Education

SHORT CASES IN AUSTRALIAN RACP CLINICAL

EXAMINATION IN PAEDIATRICS & CHILD HEALTH

T
he Clinical Examinations in both to elicit the clinical signs agreed upon by not focused on the diagnosis, but rather
Adult Medicine and Paediatrics & two senior examiners. Examiners recognise on your ability to elicit and interpret
Child Health consist of two long the variable diffi culty of each case and physical signs. For example, you need to
cases and four short cases. Each make allowances for this. They also make be able to tell a peripheral neuropathy
candidate is examined by a total of eight allowances for signs that they do not from a myopathy, a systolic murmur
examiners. The format and method of agree on. from a diastolic murmur, to examine a
the long case developed by the RACP has childs chest or abdomen with reasonable
led to a substantial improvement in the We think this simple list of diagnoses will accuracy, to examine a child with
published reliability of this assessment be useful to you, but you dont need to developmental delay or short stature and
method. The RACP Clinical Examination rush off to the textbooks and look up to relate well to the child and their carer. It
has been extensively analysed and it all the rare conditions. The marking is is really no scarier than that.
has been found to be highly reliable
and a valid means of testing the clinical Summary of diagnoses of children used as Short Cases in
curriculum. M oreover, it focuses trainees Australian RACP Paediatric Clinical Examination in 2009
on developing important and real life System Diagnosis N umber of cases
clinical skills. Contrary to rumour, there
is no difference in marks awarded from Central nervous system Hemiplegia 12
different examining hospitals and the Cerebral palsy +/ Hydrocephalus 5
variance between examiners and between Spastic diplegia/ quadriplegia 5
cases is less than 1%. Trainees need not be
afraid of being disadvantaged by having a Charcot Marie Tooth and other peripheral neuropathies 3
particularly diffi cult case or a particularly N emaline rod and other myopathies 3
hawkish examiner. Ataxia 2
Each short case counts for 10% of the Cerebellar degeneration / hypoplasia 2
total examination mark, and as there are
Dermatomyositis 2
four cases, they contribute to 40% of the
total mark. The long and short cases test Muscular dystrophy 2
different aspects of the curriculum. The Hemihypertrophy 2
domains tested by each assessment tool
M oebius syndrome 2
have been published previously and are
available on the RACP trainees website. Sturge Weber syndrome 2
The short cases concentrate on physical Brachial plexus injury 1
examination skills and are aimed at testing Charge syndrome 1
a broad range of systems. They also
provide an opportunity for examiners to Choreoathetosis 1
directly observe the ability of trainees to Complex ophthalmoplegia 1
interact with a child and his carers. Duane syndrome 1
Stephen Judd has analysed all the short Hypothalamic astrocytoma 1
cases examined in the 2009 Clinical Facial nerve palsy and deafness 1
Examination. The Adult Medicine cases
were published in RACP News in December Post encephalitis 1
2009 and we now present the cases for the Posterior fossa tumour 1
2009 Paediatrics & Child Health Clinical Facial nerve palsy and deafness 1
Examination (see Table). We do this for
transparency and to help candidates Hemihypertrophy 1
prepare for the sort of clinical cases they Rett syndrome 1
might expect to see in the examination. Septo-optic dysplasia 1
The list of diagnoses is superfi cially Spinal muscular atrophy 1
quite scary and includes conditions that Tuberous sclerosis 1
the authors of this piece and many of
the examiners will be unfamiliar with. Cardiovascular Aortic stenosis +/ Incompetence 9
However, we emphasise again that the aim Congenital heart disease +/ Cyanosis 8
of the short cases is to test the ability of VSD +/ Patent ductus arteriosus 7
candidates to detect and interpret clinical
Pulmonary stenosis +/ Vater syndrome 4
signs. The aim is not to make obscure
diagnoses. Mitral Incompetence +/ Marfan syndrome 4

M oreover, prospective candidates can be LV outfl ow obstruction +/ Williams syndrome 4

reassured that the examiners also see the N oonan syndrome +/ Pulmonary stenosis 3
short cases blind and do not know the ASD +/ Pulmonary stenosis 3
diagnosis before seeing the patient. Thus,
candidates are being tested on their ability Hypoplastic left heart 2

36 RACP News April 2010

System Diagnosis N umber of System Diagnosis N umber of
cases cases
Cardiovascular Dextrocardia +/ Valve disease 2 Growth Marfan syndrome 3
RV outfl ow obstruction 1 Russell Silver syndrome 3
Restrictive cardiomyopathy 1 Achondroplasia 2
Pulmonary stenosis and Alagille syndrome 1 Turner syndrome 2
Patent ductus arteriosus 1 Constitutional 1
Development Prematurity +/ Cerebral palsy 3 Pierre Robin syndrome 1
Agenesis corpus callosum 1 Prematurity 1
Charge syndrome 1 Undiagnosed 1
N eurofi bromatosis 1 Haematology Hereditary spherocytosis 3
Undiagnosed global delay 1 Haemoglobinopathy 1
Hydrocephalus 1 Autoimmune lymphoproliferative disease 1
Kabuki syndrome 1 Wiskoff Aldrich syndrome 1
Hemiplegia 1 Metabolic Gaucher syndrome 1
Langer-Gledion syndrome 1 Glycogen storage disease 1
Lissencephaly 1 N eurofi bromatosis 1
Lowie syndrome 1 Niemann Pick disease 1
Pfeiffer syndrome 1 Osteomalacia 1
Sturge Weber syndrome 1 M obility Prune belly variant 1
Spastic quadriplegia 1 Undiagnosed 1
Endocrinology Diabetes 2 Musculoskeletal Infl am matory arthritis 6
Premature thelarche 1 Russell Silver syndrome 1
Thyroid enlargement 1 TAR syndrome 1
Gastroenterology Portal hypertension, various causes 8 Renal Polycystic disease 2
Biliary atresia 2 Respiratory Cystic fi brosis 5
Triad syndrome 2 Kartagener syndrome 3
Triad syndrome 1 O thers (lung surgery, obstructive lung 3
disease, pulmonary agenesis)
Growth Coeliac disease, short bowel, chronic renal 3
disease Bronchiectasis 1

Professor David Isaacs FRACP

Associate Professor Stephen Judd OAM FRACP
Professor Mike South FRACP

FREE INFLUEN ZA VAC CINATIO N WH O IS ELIGIBLE IN 2010?

From 1 January 2010, eligibility for the
free seasonal infl uenza vaccine under
the N ational Im munisation Program has
been extended to include:
All individuals aged 65 years and
over
All Aboriginal and Torres Strait
Islander people aged 15 years and
over
Pregnant women
Individuals aged six months and
over with medical conditions
predisposing to severe infl uenza, function, including multiple
including: sclerosis, spinal cord injuries and
cardiac disease seizure disorders
chronic respiratory conditions impaired im munity, including
other chronic illnesses requiring HIV, malignancy and chronic
regular medical follow-up or steroid use
hospitalisation in the previous children aged six months to
year (such as diabetes mellitus, ten years on long-term aspirin
chronic metabolic diseases, therapy.
chronic renal failure and
Further information is available on the
haemoglobinopathies)
Department of Health websites for
chronic neurological conditions
each state and territory.
that impact on respiratory

RACP News April 2010 37