Communication recalls

2022
Communication 1 , child 8 months old , has Family Hx oh DDH ,
mis diagnosed , and on 8 months he developed symptoms of DDH,
like asymmetry thigh creas or folds , and they did x Ray for him
showed DDH finding , please talk with his mother , and discuss
with her the misdiagnosed issue , mother was angry for some
candidates but fir me she was OK, I don't feel there is proplem in
this station

The second Communication was about chronic constipation , talk

with nadia ( I forget inside the station who's Nadia , is she a nurse
or medical student, I ask her after introduction what she to
address her , she said Nadia , then she ask me a lot of questions,
about chronic constipation and overflow and hirshprung disease, I
forget the time and they tell me finish without summary and with no
offers for website and leaflet or books , very bad station at the end
, but I answered all her questions and time over.

Constipation
Difficult college changing notes

Missed DDH, Mother angry

Pregnant mother, talk about cleft lip and palate management when
child is born.

Comm
1. 14 yrs. tuberculosis, Inform the mother about diagnosis and
treatment
2. 15 yrs. girl stool positive for h pylori inform her about diagnosis
and management
Comm 1: Mum wants to do gene test for Huntington Chorea for
newborn baby because her father newly diagnosed. She doesn't
know if she has it.
Method of inheritance? Symptoms onset?

Comm 2: Consent NGT from 16 y old girl with Crohns for elemental
diet because she did not tolerate its taste.
Asked about analgesia? Other options? School friends making fun
of her? Support group?

Comm 1: wrong medication (haloperidol for allopurinol), talk to

mother regarding the drug error
Comm 2: URTI, no fever, no rashes, with meningitis contact
(school mate), talk to father regarding the dx
1. Comm 1
Explain to mom about NF-1 diagnosis
2. Comm 2
Long scenario describing the child has possible CoA/AS, came
in to ED (No diagnosis given, only examination findings) Explain to
mom on possible

1. Cleft lip and palate (repeated)

2. Talk to colleague for changing ward notes

Talk about management of meningitis to a mother who the Sho

had tried to cannula the five times
Talk to another whose baby on the neonate was accidentally given
formula feeds with a bottle, instead of NG breastfeeds
Constipation to medical student
DDH diagnose at 8months talk to mom
Communication talk to mother for bone marrow biopsy in child with
hepatosplenomegaly
Talk to a boy 15 years short stature for pubertal assessment
1) MRSA
2) Talk to nursery teacher about the management plan of 3 year
old girl with seizure, Known case of Ex PT with IVH and PVL

COMMUNICATION

16 years newly diagnosed type 1 DM who is refusing treatment.

During scenario boy like still uncertain diagnosis needed to explain
about type 1 DM and talk a lot on how we will be supporting him.

Comms 2: New mother day 5 child has jaundice and weight loss.
Very long scenario needed to read to make sure not missing
anything. Counsel for admission. Hidden agenda mother no
support

Explain NAI to med student

Thalassemia pt non-compliance to Exjade (Deferasirox)

Newborn with missed clavicular fracture speak to mum, mum very

angry
Neurofibromatosis
Autism
MRSA in neonate

Nephrotic exposed to chicken pox talk to mum.

Constipation
-Was about chronic constipation , talk with nadia ( I forget inside the
station who's Nadia , is she a nurse or medical student, I ask her
after introduction what she to address her , she said Nadia , then
she ask me a lot of questions, about chronic constipation and
overflow and hirshprung disease, I forget the time and they tell me
finish without summary and with no offers for website and leaflet or
books , very bad station at the end , but I answered all her questions
and time over , will see the comments later
DDH
-Child 8 months old , has Family Hx oh DDH , misdiagnosed , and
on 8 months he developed symptoms of DDH, like asymmetry thigh
crease or folds , and they did x Ray for him showed DDH finding ,
please talk with his mother , and discuss with her the misdiagnosed
issue , mother was angry for some candidates but fir me she was
OK, I don't feel there is problem in this station , will see the result
later
Communication 1:
15 years old with stool test having h pylori infection. Explain
diagnosis and treatment plan to her.
She kept asking if it's transmitted to other ppl

Communication 2:
20 wks pregnant lady with cleft lip and cleft palate on antenatal scan,
explain to mother. Asked about her fault and what you will do after
delivery.
Communication: Missed DDH mother angry
2.Communication: Talk to pregnant mother about management of
cleft lip and cleft palates when the child is born
1: Nadia 4th year medical student just 5 weeks in rotation. She has
taken history from mother of Amer 4years old with 2years h/o
chronic constipation. He has soiling and overflow. He passed
meconium within 24hours. Potty training started 2years ago. He
has mass in the left iliac fossa. Explain the causes and
management of Constipation.
2. Charlie Ward FY1 paediatric trainee. He has examined Billy who
has come with lower rashes, diagnosed as HSP. You have
checked the discharged notes and noted he has inserted BP and
dipstick urine findings and a differential diagnosis of HSP. His
previous notes didn’t have this.
Talk to Charlie and explain him about the acute contemporaneous
records.
Transition for type 1 DM with recent poor control.
Comms: Angry mum, child fitted as anti-epileptic medications were
delayed (NBM for Sx) which was delayed for emergency op.

Paracetamol OD, plan medically fit for CAMHS FU talk to mum

15 yrs old girl, vegetarian, had menorrhagia and irregular bleed for
some time. Now presented with fainting episodes 3-4 times in
school. Hb- 6.5, low iron and MCV. Talk to her.

Mother of 6 yrs old child. Her son’s one of school fellow, 1 yr senior
than him is suffering from meningitis and is admitted in our A & E
department. She has come for the check-up of her son in our A&E
,
who’s having flu for 1 wk, cough for 1 day but no fever n rash so
found to have URTI, that is viral. But she’s worried that her son
might also be having meningitis.
You are paediatric specialist registrar in Uni hospital. Talk to Dr
Kenneth new surgical MO. Nurses noted he sees patient when
parents not around few times. One incident 14yr girl appendicitis
he examined without chaperone. Talk to him regarding importance
of chaperone.
- he says he is busy, can't catch up alone in casualty, can't find
nurse
- he did say child agrees when he ask for exam
- so did patient complain him now.

