Vivas

branching clinical structured oral

22q11.2 deletion syndrome — branching viva

Branching viva on 22q11.2 deletion syndrome: recognising the multisystem fingerprint that earns a chromosomal microarray, staging every system at diagnosis, deferring live vaccines until the immune system is mapped, and managing the acute neonatal presentations and the adolescent psychiatric risk.

structured-oral

Acute metabolic decompensation: recognition and stabilisation

Viva on pattern recognition and emergency stabilisation of acute metabolic decompensation in a child.

branching clinical structured oral

Amino-acid disorders including phenylketonuria and MSUD — branching viva

Branching viva on the inherited amino-acid disorders: recognising PKU, MSUD, tyrosinaemia type I and homocystinuria on their metabolite and clinical signatures, delivering the acute 'switch off catabolism, clear the toxin' protocol for an MSUD crisis, and locking in long-term diet, cofactor and enzyme-substitution therapy with maternal PKU and homocystinuria counselling.

branching clinical structured oral

Chromosomal microarray, exome and genome sequencing — branching viva

Viva on the genomic resolution ladder, tiered test selection, variant interpretation, secondary findings, and rapid sequencing in the critically ill infant.

structured-oral

Dietary, cofactor and emergency management of metabolic disease

Viva on the four pillars of metabolic management, the sick-day regimen, and the cofactor-responsive disorders.

branching clinical structured oral

Disorders of metal metabolism: Wilson and Menkes disease — branching viva

Branching viva on the inherited copper transport disorders: the unifying ATPase concept, the three faces of Wilson disease and the integrated copper panel, the Leipzig score, the chelation-zinc-transplant management ladder, the acute Wilsonian crisis, and the infantile regression and copper histidinate therapy of Menkes disease with its X-linked counselling.

branching clinical structured oral

Down syndrome — branching viva

Branching viva on Down syndrome: recognising the three genetic mechanisms and the counselling implications, mapping the comorbidities by system, applying the age-stratified health-supervision schedule, and managing the acute newborn presentations.

branching clinical structured oral

Dysmorphology examination — branching viva

Viva on structured dysmorphology examination, anomaly classification, syndrome differential and tiered genetic testing.

structured-oral

Ethical issues in genomic diagnosis and cascade testing

Viva on the ethical classification of paediatric genetic tests and the management of predictive testing, secondary findings, and cascade testing.

branching clinical structured oral

Fatty-acid oxidation disorders — branching viva

Branching viva on the fatty-acid oxidation disorders: recognising the hypoketotic hypoglycaemia signature, delivering the intravenous-dextrose emergency protocol, localising the defect with plasma acylcarnitines, and locking in long-term management with fasting avoidance, a sick-day plan and triheptanoin for long-chain defects.

branching clinical structured oral

Fragile X syndrome — branching viva

Branching viva on fragile X syndrome: recognising the indication to test, explaining the FMR1 CGG-repeat expansion and FMRP loss, confirming the molecular diagnosis with PCR plus methylation analysis, classifying the allele, building comorbidity-driven support, and running cascade testing with premutation surveillance.

branching clinical structured oral

Genetic deafness and blindness syndromes — branching viva

Branching viva on genetic deafness and blindness: building the tiered workup for the infant who fails newborn hearing screening, separating GJB2 from syndromic causes, recognising the ECG that identifies Jervell and Lange-Nielsen, and branching to the deaf child who develops night blindness as Usher syndrome.

branching clinical structured oral

Genetic history, pedigree construction and inheritance patterns — branching viva

Branching viva on the genetic family history: constructing a standardised three-generation pedigree, recognising each inheritance pattern from its shape, applying recurrence-risk arithmetic, and counselling a consanguineous couple while handling the confounders of penetrance, mosaicism and anticipation.

branching clinical structured oral

Genomic testing, variant interpretation, and counselling — branching viva

Branching viva on genomic testing in paediatrics: choosing the right test from the hierarchy, applying the ACMG/AMP five-tier variant classification framework, managing variants of uncertain significance and secondary findings, delivering pre- and post-test counselling, and coordinating cascade testing and re-analysis.

