Towards MRCPCH Part II (Theory) Examination Tapabrata Chatterjee
INDEX
×
Chapter Notes

Save Clear


1Towards MRCPCH Part II (Theory) Examination
2Towards MRCPCH Part II (Theory) Examination
Written by Tapabrata Chatterjee MD, MRCP (UK), MRCPCH (UK) Paediatrician Laurel Close, Grimsby United Kingdom Edited by Suraj Gupte MD, FIAP Director, SOS Children's Health Centre Professor and Head, Paediatrics II Government Medical College, Jammu Jammu and Kashmir, India
3Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
EMCA House, 23/23B Ansari Road, Daryaganj
New Delhi 110 002, India
Phones: 23272143, 23272703, 23282021, 23245672, 23245683
Fax: 011-23276490 e-mail: jpmedpub@del2.vsnl.net.in
Visit our website: http://www.jpbros.20m.com
Branches
Towards MRCPCH Part II (Theory) Examination
© 2004, Tapabrata Chatterjee
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2004
9788180612268
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A-14, Sector 60, Noida4
5How to Prepare for MRCPCH (Part II) Examination
MRCPCH Part II Examination consists of
The theory consists of
• Data interpretation) TWO AND HALF HOURS EACH
The practical consists of
Pass marks
HAVE TO GET AT LEAST 50% IN THEORY TO QUALIFY FOR PRACTICAL
THEORY
Introduction
Qualifying marks to proceed to the practical 50%.
Generally 1ST impression is correct. Think twice before changing, even if tempted.
Use pencil6
Make handwriting legible
Use capital letters like “TURNER'S SYNDROME”
Pictures
Generally half are photographic pictures and half are radiological pictures.
Tips
Read the questions and the written information provided with pictures. Most of the time, clue is there in the written information.
Look at the picture in a graded way:
  1. Look at the middle of the picture
  2. Look at the side of the picture
  3. Look at the surroundings (do not miss the father and mother if they are present with a child in a picture, as there might be useful clues to the diagnosis)
  4. For a particular type of picture, think about the common possibilities
    Example – If a chest X-ray is given, think of
    Collapse of the lung
    Respiratory distress syndrome
    Bronchopulmonary dysplasia
    Cardiomegaly
    Rib fracture-non-accidental injury
    Diaphragmatic hernia
    Leaked TPN
    Pneumothorax
  5. Make a list before going for your examination like “CHEST X-RAY OF A ONE DAY OLD NEWBORN” causes include Group B sepsis, RDS, DIAPHRAGMATIC HERNIA, Meconium aspiration syndrome.7
    List will change if it is a 2 week old baby, a 4 week old baby or a two month old infant
  6. Do not forget to mention the side and try not to miss obvious adjectives; e.g.
    Right-sided Erb's palsy instead of Erb's palsy
    Right-sided tension pneumothorax instead of pneumothorax
Gray Cases
PREPARE AT LEAST 50 TYPICAL GRAY CASES. IF POSSIBLE 100 TO 150 CASES. PATTERN RECOGNITION IS MOST IMPORTANT.
Tips
  1. Read the questions first before you read the text
  2. After that read the first sentence only and underline the age and the problem
  3. Read the investigation
  4. Form an opinion about the possible diagnosis
  5. Read the whole text now
Example:
A 3-year-old Caucasian child who had prolonged jaundice in newborn period presents with abdominal pain. On examination he is pale and spleen tip is just palpable.
Investigation Hb-6 g/dl, Chest X-ray–normal.
Read the questions first before you read the text.
Q. What is the extra-abdominal cause of this abdominal pain?
Q. What further investigations are necessary to reach a diagnosis?
Q. What is the diagnosis?
You know that you are investigating a non-abdominal basic pathology causing abdominal pain.8
Possibilities are
Pneumonia or referred pain from chest
Haemolytic process causing gallstone.
Go to the next part now. The first line may be
‘This 3-year-old Caucasian child who had prolonged jaundice in neonatal period, now presents with abdominal pain.’
You already know that you are dealing with a haemolytic process in the Caucasian population.
Investigations:
Hb – 6 g/dl
Chest X-ray – normal
This child has got anaemia and the cause is not the chest. Thus without reading the text you can summarise your conclusion:
3-year-old
Anaemic child
History of jaundice
Haemolysis
Abdominal pain with non-abdominal pathology
Not chest related problem
Provisional diagnosis – Hereditary spherocytosis (do not write spherocytosis only)
Investigation – Abdominal ultrasound to rule out gallstone (do not write ultrasound).
Data Interpretation
AGAIN PATTERN RECOGNITION IS MOST IMPORTANT
Tips
  1. Read the questions first before you read the text.
  2. After that read the first sentence only and underline the age and problem.9
  3. Read the investigation.
  4. Form an opinion about the possible diagnosis.
  5. Read the whole text now.
Commonly asked topics
ECG
Supraventricular tachycardia
WPW syndrome
ASD (Secondum type)
Prolonged QTc
EEG
Rolandic epilepsy
Absence seizure
Burst suppression of SSPE or Herpes encephalitis
Hypsarrhythmia
CARDIAC CATHETERISATION
FAMILY TREE – Like that of cystic fibrosis
AUDIOMETRY
Airborne gap-conductive deafness
Sensorineural deafness
Tympanometry
ACUTE RENAL FAILURE
Urinary parameters
Fractional excretion of Na
RENAL TUBULAR ACIDOSIS
MILK COMPOSITIONS
KARYOTYPING-Turner's, Down's, Trisomy 13,18.
BLOOD GAS – Do not forget to write the full result like –“partly compensated metabolic acidosis”.10
CSF – Picture of tuberculosis or partially treated pyogenic meningitis
50 to 60% of data is expected to come from this.
Tips
Lapse of concentration is cause failure in the theory examination. So be careful. Don's read anything the day before as that helps to preserve attention span. Best policy is to read the text and the questions at least twice and check your answers after writing as you get plenty of time.
Eventually, you are stuck at any part, leave that part and go to the next
11Preface
All experienced clinicians in paediatrics, like other branches of medicine, have a system of pattern recognition in their mind, which often clinches the diagnosis or helps to approach a clinical problem.
Understanding this ever-recurring pattern is the basic philosophy behind advanced problem based learning. MRCPCH Part –II theory, tests this understanding of the common clinical scenarios of everyday life of a paediatrician.
I am including 50 gray cases and 75 data interpretation based on information of the candidates from their memory and my personal experience of the examination.
These questions are reconstruction of the themes from the basic philosophy of the questions that has come repeatedly in the examinations over a period of last five years. This book should also be a useful book for problem based learning for those who do not intend to take the MRCPCH examination. I have kept my discussions short, as this book is not intended to replace the comprehensive knowledge of common paediatric textbook, but an aid to apply the knowledge.
Tapabrata Chatterjee
12Acknowledgements
I am grateful to my father Prof. Debabrata Chatterjee MD, FIAP who has helped me with his insight from his experience in paediatrics, particularly in neonatology and my mother Mrs. Dipti Chatterjee for her continuous support and motivation
I am extremely thankful to my wife Mrs. Barnali Chatterjee, for her enormous contribution in organising my work including all computer expertise and typing the whole manuscript, apart from her continuous inspiration and encouragement.
I would also like to thank my junior colleagues for letting me teach them and giving me the information from their examination experience, from which I could reconstruct the scenarios.
Finally I would like to thank Professor Suraj Gupte MD, FIAP for editing my book.