Talk to Linda mother of 15 yr old Rose refuse to eat during school

recess, weight loss BMI 15.5, went to GP, DM, coeliac, thyroid all
normal. Pt heart rate 55/min other vitals stable. Dx: Eating
disorders Anorexia nervosa. Talk to mum on Mx.
- need admission
- nutritional rehab, refer child psychologist.

IDA vegetarian and Mx for IDA, talk to the teenager who didn’t
want to take any iron supplements or vegetables high in iron.

Talk about ethics to medical student. One case is HIE with multi
organ failure and max intensive support, another one is Ex prem
26 week with IVH grade 3 on ventilator now

explain to the angry mother with a newborn baby with right

humerus fracture post-delivery. Checked by HO was told to be
normal. Only found out by the midwife right hand not moving.
Orthopedic planned for immobilization but yet to come to review.
2. explain to the mother with a Ex prem 27 weeker currently 3
months old had stormy neonatal period. Planned for discharge and
might be earlier in view of imminent triplets’ delivery.
MRSA in a kid post op. Explain to mum.
2: Rhesus iso-immunisation. Explain to student nurse.

childhood obesity
2: explain to mom for reintroduction of enteral feeds with recent
NEC

Rh isoimmunisation, explanation to nurse

NEC to restart enteral feeding- Explain to mother

Contact with meningitis patient in class

NF1 discovered while admitted with pneumonia

Tension headache, explain to father of 10 yrs old boy.

Comm B: WPW Syndrome -2months old. Explain diagnosis and
management to father.

Rheusus isoimmunization talk to a nurse student

2. Comm 2-mother asks for more investigations for her child he
has URTI and she is afraid from meningitis and ask to break
confidentiality about another child

You are taking with Mustafa 4th yr medical student about pt with
ASD, he Assessed by psychologist and diagnosed to have sensory
processing disorder he was admitted with fever 39.5 failed to do
venepuncture. Task: to Explain to Mustafa about ASD. He asked
about sensory processing disorder. After I explaining to him the 3
features of autism. He Asked me that he feel that he is isolated, so
do you think I have ASD hhhh. (I said to him I am not in position to
diagnose you, as I am responsible only for children and best to ask
adult psychologist). He is contd to ask, ask, ask he didn't give me a
chance to summarize
Comm 2: Shahad she is 16 yrs old known to have CF on regular
F/U. He annual fasting glucose 8 mmol/l. 2h GTT 14 mmol/l. Ask
about why she has diabetes – mechanism. She is persistently
refusing insulin, she ask for alternative

Explaining ADHD to medical student.

Comm 2: Explaining intussusception diagnosis and management
to mother.

Comm 1: Mother angry that you want to re start enteral feeds in

NEC talk to her about pro and cons.
Comm 2: talk to mother asking for series of test and admission for
her 3 years old child because 1 student in the school has
meningococcal

4 years old child with TB contact, positive mantoux 15mm, normal

CXR, no BCG scar, mother not keen on isoniazid prophylaxis. Talk
to mother on Mantoux result & need of prophylaxis.

Comms B: 40 hours old baby with high jaundice secondary to ABO

incompatibility (Direct Coombs +ve). G6PD negative. TSB 420 to
470 despite intensive phototherapy and IV fluid. Talk to mother on
ET.

Bronchiolitis, concerns her child have asthma

Comm 2: 14 yr child drinking alcohol talk abt life style changes.

Mum of infant with laryngomalacia, currently having bronchiolitis.

Diagnosis mentioned in stem. Stem mentioned boy well, can be
discharged. Mum very anxious, I explored her concerns, she
revealed that the older sibling had severe bronchiolitis, went to
PICU for a week. She was scared that the boy will have similar
problems. Reassured her, told her red flags to look for, safety
netting. From other colleagues- if you do not prod about concerns
she will not volunteer about the older sibling going to PICU.

Comms 2: Teenager with HOCM. Dad died of HOCM. His recent

scan showed worsening hypertrophy. Wants to play basketball.
Talk to him. Actor kept looking at phone. Difficult to establish
rapport. Managed to tease out that he was not compliant to
medication, but couldn't get him to be interested in my explanation.
Repeatedly shrugged and said "I want to play basketball". I felt this
was a bad station. Examiner feedback: You asked too many
questions and did not have time to explain. You should have
explained more about HOCM

explain regarding insulin treatment in DM

Comm B - explain regarding missed DDH and further Mx (angry
mother)

Comm A - upset mother as child infected with RSV while admitted

for UTI
Comm B- Dangers of alcohol drinking to teenager

talk to mother- refused to use steroid cream for bad eczema for the
child
- talk to medical student about cooling therapy for HIE baby

Drug error. Cystic fibrosis. Given high dose 3times the

recommended dose of antibiotics
Comm.B mother not willing to give her 2hrs old newborn baby vit k
prophylaxis. (hepatic cancer phobia).

mon baby X ray showed DDH, missed on the newborn and 8

weeks screen, despite +ve family hx no screening was offered.
Explain to the mother.
Comm 2: 15 yr girl admitted before 2 days with DKA, she is worried
and has many questions. Talk to her. Grandma has type 2 DM.

Explain HIE to med student, cooling therapy

Explain management of ectopic eczema to parent. Mother refused
steroid cream

Epipen auto-injector and management strategies for anaphylaxis in

a child with recent hospitalization with anaphylaxis to sesame. Also
tell mom that IgE levels confirm child is 4/6 grade hypersensitive to
sesame
Comm 2: 5 day old baby with dehydration weight loss>10% and
jaundice, first baby, tired mom. Your team has planned to do RFT
& electrolytes (U&E) and Bili and admit to SCBU but midwife want
to continue only breast feeding and give DBF another chance. Talk
to her and explain

(very strange) dengue fever low platelets 24000 your junior

colleague have concern why we don't transfuse platelets. Ur task
to explain to him pathophysiology of thrombocytopenia in dengue
fever
Comm B: newly diagnosed leukemia suddenly deteriorated and
admitted in picu the nurse by mistake give him haloperidol instead
of allopurinol. U are taking to the mother

Evidence based medicine teach to med student wanting to know

whether to treat bronchiolitis.
2. Comm 2: Misdiagnosis of thymus for pneumonia. IV penicillin to
be stopped mom reassured and give her red flags and guide her to
pals as she is insisting on complaining

Talk to mother of child with suspected HUS with culture + for

enterotoxigenic E. coli.
Comm B-Talk to mother of child with relapse of nephrotic
syndrome. History-known c/o partial seizure on medication with
recent onset of frequent episodes.