branching clinical structured oral

Glycogen-storage and carbohydrate metabolism disorders — branching viva

Branching viva on the glycogen-storage and carbohydrate metabolism disorders: recognising the hepatic glycogenoses through hepatomegaly with fasting hypoglycaemia and lactic acidosis, separating Pompe disease by its cardiomyopathy and hypotonia, delivering the 'prevent fasting' management with cornstarch and continuous glucose, and holding galactosaemia and hereditary fructose intolerance as the toxic-sugar disorders.

branching clinical structured oral

Hypoglycaemia due to inherited metabolic disease — branching viva

Branching viva on hypoglycaemia due to inherited metabolic disease: recognising hypoketotic hypoglycaemia as a metabolic emergency, capturing the critical sample, classifying the cause into insulin-driven, glucose-production failure, and fuel-oxidation block, and delivering disease-specific therapy with diazoxide, carnitine and cornstarch.

branching clinical structured oral

Inborn errors presenting with neurological regression — branching viva

Branching viva on the inborn errors of metabolism that present with neurological regression: recognising regression as a red flag, grouping the disorders by affected pathway, deploying a tiered metabolic-and-genomic workup, identifying the treatable subset, and matching the disease-modifying therapy to central-nervous-system involvement.

branching clinical structured oral

Klinefelter syndrome and sex chromosome aneuploidy — branching viva

Branching viva on Klinefelter syndrome and sex chromosome aneuploidy: recognising the clinical pattern across the lifespan, the extra-X gene-dosage model and X-inactivation escape genes, the endocrine trajectory and testosterone replacement, the neurodevelopmental and psychosocial phenotype, the prenatal counselling cascade, and the lifespan surveillance framework.

branching clinical structured oral

Lysosomal storage disorders — branching viva

Branching viva on the lysosomal storage disorders: recognising the cardinal clinical patterns, classifying by stored substrate, confirming with a layered enzyme-and-genotype workup, and matching the disease-modifying therapy to central-nervous-system involvement.

branching clinical structured oral

Marfan syndrome and heritable connective-tissue disorders — branching viva

Branching viva on Marfan syndrome and the heritable connective-tissue disorders: recognising the marfanoid phenotype, confirming with the revised Ghent nosology and FBN1 sequencing, applying the lifelong aortic-root surveillance and treatment plan, distinguishing Marfan from Loeys-Dietz, vascular Ehlers-Danlos, Beals and homocystinuria by gene and lens direction, and cascade testing the family.

structured-oral

Mitochondrial disease

Structured oral viva on the dual-genome logic, threshold effect, and clinical recognition of mitochondrial disease across high-energy-demand tissues.

branching clinical structured oral

Mucopolysaccharidoses and oligosaccharidoses — branching viva

Branching viva on the mucopolysaccharidoses and oligosaccharidoses: recognising the coarse-facies phenotype, classifying the subtypes by stored substrate and the discriminating cornea-versus-intellect signs, confirming with a layered urine-and-enzyme-and-genotype workup, and matching the disease-modifying therapy to central-nervous-system involvement.

branching clinical structured oral

Neurofibromatosis type 1 and type 2 — branching viva

Branching viva on neurofibromatosis: applying the NIH diagnostic criteria for NF1, explaining the neurofibromin/RAS mechanism, building surveillance around optic glioma and plexiform neurofibroma, and separating NF2 as a chromosome-22 merlin disorder of bilateral vestibular schwannomas.

branching clinical structured oral

Noonan syndrome and RASopathies — branching viva

Branching viva on Noonan syndrome and the RASopathies: recognising the shared RAS/MAPK pathway phenotype, distinguishing Noonan from Costello and CFC by gene and cardiac profile, confirming with a multigene panel, and applying the genotype-aware surveillance schedule.

