and blue, blood which has given up the oxygen to the cells or tissues being deoxygenated. If the role player does not understand this basic concept which I hope you have explained in what normal circulation is like then you can explain again.

• Be structured and keep it simple but do not make it too simple to the point you cannot get your explanation across.

Discussed scenario of a 3 year old child with Iron deficiency anaemia. Advice dietary modifications.

Learning point:

• Don’t go with a fixed plan of discussion.
• Modify according to response of role player
• Do NOT quote exact figures unless absolutely sure.
• Do Not scare ‘patients’ / role player
• Refer to ‘experts – dietitian – as needed.
• You cannot know all.
• KEEP IT SIMPLE

Interactive Zoom Sessions – 15 Zoom sessions are schedules to cover the stations as follows:

• Communication – 3
• History & Management: 3
• Video: 3
• Development: 2
• Clinical: 3
• Optional: 1 – to answer candidates questions and queries.

Sessions have been scheduled in consideration of their total marks and relevance to various stations and How easy or difficult it is to score marks with appropriate guidance. These can be adopted to meet individual needs.

Sessions are normally on Tuesday and Thursday 4:00 pm and Saturday 10:00 am UK time.

Other sessions will be scheduled on Mon & Wednesday  at 4:00 pr or earlier if requested by majority.

The sessions are modular hence one can attend topics they will are more important to them.

We are starting an Intensive Revision Course for candidates appearing in the January Examination  from 1 January 2020.

We will cover all 5 stations: H&M, Communication, Video, Clinical 1-4 & Development. Powerpoint presentations of important Do’s and Don’ts plus how to score marks in each domain. Practical sessions of scenarios with feedback from senior faculty.

Do not miss this opportunity to polish your presentation, clinical reasoning and discussions skills.