Constipation talking with colleague-causes/treatment

(2 task) neonatal jaundice (ABO) and exchange transfusion. use

simple language only do not elaborate more like talking kernicterus

Talk about glycopyrrolate

Comm 2: Angry mother: son admitted for UTI, catch up RSV in
ward. Very upset mother.

progressive pelvis dilatation fr antenatal scan issues auntie passed

away dt urine infection and mum has recurrent UTI
Comm 2: ribs fracture - Ex prem 29 weeker- NAI

Adolescent with DM, has many social issues, missed meal and
insulin, uncontrolled sugar level. Task- talk to him on positive urine
microalbuminuria for 3 consecutive result and management plan.
Coms B: anxious mother, with baby diagnosed Eczema, recovered
from eczema herpeticum, has recurrent flare. Discuss on
management plan. Respiratory/ other: look at face and chest and
proceed. Finding: left lower motor neurone facial nerve palsy with
left malformed ear has right VP shunt, thoracic scoliosis, and left
chest wall deformity.

15 yo DM on insulin: uncontrolled d/t social issue, microscopic

proteinuria +, explains Urine result

Comm 2: Anxious mom has 9 months old baby with eczema. had 1
admission for eczema herpeticum. eczema still flares. worried
about mx eczema and concern about probiotic, breast feeding only
for 2 months, disturbed sleep, on hydrocortisone prn and emollient.
mum concern regarding steroid, formula milk, poor knowledge

Edward syndrome with complex CHD. Child passed away at 3

hours of life. Late booking at 32 wks. Parents counselled, decide -
no active resuscitation. Explain ethics of non-intervention to
student nurse.

Comm 2: Single mom with 6 mo FTT baby. Investigations were

normal. Followed up but noted weight not gaining. Planned for
admission and referral to medical social worker. Explain to mom
that child need admission and referral to social worker

A: Explain to junior Dr about pathophysiology of

thromobocytopenia in dengue and why we are not transfusing the
boy besides platelet 24, everything else ok, not in shock, no
warning signs. Talked about pathophysiology of dengue basically,
ie phases and warning signs etc. Checked the junior's
understanding too. 8/8, no comments.

Comms B: Drug error, explain to mother. Newly-diagnosed ALL

instead of Allopurinol received Haloperidol instead. 8/8, no
comments.

Refuse IV vit k and antenatal hydronephrosis

A: Setting: Neonatal ward. Suhaila a houseman recently joined

SCN is curious about management of extreme preterm infant. After
seeing you counsel a 35-year-old mother, primigravida at 24
weeks+2 days, she is interested to know the management of
extreme preterm infant and limited viability.

Comm B: Mrs Huang, mother of 16-month-old Beng Sim. He was

admitted burn injury after she accidentally pulled the table clothes
which contains the hot kettle. Mrs Huang was having tea with her
friend at that time when he went over. He sustained scalding over
her shoulder and chest. Mrs huang also has 2 other children, yi
hua, 2 ½ year old and mei mei 3 ½ year old who were recently
admitted for paracetamol overdose after they took the bottle and
ingested the medication. Your nurse has talked to mrs huang
regarding accident prevention and safety at home. But she wishes
to talk to a doctor

Tension headache &

bone marrow aspiration

EBM &
Recurrent hypoglycaemia

Comm 1: Teach a medical student about evidence-based

medicine.
Comm 2: Recently diagnosed T1DM with recurrent hypoglycemia
at 2 months after the diagnosis was made.

WPW, Comm
2: UTI and DMSA

Stable eczema discharged from hospital follow up to follow with go

mum upset.
2: Audit about ORS

Nephrotic syndrome 3rd relapse to start steroid

Comm 2: Audit cycle and he ask also about research and Clinical
governance

counsel to mother for a medication error of dexamethasone given

10 times higher than normal dose.
Comm 2: counsel the mum who refused Ab for clinical evidence of
sepsis/ NEC.
Talk to colleague; missed clinical notes and didn’t tell anyone. Talk
to him.
Comms: Obesity and long-term implications. Talk to mum.

Tension headache
Comm 2: SHO second year doesn’t want to do discharge summary

1. Mother of 8month, who have family hx of hip dislocation. Baby

checks was normal, even at 8weeks check. Mother notice child’s
lower limb was not moving correctly n shorter than the other limb.
Hip X-ray - features of hip dislocation. Task: talk to mother about
X-ray findings, limitations of screening of hip dislocation.

2. Frm Rebecca book. Child admitted for elective surgery and got
postponed. Child have underlying epilepsy, stable on Epilim (sod
valproate). Ur ENT colleague asked u to talk to Mum as child fitted
for a minute. This station, mother kept talking non-stop. Don’t know
if I pass

Talk to girl with Labrune syndrome, a complex neurological

condition and her mum. Task is to get past medical history current
condition, complications and how it affected her school and life.

Teenager with T1 DM
Comm 2: 10 months with DDH

Speak to mum who wants circumcision for 2 year old son with non-
retraction penis
Comms 2: Speak to 15 year old boy not compliant to Valproate

Talk to ST1 about effect of pre-eclampsia on premature babies

Comm 1: Baby diagnosed with Meningitis. Has cannula issues.
Also mention in that question that baby presented in shock so poor
perfusion. Houseman tried too many times but did not tell
registrar/MO. MANAGEMENT of meningitis. Mother not too angry
but more to worry and upset.Approach: Apologise (briefly only as
this is not the main focus of stem). Explain that baby vessel is
small. could be a challenge, especially when baby not well. Abx is
a must. Promise that you will insert yourself (mother ask why not
oral abx): Not possible. (But I dun know why I said oral abx is not
suitable, I should have said not possible! I said there is oral form
but not suitable for patient). Suggest long line as need weeks
antibiotics. Follow up on development later.