branching clinical structured oral

Organic acidaemias — branching viva

Branching viva on the organic acidaemias: recognising the high-anion-gap metabolic acidosis that distinguishes them from the urea cycle disorders, delivering the 'treat on suspicion' emergency protocol with carnitine and toxin removal, trialling cofactor responsiveness in methylmalonic acidaemia, and locking in long-term medical and transplant-based management with family counselling.

branching clinical structured oral

Peroxisomal disorders — branching viva

Branching viva on the peroxisomal disorders: recognising the cardinal clinical patterns, classifying into biogenesis disorders and single-enzyme deficiencies, confirming with a plasma very-long-chain fatty acid panel, and matching the disease-modifying therapy to the disorder and its pace.

branching clinical structured oral

Prader-Willi and Angelman syndromes — branching viva

Branching viva on Prader-Willi and Angelman syndromes: recognising the neonatal hypotonia of PWS and the ataxic happy demeanour of AS, explaining the reciprocal imprinting mechanism at 15q11-q13, confirming the molecular diagnosis with methylation analysis, determining the subtype for recurrence-risk counselling, building syndrome-specific management, and running cascade genetic counselling.

branching clinical structured oral

Prenatal diagnosis and reproductive genetics — branching viva

Branching viva from a positive cell-free DNA screen through microarray interpretation, variant of uncertain significance reasoning, consanguinity and PGT-M counselling, and the paediatrician's role in translating genotype to postnatal plan.

branching clinical structured oral

Skeletal dysplasias — branching viva

Branching viva on the skeletal dysplasias: recognising the lethal short-limbed newborn and the disproportionate child, classifying by molecular pathway, confirming with a skeletal survey and molecular testing, and matching the therapy to the diagnosis while running surveillance for the lethal complications.

branching clinical structured oral

Syndromic craniosynostosis and craniofacial disorders — branching viva

Branching viva on syndromic craniosynostosis: recognising the head-face-limb fingerprint, naming the big six by gene, mapping every fused suture, securing the airway, the exposed eye and raised intracranial pressure before any cosmetic plan, and coordinating an age-based craniofacial team.

branching clinical structured oral

Tuberous sclerosis complex — branching viva

Branching viva on tuberous sclerosis complex: applying the 2012 consensus diagnostic criteria, explaining the hamartin-tuberin-Rheb-mTORC1 mechanism, building surveillance around SEGA and epilepsy, and offering everolimus for growing SEGA and refractory seizures.

branching clinical structured oral

Turner syndrome — branching viva

Branching viva on Turner syndrome: recognising the age-based presentations, explaining the SHOX-driven pathophysiology, confirming the karyotype and classifying it, building the growth-hormone and timed-oestrogen management, and running the cardiovascular and gonadoblastoma surveillance — then branching to the Y-mosaic gonadectomy decision and the pregnancy aortic-risk counselling.

branching clinical structured oral

Urea cycle disorders and hyperammonaemia — branching viva

Branching viva on the urea cycle disorders: recognising the neonatal and late-onset presentations of hyperammonaemia, localising the defect with plasma amino acids and urinary orotic acid, delivering the 'treat on suspicion' emergency protocol, and locking in long-term medical and transplant-based management with family counselling.

branching clinical structured oral

Williams syndrome — branching viva

Branching viva on Williams syndrome: recognising the multisystem pattern of the 7q11.23 microdeletion, explaining the ELN-driven elastin arteriopathy and coronary risk, confirming the deletion with chromosomal microarray, managing infantile hypercalcaemia, and counselling the autosomal dominant inheritance.

branching clinical structured oral

AAC and assistive technology — branching viva

Structured oral on early AAC, PECS/SGD evidence, seating/access, powered mobility and hospital communication safety.

branching clinical structured oral

Adolescent transition for neurodevelopmental disability — branching viva

Viva on structured transition, readiness, warm handoff and crisis rescue in neurodevelopmental disability.

branching clinical structured oral

Attention-deficit hyperactivity disorder — viva

Branching viva on ADHD diagnosis, mimics, multimodal treatment and monitoring.

