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Points : 42144
Join date : 2013-12-26

PostSubject: AMC Clinical exam preparation   Sat Dec 28, 2013 1:56 pm

amc clinical exam

Mother of 2 year old child came in because she is concerned about the development of her child and also reduced eating.

Task- Ask the mother’s concern , ask examination findings from examiner and manage accordingly. ( GP setting)

Me- Hello, how can I help you today?
RP- Doc, I am worried for my child cos he is not eating as much as he ate before.

Me- Can you tell me a little more about it?
RP- He seems more interested in playing and very picky at food. He just chooses the food he likes and stopped eating after eating a little bit.

Me- When did it start?
RP- Few months now.

Me- Any vomiting and problems during feeding like choking or difficulty swallowing?
RP- No

Me- Does he eat regular meals 3 times a day? Does he eat snacks ? What sorts of food does he like?
RP- Yes, he joins family dinner regularly, he also eats at child care but he just seems very picky and eats a little bit only.

Me- Apart from that , do you have any other concerns? Any recurrent fever, diarrhoea, cough ? Bowel and urination ok ?
RP- No other concerns.

Me-How do you think of his growth?
RP- Umm, he has one sister and I think growth is same as his sister. No worries for that.

Me- Any concerns with his development?
RP- No ( I am a bit confused at this stage cos the question says “ mother is concerned about development” )

Me- I asked detailed developmental history ( I don’t remember anymore) . All are normal.

Me- Do you think he is more active than other children or his sister? How is his relationship with his sister and friends? Any problems like bullying the other child at school or sister at home? Do you think he is impatient? Does he bother other children at childcare? Do you think he is a difficult child? ( ADHD questions )

RP- He plays a lot but NO to all other questions.

Me- Does he like to stay on his own or like playing with other children and sister? Any eye to eye contact? Any repetitive behaviors? Any attachment to particular toys or something ?
( Autism questions )

RP- No to all questions.

Me- Any concerns with hearing or vision?
RP- No

Me- Any complications during pregnancy?
RP- No

Me- NSVD ? Prolonged labour/ obstructed labour ? Any instrumental delivery? Any prolonged resuscitation after delivery ? Any low sugar after delivery? Any prolonged hospital stay? Any jaundice ?
RP- No to all.

Me- Immunisation up to date? Any other significant medical issues after delivery?
RP- No

Examiner was hurrying to give P/E findings to me. I was also very confused whether it is just fussy eater or some other significant things.
In question, it says “ Mom is concerned of development” so I was expecting something. But when I really talked with her, everything seems normal so I thought I am missing something.

Examination findings

General Appearance- A very active child playing around the room. Eye to eye contact present.

Growth chart for Ht and Wt given. Have to check by yourself though you don’t need to plot on your own.
Both ascending and between 25 th to 50 th.
Explained the RP.

Vital signs- NAD
CNS examination- NAD
Signs of CP ( Scissoring, tip toe walking) – None

Me- Distraction hearing test?
Examiner interrupted me and says the examination findings are non contributory. You can just see a very active child just interested in his playing. You can’t grasp him.

It makes me still confused. However, I got no time and I just decided it to be fussy eater.

Me- Well Mrs X, I have just examined your baby. Apart from being very playful, he seems ok in everything. As you see, he is growing well, doing things like other children.
It seems that he is just being a fussy eater. And it is very common in children of this age group.
At 2 years , energy requirement is less than first year and they became more playful.
So, parents are always concerned that their child eats less than usual.
As long as a child is thriving well, I am not very concerned.

I just want to suggest you simple things. Be patient while feeding him. Don’t punish him for not eating much. Don’t push him to eat food. Make a variety of nutritious foods and let him choose whatever he likes in the table. I can refer you to a dietician if you want to know more about nutritious food.
Try some finger foods which will be fun for him.

And at the same time, I want to refer him to a Pediatrician for hearing and vision testing and for second opinion if you are worried.
( Actually I am just inconfident of my diagnosis and said this unwillingly).

Bell rang and examiner says “ do you still want to test hearing and vision while mom has no concern? “
I smiled at him and didn’t give any answer.

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