Discussed a 18 month old child with complex cyanotic heart condition, operated with central sternotomy scar with a residual murmur.

Learning point:

• Murmur – think of relevant differential diagnosis
• Know the physiology underpinning the anatomical defect.
• Work on presentation and leading on to discussion.
• Think of the findings and work out how they related to each other and over all.
• Put ‘things’ into 1,2 or 3 common causes – if possible.

Today we discussed a case of Coaractation of Aorta.

Clinical findings, what to look for, how to summarise and present to the examiner. Differential and management plan.

Learning points fro participants were:

• Describe complex cardiac lesion – avoid giving a specific diagnosis
• + ve finding, differential diagnosis, investigations and presentation
• ALWAYS feel for FEMORALS – if not – definitely ASK.
• Mention scars in summary
• Do not over interpret clinical signs.

Role played and discussed scenario on 8 month old with noisy breathing. Born at 28 weeks, 900 gms. Progressive feeding difficulty over past 3 months.

Learning points from group:

• Relevant history only – else can risk being marked done for irrelevant questions.
• Explore current problems.
• Ask ‘mother’ to demonstrate noise if possible, to determine site in respiratory tract
• Think of 3 differential diagnosis when reading details and work through them
• Broad base DD and then narrow down.
• Succinct presentation – try and not ramble on.

Common themes but we still fall down at basics.

We have added two videos on a communication scenario.

Discussion is with mother of a child with evidence of poor compliance.

The scenario is role played by faculty. We will let you decide which ‘role’ you would like to be to ‘Meet Standard’ in the examination – if this were for real.

Watch and we look forward to your comments.

We had an interactive zoom video session. Discussed two scenarios:

1: newborn with anal atresia

2: 6 month old with gastroenteritits  with a Ventriculo-Peritoneal (VP) shunt for repaired meningomyelocele.

Interesting to note that in stress participants do not identify very obvious clinical signs.

Thinking of differential diagnosis is essential to doing well at this station. I suggest have a list of 3 common possible causes – common things common – that one can support with the clinical signs noted.

Rest should be easy.

Interesting session with scenario of young adolescent diabetic with weight loss for 3 months and abdominal symptoms.

Important learning point:

• Important negatives in history even if aetiology of symptoms seems obvious.
• Weight loss – check menstrual history – if appropriate
• Keep the task given in focus – need not take ‘irrelevant’ history
• Role player – also offers learning of the scenario.
• Manage time – if have spare time at end – explore rather than to sit quietly.

Discussed Video station scenario – young adolescent in Diabetic Keto-Acidosis. identifying clinical signs was good. Adequate differential diagnosis needs to be thought of and a good knowledge of initial management steps with fluid hydration need to be clear. Do not get mixed up with volume and type of fluid.