branching clinical structured oral

Autism spectrum disorder — viva

Branching structured oral on autism spectrum disorder assessment and management.

branching clinical structured oral

Behavioural assessment and functional analysis — branching viva

Branching viva on functional assessment, four functions, PBS/FCT, medical screen and medication thresholds.

branching clinical structured oral

Behavioural management of defiance and oppositional behaviours — branching viva

Branching viva on ODD formulation, coercive cycles, parent training, ADHD comorbidity, medication boundaries and safeguarding.

branching clinical structured oral

Cerebral palsy early recognition — branching viva

Viva on CP definition, early detection tools, GMFCS/MACS and communication.

branching clinical structured oral

Cerebral palsy surveillance — branching viva

Branching viva on CP definition, functional scales, hip surveillance, tone pathways, medical-home coordination and transition.

branching clinical structured oral

Children with developmental disability in acute care — branching viva

Structured oral on diagnostic overshadowing, pain tools and reasonable adjustments in ED.

branching clinical structured oral

Children with disability in school and community settings — branching viva

Structured oral on school letters, ICF function, emergency plans and transition.

branching clinical structured oral

Developmental assessment — branching viva

Viva on history, examination, tool choice and synthesis.

branching clinical structured oral

Developmental coordination disorder — branching viva

Branching viva on DCD criteria, red flags, tools, task-oriented care, comorbidity and activity risk.

branching clinical structured oral

Developmental delay: global diagnostic approach — viva

Branching structured oral on global developmental delay diagnostic approach.

branching clinical structured oral

Developmental regression — branching viva

Branching viva on urgent diagnostic approach to developmental skill loss.

branching clinical structured oral

Early intervention and developmental care planning — branching viva

Viva on parallel EI referral, family goals, urgent gates and evidence humility.

branching clinical structured oral

Family-centred developmental care and goal setting — branching viva

Structured oral on PFCC, F-words, ICF-CY and GAS/COPM co-production.

branching clinical structured oral

Feeding problems, food refusal and selective eating — branching viva

Branching viva from toddler neophobia reassurance through autism selectivity, ARFID fear subtype, growth faltering and tube-exit planning.

branching clinical structured oral

General movements and HINE — branching viva

Viva on GMs, HINE, combined early detection and family communication.

branching clinical structured oral

Hearing impairment and development — branching viva

Structured oral on PCHI classification, early intervention, CI evidence, mild loss and OME.

branching clinical structured oral

Intellectual developmental disorder — branching viva

Branching viva on IDD criteria, aetiological evaluation, anti-overshadowing and transition.

branching clinical structured oral

Motor delay, hypotonia and the floppy infant — branching viva

Branching viva on tone versus strength, central versus peripheral localisation, SMA, botulism, maternal myotonia and disposition.

branching clinical structured oral

Neurodiversity-affirming developmental care — branching viva

Structured oral on affirming posture, double empathy, language preference, camouflaging/burnout and medical vigilance.

branching clinical structured oral

Normal cognitive, emotional and behavioural development — branching viva

Viva on temperament, executive function, self-regulation and escalation thresholds.

branching clinical structured oral

Normal growth from fetal life through adolescence — viva

Branching structured oral on normal growth physiology, chart choice and red-flag patterns.

branching clinical structured oral

Normal language and social communication — branching viva

Viva on normal language milestones, social communication and red-flag action.

branching clinical structured oral

Normal motor development and developmental variation — branching viva

Viva on WHO motor windows, quality of movement, variation patterns and escalation thresholds.

branching clinical structured oral

School refusal and school attendance problems — branching viva

Branching viva on school refusal formulation, Kearney functions, graded return, CAMS/Melvin evidence, and certificate pitfalls.

branching clinical structured oral

Sensory processing differences — branching viva

Structured oral on sensory classification, ASD evidence, OT interventions and ethics of tactile defensiveness.