Comm 2: EBM Missing. Feed prem baby with formula milk. Mother
angry and also have background h/o struggle with EBM. Angry
mother who want to see doctor and find out what happen. (I should
have talked louder, only realised when the station is almost
finished, noticed that he tilted his head to listen to me).
Approach for second comm:
Apology - Incident report, investigation - Explain NEC that not only
because of not getting EBM - Reassurance- just check → baby is
fine - Refer to EBM nurse

Comm 1: 13 years old boy newly diagnosed type 1 DM. Refused

insulin injection. Pls communicate with him regarding this. He is
football player in school, afraid that he won’t be able to play football
anymore. Ask if he can take oral medication instead of inject
insulin. Parents are not supportive to him and he feel lonely.

Comm 2: 5days old baby, with significant weight loss with

dehydration and jaundice above photolevel. Mother refused
admission. Pls talk to mother. mother's first child. During
counselling she broke down in tear saying she is alone here,
husband work outstation, no one can help her.
Comm 1 - asthma, counsel regarding steroids and also why child
not started on abx.
Comm 2 - teach med student about fluid calculation in a pt with
pyloric stenosis.

Comms 1: Mother, unkempt, baby jaundice and lost a lot of weight.

Counsel for admission, explain jaundice, and management. Get
the hidden agenda why she doesn’t want to be admitted. Show
empathy and plan support for her.

Comms 2: Counsel a teenager to inject his insulin. Newly

diagnosed diabetic. So have to talk to teenager and explore issues.
Asked if can object if playing sports. Can take tablet and why not

Communication
▪ Speak to teenager about drinking
▪ Speak to parent about child in neonatal unit having MRSA
▪ Infant on ward for UTI developed RSV + bronchiolotis, explain to
mum
▪ 4 month old infant with spiral humeral fracture, explain concerns
and further management to mum
▪ Explain to a medical student re a situation of a 15 year old child
with CF who refused IV antibiotics and how I handled this
▪ Precocious puberty
▪ Mum of 4 year old boy with leg pains, investigations normal.
Diagnosis Benign Nocturnal Growing pains of childhood. Task:
Give diagnosis and explain management. Mum widowed, dad
died of leukaemia, presented in same way so anxious ++
▪ 8 hr old baby found blue on PNW - congenital cyanotic heart
disease - now ventilated on prostin and awaiting transfer to
tertiary centre. Task: Explain to mum what cong cyanotic heart
disease is and its management (also had to update her on the
baby's current clinical condition!!)
▪ Speak to this teenager who has taken paracetamol overdose
▪ Talk to a mum whose daughter came in overnight with a
significant paracetamol OD explain medical management and
plan
▪ Child given someone elses intrathecal methotrexate (too small a
dose) - Drug error scenario
▪ Headache - mum wanted brain scan but history of tension
headache (explaining why not necessary and referral to
headache clinic)
▪ Boy with learning difficulties. Get consent for genetics for fragile
X. Mum asked why needs consent (examiner commented on
feed back sheet that you need to clarify with parents that they
would need to be tested if positive - need to spell out would
indicate non paternity)
▪ Baby with hypothyroidism: abnormal Guthrie and TFTs. Explain
the diagnosis to Mum, treatment and investigations
▪ Speak to a mother about her 7 year old child with nocturnal
enuresis (see NICE guidelines)
▪ Bruising noted on the back of a child with CF. Mum claimed it is
secondary to chest physio. Discuss with Mum, including
concerns and management
▪ Explain to medical students about drug trials in paediatrics
▪ 4 month with spiral fracture of humerus – discuss with parents
including management
▪ Duchenne’s Muscular Dystrophy – explain the
genetics/inheritance to the parents
▪ Febrile neutropenia – Mum upset as she felt staff on ward not
following proper infection control guidelines
▪ Discuss with mother the benefits of treatment of helicobacter
pylori treatment – mum doesn’t believe in giving medicines to
children.
▪ Explain to Mum why her baby (an ex-34 weeker) isn’t going to
be offered the RSV vaccine as her friend has a baby who was
an ex-27 weeker with CLD who is.
▪ Discussion with surgical ST4 who is refusing to accept a likely
case of appendicitis in a child.
▪ D5 infant collapsed and unwell in resus – ventilated with
probable diagnosis of aortic coarctation. Counsel parents,
including need for transport, surgery, PICU
▪ Infant with UTI – discuss results of US/MCUG/DMSA – explain
follow up including BP, review etc
▪ Mum angry that her baby (breastfeeding) given formula feed on
PNW
▪ Child with CP in residential home – Mum has full parental rights.
Consultant wants hyoscine but Mum refuses. Discuss the
risks/benefits/ethics of this with as medical student
▪ Discuss management of NAS with a Mum who denying drug
abuse/social work involvement
▪ Discuss H.pylori treatment with a 14 year old with abdominal
pain and positive stool results (family history of gastric cancer)
▪ Discuss with Mum who has a child with short stature and is
enquiring about growth hormone although it isn’t indicated.
▪ 2 year old with bloody stools – lives on farm. Mum doesn’t want
to stay for bloods to be checked – manage
▪ Infant with UTI – discuss with parents including investigations
and management
▪ Discuss with mum in child presenting with NAI – FTT,
unexplained bruising, torn frenulum (+ disclosed domestic abuse
from Mum)
▪ Discuss with mother of 4m old presenting with spinal fracture
▪ Discuss with teenage girl having NGT passed for new diagnosis
of Crohns
▪ Drunk teenager, morning after admission. Discuss risks of
drinking alcohol, explore other risk taking behaviour
▪ Talk to mother of 14 yr old girl with +ve Mantoux and normal
CXR after TB contact. Explain results and management

Comm B: talk to mother whose daughter is having H Pylori gastritis

and she's refusing abx explain her why it is important to give
antibiotics
Viral pneumonia. Discuss discharge plans n no need for antibiotics.
Angry mom who thinks we don’t take her seriously
Coms 2: Junior who doesn’t want to do discharge summary

Talk to teenager found unconscious by road side. New n old scar

on hand. Talk to her about Mx
Comm 2: Critical incident. Missed imperforate anus.

