This is what happened with me in the previous exam, first station, videos, as far as I remember, you can hear the murmur on a teenager with dizziness, aortic stenosis, swollen digits in a child, differentials were JIA, SCD, trauma, angioedema and others, orbital cellulitis after trauma, elevated acute phase reactants and mildly elevated TLC, feverish, stable vitals, what to do, antibiotics IV, bruises large one with a low platelet count, what to do, ITP, many choices, child with acidotic breathing, random sugar in options, dont remember the rest, I guess croup/stridor. Clear Pass CVS station, 6 year old child, thin, cyanotic, no scars though a burn scar with keloid on his chest wall, not in failure, apical systolic murmur radiating to the axilla, systolic murmur in the left sternal border, PS vs VSD, heard on the back, thin child. Clear Pass Communication station: Father of a 10 year old girl who had atopic eczema, severe as a child, admitted a few times to the hospital with severe flares, now, only mild flexural eczema, now requiring only emollients, now father wants to follow up in the hospital, talk to him to explain. The examiner was british, just before I started he told me you have to do this scenario the british way, not the Egyptian way!!! Just contain the situation, explain that there is no need for long term follow up,greet, introduce, ask about the child, ask about prior knowledge, worries, explain that there is no need for long term follow up at the hospital, that 50% will clear by the age of 12 years, summarise, reassure, just consistent about that no need for further meetings unless there are unusual flares, only emollients at the moment. Clear Pass Respiratory/other: Short girl with Turner syndrome, opening statement, this child coming for assessment before participating in sports, short girl, check measurements, US/LS ratio, symmetric, arm span, manoeuvres for short stature, features of Turner, sphinx facies, multiple nevi, wide carrying angle, hypo plastic 4th knuckles, no shield chest nor wide spaced nipples, no radio femoral delay, offer to check blood pressure, pubertal assessment, thyroid functions, bone age, checking mid parental height, what would you advise, multidisciplinary team, geneticist, endocrinologist, psychiatrist, social worker, OT, school doctor, long term follow up for the need for hormone replacement to induce puberty, echo, screen for renal anomalies, school problems, memory, spatial problems, etc. Clear Pass Abdomen/other: splenectomy scar, tinge of jaundice, hepatomeglaly, differential, chronic haemolytic anemia, thalassemia, discussion about diagnosis and management, new treatment modalities. Clear Pass MSK station: old boy with mono arthritis, big knee, many bruises, ecchymosis, haemophilia, antalgic gait with reduced stance on one leg, limited knee flexion, limited hip flexion, slightly tender, discussion about diagnosis and management, differential of mono arthritis. Clear Pass Neuro station: was a messy one, saw a child with clear hemiplegic gait leaving the room and a wheel chair with an older child entering, obese and older, shivers!!!!!!! :$ Obese child with flaccid paralysis of the lower limbs, some contractures at the knee, no sensations, asked to check the back, scar of a myelomeningeocele, in nappies, wheel chair beside the bed, head looks normal, child seemed intelligent, discussion about neural tube defects, possibly low thoracic or high lumbar, what else would you like to check for, head circumference and plot, history of maternal folate intake, similarly affected sibs in less likely recessive types, eye and fundus for papilledema, previous shunts, unfortunately the child had a very small shunt, was obese and had a very short neck, I couldnt see it initially, the examiner prompted me to check the neck at the end of the station. Pass Child development: Gross and fine motor skills in a 2 and a half year old child: stiff child with apparently small head, can walk stiffly for few steps before falling, can pull to stand, shuffles on bottom, uncooperative child, would not engage to kick a ball or stay still for a few seconds, fine motor, immature pincer grasp, seemed to show some hand preference, would not indulge in cubes, turning pages, shapes board or simple shapes, simply an observation station since the child refused to do anything, I tried to start from what what she was doing, tried to be flexible but child wouldnt do anything, so in the end asked the examiner to ask the mother. Clear Pass. Communication scenario: infant with recurrent simple febrile seizures, one of them prolonged, almost 15 minutes, more or less typical, mom worried, relative with seizures diagnosed as tuberous sclerosis, talk to her, greet, introduce, understand prior knowledge, contain her worry, simple explanation that it is a benign condition, no need for imaging or investigations, as long as it fits in the classic image of simple febrile seizures, most likely will outgrow, simple instructions about what to do when the child is having a seizure. Pass History taking management planning: obese child with acute abdomen, jaundice and dark urine, 3 days, missing school for years, has joint pains from obesity, orthopneic during sleep and needs pillows behind the back at night, discussion about initially what to do, admit, pain killers, fluids, surgical consultation, rule out peritonism and acute surgical cause, workup, blood picture, inflammatory markers, urine analysis, bilirubin, liver functions, sonar, management with multidisciplinary team, case was gall stones. Bare fail.
Posted on: Fri, 04 Jul 2014 21:56:45 +0000