branching clinical structured oral

Social communication concerns — branching viva

Viva on autism red flags, M-CHAT-R/F limits and early referral counselling.

branching clinical structured oral

Specific learning disorders — branching viva

Branching viva on SLD definition, domain classification, medical exclusion, vision-therapy counselling, comorbidity and school–health planning.

branching clinical structured oral

Speech and language delay — branching viva

Branching viva on speech versus language, hearing, DLD terminology, autism branch and closed-loop care.

branching clinical structured oral

Temper tantrums, aggression and emotional dysregulation — branching viva

Branching viva on developmental temper loss, ABC assessment, parenting evidence, corporal punishment counselling, telehealth access and safety conversion.

branching clinical structured oral

Toilet training and elimination behaviour — branching viva

Viva on toilet-training readiness, enuresis phenotype and non-punitive elimination management.

branching clinical structured oral

Visual impairment and development — viva

Branching structured oral on visual impairment and development.

branching clinical structured oral

ABCDE assessment and stabilisation of the acutely ill child — branching viva

A branching viva following one acutely ill child from the doorway through recognise-and-call, a hands-on ABCDE primary survey that treats each threat as found, age-appropriate oxygen, fluid, glucose and seizure decisions, recognising the tiring child, escalation to arrest doses, rural retrieval and structured handover.

branching clinical structured oral

Airway assessment and basic airway management: Viva

Branching structured oral on paediatric airway assessment and basic airway management: the anatomy that makes children obstruct, airway manoeuvres and adjunct selection, two-person bag-valve-mask ventilation, and escalation.

branching clinical structured oral

Altered conscious state in children — branching viva

A branching viva following one child with an altered conscious state from the doorway through airway security, AVPU and an age-adapted Glasgow Coma Scale, the bedside glucose and DEFG, convulsive status epilepticus at five minutes, recognition of raised intracranial pressure, and rural retrieval with a structured handover.

branching clinical structured oral

Burns assessment, resuscitation and safeguarding — branching viva

A branching viva following one burned child from pre-alert through cooling, age-adjusted TBSA estimation, modified-Parkland fluid resuscitation titrated to urine output, recognition of the threatened airway and inhalation injury, circumferential burn referral, safeguarding in parallel, and a structured handover.

branching clinical structured oral

Button-battery and magnet ingestion — branching viva

A branching viva following one child with a suspected button-battery ingestion from the doorway through airway security, the localising radiograph and the halo sign, the two-hour endoscopic removal target, the honey adjunct and its limits, the multiple-magnet counterpoint, and the delayed aorto-oesophageal-fistula teaching point, with safeguarding and prevention throughout.

branching clinical structured oral

By the product, not the symptom — household chemical exposure viva

A branching viva following one child who presents after a household chemical exposure, beginning as a suspected lamp-oil ingestion and then crossing into a caustic comparator. The candidate must identify the product, apply the contraindications of induced emesis and gastric lavage for hydrocarbons and of neutralisation for caustics, run the six-hour hydrocarbon observation, justify the six-to-twenty-four-hour endoscopy window, apply the Zargar grade, and arrange surgical and long-term surveillance.

branching clinical structured oral

Cardiogenic and obstructive shock: Viva

Branching clinical structured oral on paediatric cardiogenic and obstructive shock: recognising the cold low-output phenotype, distinguishing pump failure from mechanical obstruction, the cautious fluid and inotrope strategy, the emergency decompression of tamponade and tension pneumothorax, and the role of VA-ECMO in refractory cardiogenic shock.

branching clinical structured oral

Cardiorespiratory arrest and post-arrest care — branching viva

Branching viva on paediatric cardiorespiratory arrest and post-arrest care: recognising the arrest, achieving return of spontaneous circulation, running the post-arrest bundle, and prognosticating honestly.

