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Year Guide: Fourth Year: COMP 1


Epidemiology

3 weeks of lectures taught at Canyge Hall. Good to be in Bristol for 3 weeks.

The problem is the SSC. Ruins the experience of Paediatrics where you would much rather be doing clinical activities! But my advice would be just do it asap and get it out of the way. Also choose a question which compares two treatments as then you are more likely to be able to find RCTs and papers which are easier to analyse.

There are really good examples of essays so look at them. Just follow the mark scheme, keep it logical and you will definitely pass.

With respect to revision: learn the DEFINITIONS!!! And public health (Including Millenium Development Goals). Do all the practice questions which are online and that you are given. Also, go through the booklet and go over the examples again to ensure that you understand how it is done. Exam was fair.

Paediatrics

Enjoyable unit. Very different as to whether you do it at the Children’s Hospital or in the Academies outside of Bristol. In BCH you actually don’t see many children. You see awesome and exciting patients but when it comes down to it there are too many distractions in Bristol and people don’t generally go onto the wards.

Textbook which will make you pass: Lissauer and Claydon. Really easy to read and has everything you need to know. Also if you buy it there is a code at the front of the book to log on to Student Consult and the online resources are really good. It contains MCQs and good revision summaries. I would really recommend it, especially when you are struggling with revision!

Exam: Written – the exam I sat was really fair. Learn Lissauer and you won’t have any problems. Liver syndromes eg Crigler-Naigler, Dubin-Johnson have come up in the last two lot of exams. So has Potters Syndrome. Also know about Downs Syndrome.

OSCE:

2x examination
2x communication
2x interpretation
2x video

After all the examinations remember to say that “To complete my examination I would… eg obs, sats, temp, peak flow etc depending on the examination.

And PRACTICE presenting. This really shows who the top students are. If you can look confident whilst presenting it really helps.

Tips for examining children:

  • Have some banter with them eg ask them about school, how old they are, did they get a day of school, are you a naughty boy etc?
  • Talk to mum at the same time. The reassures both mum and child. When examining you can show on mummy eg just going to tap on mummy’s chest. See it won’t hurt. Also you can get them to listen to your chest etc if they are worried.
  • If child clearly has ADHD don’t panic – just run with it and do opportunistic examination. Examiner will be understanding
  • Specific bits of advice: when looking in eyes – get the child to pull eyes down “to make a funny face”, with JVP get them to look towards you when examining the neck. Always palpate liver. Tickle their tummy etc.
  • Neuro – “I want you to show me how strong you are… I bet I’m stronger than you” Put your arms like a chicken.. like a boxer, or lower limb – try and kick me
  • Resp: when listening to back of the chest try not to listen over the scapula and to listen more medially
  • Cranial Nerves – you probably won’t get this and if you do it is likely to be in an older child. But is younger then be opportunistic and use toys as tools to do their eye movements etc.

OSCE Stations 2007:

1) Communications station: scenario given to us a week beforehand.

  • Febrile convulsion. (explain to anxious parent what a febrile convulsion is.)
  • Intersucception.(anxious parent describes red jelly stole – diagnose.)
  • Headache. (child missing school w/ headache. Check social hx. Child just moved to new school, faking headache, not many new friends, mother staying home to treat him.)

2) Upper or lower limb neuro ex.

  • The child may have some other pathology eg renal bruit in arm

3) Respiratory ex.
4) CVS ex.

  • Wash hands.
  • The child is likely to have nothing wrong, so if you don’t hear anything, probably because there is nothing, so just say that.

5) Growth chart. (Plot figures + answer qu’s relating to it, remember to turn page over).
6) Drug dosage. (scenario, find drug using BNF, work out correct dosage, will be a antibiotic of some sort.)
7) Video – 1st video: describe 3 things the child can do
2nd video: describe what child can’t do, has cerebal palsy.

OSCE Stations February 2009:

1. Resp exam – make sure say “kid small or some comment of that effect” Also palpate the liver and say you would like to do an ENT examination
2. Neuro exam – I had a kid with a pelvic abscess but it was meant to be a peripheral neuro exam… obv no neuro signs – just reduced power. He also was dyspraxic – so ask how walk normally (or talk etc… depending on the symptoms)
3. Video – had to say signs the kid had of developmental delay (motor signs) kid had cerebral palsy. But also know about equipment the kid used. I didn’t have a clue!
4. Growth chart – was CF, easy
5. Drug prescribing – remember kids can’t take tablets so you need syrup. Also time was quite tight on this station
6. History taking – just go through it logically, make sure you ask about social history and what mum is worried about. Also really important to make a plan. Say what you are going to do and reassure
7. Breaking bad news – errr.. this was pretty bad – so ask someone else! We had to say kid may have downs – once again make a plan and reassure (but I didn’t do very well/well at all on this station!)

Knowledge:

  • Dr Tulloh’s cardiology notes (really good) and also if you are in Bristol go to one of his clinics
  • Development
  • Know the core problems which present in early childhood and when and how they present eg intussuseption, pyloric stenosis, testicular torsion, celiac disease
  • Asthma and know the stepwise treatment and the different characteristics of a severe and lifethreatening attack