SCENARIOS
1. WPW
2. Epilepsy
1. Costitutional Delay
2. DDH
3. FUNC COSTIPATION
4. HSM, ANAEMIA, TH PENIA DD AND BM BIOPSY
5. OBESITY TO MOTHER
6. TEEN NOT TAKIN ASTHMA

Speak to teenager about drinking alcohol & its hazards

Infective endocarditis Explain management. Single mom,

known small VSD lost follow up. dental carries.

Explain blood test. Obesity, Learning difficulty , ?PWS, now

type 2 diabetes hba1c elevated and elevated glucose.

Explain to mother about diagnosis of tb and management

1. Explain to mother about diagnosis of child with

intussuception post rotavirus and explain management
2. Speak to parent about child in neonatal unit having MRSA

3. Infant on ward for UTI developed RSV + bronchiolitis,

explain to mum

4. 4-month-old infant with spiral humeral fracture, explain

concerns and further management to mum NAI

5. Explain to a medical student re a situation of a 15-year-old

child with CF who refused IV antibiotics and how I handled
this

6. Precocious puberty

7. Mum of 4-year-old boy with leg pains, investigations

normal. Diagnosis Benign Nocturnal Growing pains of
childhood. Task: Give diagnosis and explain management.
Mum widowed, dad died of leukemia, presented in same way
so anxious ++

8. 8 hr. old baby found blue on PNW congenital cyanotic heart

disease - now ventilated on prostin and awaiting transfer to
tertiary center. Task: Explain to mum what cong cyanotic
heart disease is and its management (also had to update her
on the baby's current clinical condition!!)

9. Speak to this teenager who has taken paracetamol

overdose Talk to a mum whose daughter came in overnight
with a significant paracetamol OD
10. explain medical management and plan Child given
someone else intrathecal methotrexate (too small a dose)
Drug error scenario

11. Headache - mum wanted brain scan but history of tension

headache (explaining why not necessary and referral to
headache clinic)

12. Boy with learning difficulties. Get consent for genetics for
fragile X. Mum asked why needs consent (examiner
commented on feedback sheet that you need to clarify with
parents that they would need to be tested if positive - need to
spell out would indicate non paternity)

13. Baby with hypothyroidism: abnormal Guthrie and TFTs.

Explain the diagnosis to Mum, treatment and investigations

14. Speak to a mother about her 7-year-old child with

nocturnal enuresis (see NICE guidelines)

15. Bruising noted on the back of a child with CF. Mum

claimed it is secondary to chest physio. Discuss with Mum,
including concerns and management NAI

16. Explain to medical students about drug trials in pediatrics

17. 4 month with spiral fracture of humerus – discuss with

parents including management
18. Duchenne’s Muscular Dystrophy – explain the
genetics/inheritance to the parents

19. Febrile neutropenia – Mum upset as she felt staff on ward

not following proper infection control guidelines

20. Discuss with mother the benefits of treatment of

helicobacter pylori treatment – mum doesn’t believe in giving
to children.

21. Explain to Mum why her baby (an ex-34 weeker) isn’t going
to be offered the RSV vaccine as her friend has a baby who
was an ex-27 weeker with CLD who is.

22. Discussion with surgical ST4 who is refusing to accept a

likely case of appendicitis in a child.

23. D5 infant collapsed and unwell in resus – ventilated with

probable diagnosis of aortic coarctation. Counsel parents,
including need for transport, surgery, PICU

24. Infant with UTI – discuss results of US/MCUG/DMSA –

explain follow up including BP, review etc

25. Mum angry that her baby (breastfeeding) given formula

feed on PNW
26. Child with CP in residential home – Mum has full parental
rights. Consultant wants hyoscine but Mum refuses. Discuss
the risks/benefits/ethics of this with as medical student

27. Discuss management of NAI with a Mum who denying

drug abuse/social work involvement

28. Discuss H.Pylori treatment with a 14-year-old with

abdominal pain and positive stool results (family history of
gastric cancer)

29. Discuss with Mum who has a child with short stature and
is enquiring about growth hormone although it isn’t indicated.

30. 2-year-old with bloody stools – lives on farm. Mum doesn’t

want to stay for bloods to be checked –

31. manage Infant with UTI – discuss with parents including

investigations and management

32. Discuss with mum in child presenting with NAI – FTT,

unexplained bruising, torn frenulum (+ disclosed domestic
abuse from Mum)

33. Discuss with mother of 4m old presenting with spinal

fracture NAI
34. Discuss with teenage girl having NGT passed for new
diagnosis of Crohn's

35. Drunk teenager, morning after admission. Discuss risks of

drinking alcohol, explore other risk-taking behavior

36. Talk to mother of 14 yr old girl with +ve Mantoux and

normal CXR after TB contact. Explain results and
management

37. drug error gentamicin instead of single daily dose given 3

doses for three days

38. familial short stature 17 yrs old girl with normal puberty

39. fluid management of preterm neonate

40. management of constipation

41. Talk to mother about her concern of 7 y. uncontrolled DM

42. case of collapsed neonate, due to COA, ventilated and

started dopamine, arrange to be sent for urgent surgery
Mather was crying all the time,

43. Teach student regard inhaled steroids and maintenance of

treatment in bronchial asthma
44. Teenage with type 1 DM

45. 10-month baby with DDH

46. Explain NAI to med student

47. Thalassemia pt non _ compliance to ttt

48.Viral pneumonia. Discuss discharge plans n no need for

antibiotics. Angry mom who thinks we don’t take her seriously

49. . Teach final year medical student regarding therapeutic

cooling in a term infant with HIE

50. Talk to Mrs. Tan, Paul’s mother – Paul is a 8-year-old boy

with cystic fibrosis admitted for pseudomonas aeruginosa
infection. IV tobramycin was given 3x more of the usual dose
and 2 doses given so far. Explain to mother about the drug
error and further management