branching clinical structured oral

Cardiotoxic and psychotropic medication poisoning — branching viva

A branching viva following one adolescent who presents after a deliberate overdose of unknown tablets, through the reading of the ECG and the toxidrome, the choice of antidote (sodium bicarbonate for the tricyclic widened QRS, calcium and high-dose insulin for the beta-blocker and calcium channel blocker), the avoidance of the class Ia and Ic antiarrhythmic trap, the rescue role of lipid emulsion and extracorporeal support, and the safeguarding and mental-health follow-up.

branching clinical structured oral

Care after death, unexpected child death and family support — branching viva

Branching structured oral on the unexpected child death: the immediate care-after-death response, coronial referral and certification, the multi-agency SUDI investigation, breaking bad news, and the AAP 2022 safe-sleep message for the next baby.

branching clinical structured oral

Difficult paediatric airway and emergency front-of-neck access — branching viva

Branching viva on the difficult paediatric airway: anticipating and recognising difficulty, the recognise-oxygenate-escalate-rescue sequence, supraglottic-airway rescue, and emergency front-of-neck access for cannot-intubate-cannot-oxygenate.

branching clinical structured oral

Envenomation and marine bites — branching viva

Viva on the pressure-immobilisation first aid and antivenom management of a snake-bitten child, the venom-induced consumption coagulopathy pattern and recovery, the management of an antivenom reaction, and the funnel-web and redback spider distinctions.

branching clinical structured oral

Fluid bolus therapy and vasoactive support — branching viva

A branching viva following one shocked child through fluid bolus therapy with reassessment after each aliquot, the transition to vasoactive support for fluid-refractory shock, cold versus warm shock phenotyping, the FEAST caution, the dopamine downgrade, and early retrieval in a resource-limited setting.

branching clinical structured oral

Heat illness, hypothermia and environmental emergencies — branching viva

Viva on the recognition and rapid cooling of exertional heat stroke, the Swiss hypothermia staging and the rewarming ladder, the hypothermic-arrest defibrillation and drug rules, the Lake Louise score and the altitude descent rule, and the lightning reverse-triage principle.

branching clinical structured oral

Humane restraint and behavioural support in emergency care — branching viva

A branching cross-table viva on the management of a nine-year-old boy with autism and intellectual disability brought to the emergency department in acute behavioural disturbance. The candidate is taken through ensuring safety, recognising autistic meltdown, treating reversible medical causes, leading verbal and environmental de-escalation, the oral-first pharmacological approach, escalation to parenteral rapid tranquillisation with cautions, restraint as a last resort, and the post-event debrief and safeguarding review. Designed to probe the why, the corners and the law.

branching clinical structured oral

Hypovolaemic and haemorrhagic shock — branching viva

A branching viva following one bleeding child from the doorway through recognition of compensated shock, bleeding control, activation of the paediatric massive transfusion protocol, tranexamic acid dosing and timing, prevention of the lethal triad, damage control resuscitation, early surgical and retrieval escalation, and structured handover.

branching clinical structured oral

Initial stabilisation of major paediatric head injury — branching viva

A branching viva following one child with severe traumatic brain injury from first contact through the neuroprotective primary survey, airway threshold, ventilation target, fluid strategy, raised intracranial pressure management, hyperosmolar therapy evidence, neurosurgical escalation and rural retrieval.

branching clinical structured oral

Iron, salicylate and toxic alcohol poisoning — branching viva

A branching viva following one adolescent who presents with a high-anion-gap metabolic acidosis after a deliberate overdose, through the recognition of the poison-specific signature, the choice of decontamination, the weight-based antidote (desferrioxamine, urinary alkalinisation or fomepizole), the avoidance of the three lethal traps, and the escalation to dialysis and retrieval.

branching clinical structured oral

Major trauma and paediatric trauma systems — branching viva

A branching viva following one injured child from pre-alert through team-led primary survey that controls catastrophic haemorrhage first, protects the cervical spine, weight-based fluid with early blood for haemorrhagic shock, avoiding the lethal triad, applying paediatric imaging rules, escalating to a paediatric trauma centre before local support is exceeded, and structured handover.

branching clinical structured oral

Mechanical ventilation principles in children — branching viva

Branching viva from the definition of mechanical ventilation and its modes, through the lung-protective strategy and the PALICC-2 targets, the deteriorating ventilated child, liberation and post-extubation support, and ventilator-associated pneumonia prevention.

branching clinical structured oral

Oesophageal and gastrointestinal foreign-body ingestion — branching viva

A branching viva following one toddler after a suspected button-battery ingestion, from the doorway radiograph through emergency endoscopy timing, the honey demulcent adjunct and its contraindications, recognition of delayed aorto-oesophageal fistula, and the contrast with an asymptomatic gastric coin and a multiple-magnet ingestion.

branching clinical structured oral

Opioid, sedative and recreational-drug toxicity — branching viva

A branching viva following one adolescent from the recognition of opioid and recreational-drug toxicity through an ABCDE primary survey, naloxone titrated to effective ventilation with an infusion for a long-acting agent, the flumazenil caution for a co-ingested benzodiazepine, sympathomimetic and serotonergic management of MDMA toxicity, and disposition with safeguarding and mental-health follow-up.

branching clinical structured oral

Oxygen, high-flow and non-invasive respiratory support — viva

Branching structured oral on selecting, dosing and escalating oxygen and non-invasive respiratory support in children.

branching clinical structured oral

Paediatric basic and advanced life support — branching viva

Viva on the paediatric basic life support sequence, high-quality CPR, the ALS loop with defibrillation and adrenaline, the reversible causes, and post-arrest temperature management.

branching clinical structured oral

Paracetamol poisoning — branching viva

A branching viva following one child from the recognition of a significant paracetamol ingestion through the ingestion history, the four-hour nomogram decision, activated charcoal, the intravenous N-acetylcysteine regimen, an anaphylactoid reaction, the monitoring of hepatotoxicity, and escalation when King's College criteria appear.

branching clinical structured oral

Poisoned child: structured assessment and decontamination — branching viva

A branching viva following one poisoned child from the doorway through resuscitation before decontamination, the four-question ingestion history, reading the toxidrome, calling the Poisons Information Centre, deciding on activated charcoal within the first hour, escalating to whole bowel irrigation for a sustained-release ingestion, and a structured handover with safeguarding in parallel.

branching clinical structured oral

Rapid sequence intubation in children — viva

Branching structured oral on preparing for and performing rapid sequence intubation in children across different clinical scenarios.

branching clinical structured oral

Retrieval, transport and interfacility stabilisation — branching viva

A branching viva following one critically ill child through a rural retrieval: bringing intensive care to the child, completing pre-transport stabilisation, managing the physics of altitude vibration and cold, choosing the right mode and escort, running a structured referral and handover, and rehearsing the contingency for deterioration in transit.

branching clinical structured oral

Septic shock resuscitation and vasoactive support — branching viva

A branching viva following one child from the recognition of septic shock through the first-hour bundle of oxygen, access, reassessed fluid aliquots and antibiotics, the choice of adrenaline for cold shock, recognition of fluid accumulation injury, escalation to catecholamine-resistant management, and rural retrieval and handover.

branching clinical structured oral

Shock in children: physiology and classification — branching viva

A branching viva following one child from the doorway through recognising compensated shock from the whole child, explaining the compensation-to-collapse physiology, classifying severity and phenotype, applying the fluid-as-a-ceiling principle, escalating to vasoactive support and arrest doses, and giving a structured handover.

branching clinical structured oral

Submersion injury and hypothermia — branching viva

Viva on the rescue-breath-first resuscitation of the drowned child, the Szpilman severity grades, the Swiss hypothermia staging, the rewarming ladder, and the defibrillation and drug rules for hypothermic cardiac arrest.

branching clinical structured oral

Abdominal radiograph and acute imaging decisions — branching viva

Branching viva on the acute paediatric abdominal imaging decision: the role and the low yield of the abdominal radiograph, the ALARA principle and the Pearce 2012 radiation-risk evidence, the ultrasound-first pathway for appendicitis and intussusception, the upper gastrointestinal contrast study for malrotation, and the radiograph for the perforation and the button battery.