51. teaching medical student about therapeutic cooling, asked

about what it is, why, what is the evidence behind cooling,
Hidden agenda: he has a brother with CP, would he have
benefitted from cooling if it was done for him

52. tobramycin overdose for child with CF – a. Mother very

angry & asked about side effects and why and she want to
complain. usual stuff
53. Teach final year medical student regarding therapeutic
cooling in a term infant with HIE. Asked about evidence
behind therapeutic cooling, how it was done (using machine
or with blood products?). At 7minute, medical student will
bring up hidden agenda that his brother has cerebral palsy
from birth related issue (that is what the medical student
thinks) and he wonders if therapeutic cooling could have
reversed the neurological outcome. Give empathy +++ and
state that therapeutic cooling does not reverse neurological
damage

54. Talk to Mrs Tan, Paul’s mother – Paul is a 8-year-old boy

with cystic fibrosis admitted for pseudomonas aeruginosa
infection. IV tobramycin was given 3x more of the usual dose
and 2 doses given so far. Explain to mother about the drug
error and further management. 2 doses given so far. Explain
to mother about the drug error and further management.
Angry mother → have to explain that need to take renal panel,
monitor urine output. Mother will ask how she can complain,
who is involved in this drug error.

55. 16 years newly diagnosed type 1 dm. who is refusing

treatment. During scenario boy like still uncertain diagnosis
needed to explain about type 1 dm and talk a lot on how we
will be supporting him

56. new mother day 5 child has jaundice and weight loss. Very
long scenario needed to read to make sure not missing
anything. Counsel for admission. Hidden agenda mother no
support.
57.angry mum, child fitted as anti-epileptic medications were
delayed as NBM for operation which was delayed for
emergency

58. Talk to teenager. Found unconscious by road side. Noted

new and old scar on hand. Talk to her about the management.

59. critical incident. Missed imperforate anus

60. 15 y/ DM on insulin: uncontrolled d/t social issue. having

microscopic proteinuria- explains Urine results

61. anxious mom has 9 months old baby with eczema. had 1
admission for eczema herpeticum. eczema still flares. worried
about mx eczema and concern about probiotic, breast feeding
only for 2 months, disturbed sleep, on hydrocortisone prn and
emollients mum concern regarding steroid, formula milk, poor
knowledge

62. 8 Month baby X ray showed DDH, missed on the newborn

and 8 weeks screen, despite +Ve family hx no screening was
offered. Explain to the mom

63. 15 yr girl admitted before 2 days with DKA, she is worried

and has many questions. Talk to her. Grandma has type 2 DM.

64. 16 yr. girl known to have seizures since infancy referred

with recent increase in the frequency ... She had been
diagnosed before 1 yr. with a rare genetic disease. The girl
was in a wheelchair, has GDD with multiple issues
65. Edward syndrome with congenital complex heart defect.
Child passed away at 3 hours of life. Late booking at 32
weeks. Parents counselled and decide of no active
resuscitation. Explain ethic of non-intervention to the student
nurse

66. . Single mom with 6 mo baby who is failure to thrive.

Investigations were normal. Followed up but noted weight not
gaining. Planned for admission and referral to medical social
worker. Explain to mom that child need admission & refers to
social worker

67. Evidence based medicine teach to med student wanting to

know whether to treat bronchiolitis

68. Misdiagnosis of thymus for pneumonia. I V penicillin to be

stopped mom reassured and give her red flags and guide her
to pals as she is insisting on complaining

69. counsel to mother for a medication error of

dexamethasone given 10 times higher than normal

70. : counsel the mum who refused Ab for clinical evidence of

sepsis/ NEC

71. Talk to colleague; missed clinical notes and didn’t tell

anyone. Talk to him

72. second year medical student doesn’t want to do discharge

summary
73. EpiPen auto injector and management strategies for
anaphylaxis in a child with recent hospitalization with
anaphylaxis to sesame, also tell mom that igE levels confirm
child is 4/6 grade hypersensitive to sesame

74. 5-day old baby with dehydration weight loss>10% and

jaundice, first baby, tired mom. Your team has planned to do
u&e and sbr and admit to scuba but midwife want to continue
only breast feeding and give her another chance, talk to her
and explain

75. Speak to mum who wants circumcision for 2-year-old son

with non-retraction penis

76. : Speak to 15-year-old boy not compliant to Valproate

77. talk to girl with Labrune syndrome, a complex neurological

condition and her mum. Task is to get past medical history
current condition, complications and how it affected her
school and life. Discussions went badly because I can’t get
enough information and at the end only, she told me her
seizure was uncontrolled recently. And examiner wasn’t
happy I couldn’t tell many of the supports available. She
keeps saying did you ask... obviously I didn’t ask because I
don’t have the time.

78. explain HIE to medical student, cooling therapy

79. explain management of atopic eczema to parent. Mother
refused steroid cream

80. progressive pelvis dilatation in antenatal scan issues

auntie passed away dt urine infection and mum has recurrent
UTI

81. ribs fracture - ex prem 29 weeks NAI

82. Talk about glycopyrrolate

83. Angry mother: son admitted for UTI, catch up RSV In ward.
Very upset mother

84. Mother refuse iv vit k

85. Talk to mom about antenatal hydronephrosis

86. Explain to junior Dr about pathophysiology of

thrombocytopenia in dengue fever and why we are not
transfusing the boy. Besides platelet 24, everything else ok,
not in shock, no warning signs & talked about
pathophysiology of dengue basically, ie phases and warning
signs etc * Checked the junior's understanding too

87. Drug error, explain to mother. Newly-diagnosed ALL

instead of Allopurinol received Haloperidol instead
88. WPW

89. UTI & DMSA

90. Teach a medical student about evidence-based medicine.

91. Recently diagnosed type 1 DM with recurrent

hypoglycemia at 2 months after the diagnosis was made

92. Adolescent with diabetes mellitus, has many social issues,

missed meal and insulin, uncontrolled sugar level. Task- talk
to him on positive urine microalbuminuria for 3 consecutive
result and management

93.Newborn with Erbs palsy

94. You are pediatric specialist registrar in Uni hospital. Talk

to Dr Kenneth new surgical MO. Nurses noted he sees patient
when parents not around few times. One incident 14yr girl
appendicitis he examined without chaperone. Talk to him
regarding importance of chaperone. - he says he is busy, can't
catch up alone in casualty, can't find nurse - he did say child
agrees when he ask for exam - so did patient complain him
now

95.talk to Linda's mother of 15 yr old Rose refuse to eat during

school recess, weight loss BMI 15.5, went to GP, DM, coeliac,
thyroid all normal. Pt heart rate 55/min other vitals stable. Dx:
Eating disorders Anorexia nervosa. Talk to mum on Mx. - need
admission - nutritional rehab - refer child psychologist
96. explain to the angry mother with a newborn baby with right
humerus fracture post-delivery. Checked by HO was told to be
normal. Only found out by the midwife right hand not moving.
Orthopedic planned for immobilization but yet to come to
review

97. explain to the mother with a Ex prem 27 weeks currently 3

months old had stormy neonatal period. Planned for
discharge and might be earlier in view of imminent triplets’
delivery.

98. IDA vegetarian and Mx for IDA, talk to the teenager who
didn’t want to take any iron supplements or vegetables high in
Iron

99. Talk about ethics to medical student. One case is HIE with
multi organ failure and max intensive support, another one is
Ex prem 26 weeks with IVH grade 3 on ventilator now

100. MRSA talk to mom

101. Rhesus iso-immunization. Explain to student nurse

102. childhood obesity (Jeddah - Dec 2021 - Day 1)

103. explain to mom for reintroduction of enteral feeds with

recent NEC (Jeddah - Dec 2021 - Day 1)
104. Contact with meningitis patient in class (Jeddah - Dec
2021 - Day 2)

105. NF1 discovered while admitted with pneumonia (Jeddah -

Dec 2021 - Day 2)

106. Tension headache, explain to father of 10 yrs. old boy.

(Jeddah - Dec 2021 - Day 3)

107. WPW Syndrome -2months old. Explain diagnosis and

management to father. (Jeddah - Dec 2021 - Day 3)

108. Rhesus isoimmunization talk to a nurse student (Jeddah -

Sep 2021)

109. mother asks for more investigations for her child he has
URTI and she is afraid from meningitis and ask to break
confidentiality about another child. (Jeddah - Sep 2021)

110. Shahad she is 16 yrs. old known to have CF on regular

F/U. He annual fasting glucose 8 mmol/l. 2h GTT 14 mmol/l.
Ask about why she has diabetes – mechanism. She is
persistently refusing insulin; she asks for alternative (Jeddah
- August/Sept 2021)

111. You are taking with Mustafa 4th yr medical student about
pt with ASD, he Assessed by psychologist and diagnosed to
have sensory processing disorder he was admitted with fever
39.5 failed to do venipuncture
112. Explaining ADHD to medical student. (Jeddah - Aug 2021
- Day 2 (26/8/21)

113. talk to mother asking for series of test and admission for
her 3 years old child because 1 student in the school has
meningococcal. (Jeddah - Aug 2021 - Day 2 (26/8/21)

114. 4 years old child with TB contact, positive Mantoux

15mm, normal CXR, no BCG scar, mother not keen on
isoniazid prophylaxis. Talk to mother on Mantoux result &
need of prophylaxis.

115. 40 hours old baby with high jaundice secondary to ABO

incompatibility (Direct Coombs +Ve). G6PD negative. TSB 420
to 470 despite intensive phototherapy and IV fluid. Talk to
mother on ET. 2020

Task: to Explain to Mustafa about ASD. He asked about

sensory processing disorder. After I explaining to him the 3
features of autism. He Asked me that he feel that he is
isolated, so do you think I have ASD (I said to him I am not in
position to diagnose you, as I am responsible only for
children and best to ask adult psychologist). He is cont. to
ask, ask, ask he didn't give me a chance to summarize
(Jeddah - August/Sept 2021)
116. Teenager with HOCM. Dad died of HOCM. His recent scan
showed worsening hypertrophy. Wants to play basketball.
Talk to him. Actor kept looking at phone. Difficult to establish
rapport. Managed to tease out that he was not compliant to
medication, but couldn't get him to be interested in my
explanation. Repeatedly shrugged and said "I want to play
basketball". I felt this was a bad station. Examiner feedback:
You asked too many questions and did not have time to
explain. You should have explained more about HOCM.

117. dengue fever low platelets 24000 your junior colleague

have concern why we don't transfuse platelets. Ur task to
explain to him pathophysiology of thrombocytopenia in
dengue fever JEDDAH 2019

118. newly diagnosed leukemia suddenly deteriorated and

admitted in picu the nurse by mistake gives him haloperidol
instead of allopurinol. U are taking to the mother JEDDAH
2019

119. Evidence based medicine teach to med student wanting

to know whether to treat bronchiolitis. Jeddah - May 2019

120. Misdiagnosis of thymus for pneumonia. IV penicillin to be

stopped mom reassured and give her Jeddah - May 2019

121. Constipation talking with colleague-causes/treatment

Jeddah - Feb 2019

122. neonatal jaundice (ABO) and exchange transfusion. use

simple language only do not elaborate more like talking
kernicterus. Jeddah - Feb 2019
123. Anxious mom has 9 months old baby with eczema. had 1
admission for eczema herpeticum. eczema still flares. worried
about mx eczema and concern about probiotic, breast feeding
only for 2 months, disturbed sleep, on hydrocortisone prn and
emollient. mum concern regarding steroid, formula milk, poor
knowledge.
124. Audit about ORS

125. Nephrotic syndrome 3rd relapse to start steroid

126. Audit cycle and he ask also about research and Clinical
governance

127. Baby diagnosed with Meningitis. Has cannula issues.

Also mention in that question that baby presented in shock so
poor perfusion. Houseman tried too many times but did not
tell registrar/MO. MANAGEMENT of meningitis. Mother not too
angry but more to worry and upset. Approach: Apologies
(briefly only as this is not the main focus of stem). Explain
that baby vessel is small. could be a challenge, especially
when baby not well. Abx is a must. Promise that you will
insert yourself (mother ask why not oral abx): Not possible.
(But I dun know why I said oral abx is not suitable, I should
have said not possible! I said there is oral form but not
suitable for patient). Suggest long line as need weeks
antibiotics. Follow up on development later

128. EBM Missing. Feed prem baby with formula milk. Mother
angry and also have background h/o struggle with EBM.
Angry mother who wants to see doctor and find out what
happen. (I should have talked louder, only realized when the
station is almost finished, noticed that he tilted his head to
listen to me). Approach for second comm: Apology - Incident
report, investigation - Explain NEC that not only because of
not getting EBM - Reassurance- just check → baby is fine -
Refer to EBM nurse

129. teach med student about fluid calculation in a pt with

pyloric stenosis

Cardiology
● Explain to parents what is meant by an ‘innocent murmur’ and
what is its’
significance?
● Duct dependent lesions – explain likely diagnosis and
management
Ie child stated on prostin and transferred to tertiary centre
● My child has been given a diagnosis of PPHN – what is this?
● Counsel parents on a child with first episode of SVT.
● ‘My child has a VSD. Do they need to take ongoing antibiotics to
avoid a bacterial
infection?’
● Child with VSD – explain risks of infective endocarditis and NICE
guideline
Child Development & Community Paediatrics
● What is a squint and how is this managed?
● Management of a child referred for global developmental delay –
include excluding
genetic and medical causes and involvement with community
paediatrics
● A mother has come to see you because her school has
suggested her child is on the
autistic spectrum. What does this mean?
● Explanation about the diagnosis of ADHD.
● Mother does not want to have her child immunised and has been
referred to discuss
the pros/cons.
● NAI – this comes up commonly in these scenarios!!
● Psychiatry – topics that often come up are overdose and alcohol
intoxication.
● Be aware of areas of competence in children – ie when is a child
competent to make
their own decisions ie Gillick competence and Fraser guidelines
Dermatology
● Eczema – management
Endocrinology
● Every strange endocrine abnormality has been asked in either
communication
stations or physical examinations so know about hormones,
feedback.
● ‘My child is short . . . is this normal?’
● ‘My child is 6 years old and has some breast development and
pubic hair . . . ‘ – have
an algorithm of investigation for precocious and also delayed
puberty
● Ambigious genitalia in the newborn – they would have to be
really nasty to ask you
this.
● Diabetes – so many communication things regarding this. Sick
day management,
counselling re poor compliance/recent DKA, management of
hypoglycaemic
episodes, insulin pumps
● Assessment of the obese child.
Gastroenterology
● Discussion with mother regarding the benefits of breast feeding
● My child is falling off their growth chart . . . organic vs nonorganic
FTT
● Mother with baby with reflux . . . how do the agents work ? ie
gaviscon, carobel,
ranitidine, domperidone, omeprazole
● Child diagnosed with coeliac disease – discuss with parents the
implications for
management and effect on the child.
● Gastroenteritis – give advise on treatment and management at
home to parents.
Know the NICE guidelines
● Counselling on treatment of constipation – 3 phases:
disimpaction, maintenance and
bowel retraining.
● Explain to a mother why her baby is jaundiced (newborn
unconjugated
hyperbilirubinaemia) and is this is serious?
● The same as above with conjugated hyperbilirubinaemia and
further management
Genetics
● Explain to the parents the mode of inheritance of . . . . know this
for the rarer
X-linked etc and make sure you can explain how. Diagrams help.
● Important genetic topics
- My child has been diagnosed with Down’s Syndrome. What does
this mean?
- A blood test was taken without us knowing for Trisomy 21? Why
& why wasn’t I
informed?
- I am a carrier for CF. What is the impact this will have on having a
child?
Haematology & Oncology
● Explain to a medical student the ABO system/Coombs & Direct
Coombs test
● A mother refuses vitamin K for her newborn baby. Explain why
this is important.
Also oral vs IM.
Infectious Diseases
● Bacterial meningitis – an infant/child has been diagnosed with
bacterial meningitis.
Explain diagnosis to parents, treatment and likely outcome.
● Counsel a parent regarding LP – why must their child have this
done and what are
the contraindications?
● Parent doesn’t want her child immunised with Hepatitis B /TB etc
Metabolic Medicine
● Know neonatal screening/Guthrie test and about the diseases it
tests for ie PKU, CF
● Explain to a medical student the principles for screening
metabolic diseases in the UK
Neonatology
● Counsel parents whose is 23+ weeks pregnant who has gone
into labour . . . (also for
differing gestations)
● Explain to a medical student about survival of preterm neonates,
including the
epicure study
● Counsel parents regarding the finding of a grade 1/2/3/4 IVH
bleed in their infant
and what this means
● As above, vitamin K in the newborn and physiological vs non
physiological jaundice
● Explain to a medical student some of the common problems
associated with
prematurity
Nephrology
● My child has an UTI. What is the treatment and follow up? Why
is this necessary?
● My child wets the bed at night. Why and what the treatment
options?
Neurology
● Neonatal neurology – HIE, PVL, IVH
● Counsel parents with first seizure/ongoing seizures etc including
medical
management
● My child has a headache . . . . I want a scan. What are the
different types of
headaches and treatment options.
● Non-accidental head injury
● Cerebral palsy – breaking bad news to parents.
Respiratory
● Management of chronic asthma – know the BTS guidelines, how
to use a
puffer/inhaler etc
● Counselling parents on the importance of treatment after an
acute episode requiring
admission with poor compliance
● Cystic fibrosis
- Genetics: explain the inheritance and likelihood of transmission
- Diagnostic tests available
- Ongoing management. Remember GI effects also.
- Follow up/management
● Bronchiolitis – parents with ex 28 week infant want to know if
their child should be
vaccinated and how can they avoid their child getting it?
Rheumatology/Musculoskeletal
● Counsel parents regarding diagnosis of JIA
Surgery
● Antenatal counselling of diagnosis of congenital diaphragmatic
hernia/exomphalos
etc
Additional
● Managing difficult situations – ie importance of recannulation
after several missed
attempts for bacterial meningitis etc