branching clinical structured oral

Abscess drainage and minor procedures — branching viva

Branching viva on abscess drainage and minor paediatric procedures: the bedside decision between a drainable abscess, cellulitis and a necrotising soft tissue infection; the weight-based local anaesthetic dose and the prevention of local anaesthetic systemic toxicity; the loop drainage technique and the indications for adjuvant antibiotics; and the conservative-first approach to a perianal abscess in a male infant.

branching clinical structured oral

Airway suction, oxygen devices and nebuliser technique: Viva

Branching structured oral on three linked bedside skills: why oxygen devices deliver different FiO2, suction technique and its complications, and the evidence for spacer-MDI over nebuliser and for high-flow nasal cannula.

branching clinical structured oral

Artificial intelligence and clinical decision support in paediatrics — viva

Branching structured oral on the four classes of paediatric AI, how a machine-learning prediction model is built and where it fails, the validation ladder, alert fatigue and stewardship, automation bias, the retinopathy-of-prematurity and sepsis-prediction evidence, and the four deployment safeguards.

branching clinical structured oral

Audiology and hearing-test interpretation — branching viva

Branching viva on paediatric hearing-test interpretation: reading the pure-tone audiogram for degree and type, the Jerger tympanogram types and the 1000 Hz probe tone in infants, the OAE-to-ABR dissociation of auditory neuropathy, the two-stage newborn screen and the 1-3-6 milestones, and the late-onset risk in congenital cytomegalovirus.

branching clinical structured oral

Bag-mask ventilation and basic airway adjuncts: Viva

Branching structured oral on opening the airway and ventilating a child: manual ventilation device classification, one- and two-person technique, ventilation rates by context, airway adjunct selection and contraindications, and the failed-airway escalation to a supraglottic airway.

branching clinical structured oral

Blood gas, electrolyte and acid-base interpretation — branching viva

A branching viva following one child through the five-step systematic blood gas method, the choice between arterial, venous and capillary samples, Winter's formula for compensation, the anion gap and the KULT differential of a high-gap acidosis, and the corrected sodium and cerebral-oedema risk in diabetic ketoacidosis. The candidate must defend the five-step order, judge compensation correctly, and distinguish a mixed disorder from appropriate compensation.

branching clinical structured oral

Bone-marrow aspiration and biopsy principles — branching viva

A branching viva following one child with suspected acute leukaemia, through the choice of aspirate and trephine, the posterior superior iliac spine site and why the sternum is avoided, the handling of the first aspirate pull, the meaning of a dry tap, the bleeding risk in the thrombocytopenic child, and the staging decision that calls for bilateral trephines. The candidate must defend the two-samples-one-site principle, the periosteal lidocaine dose, and the corrective action for a dry tap.

branching clinical structured oral

Central venous and arterial access in children — viva

Branching structured oral on choosing the site, performing ultrasound-guided central venous and arterial access, and managing complications across a range of paediatric scenarios.

branching clinical structured oral

Chest decompression and intercostal drain insertion — branching viva

Branching viva on chest decompression and intercostal drain insertion in children: the clinical diagnosis of tension pneumothorax and immediate needle decompression at the second intercostal space mid-clavicular line or the fourth or fifth intercostal space in the anterior axillary line; the safe triangle borders and the above-the-rib-below rule; drain sizing by content; the never-clamp rule; the ventilated neonate; and the management of empyema.

branching clinical structured oral

Chest radiograph interpretation in children — branching viva

Branching viva on paediatric chest radiograph interpretation: the technical-quality check before the fields, the ABCDEFGH systematic approach, the normal paediatric thymus and the sail sign, the inhaled foreign body and air-trapping, and the radiation-aware principle of justification and ALARA.

branching clinical structured oral

Defibrillation, cardioversion and transcutaneous pacing — branching viva

A branching viva following one child through cardiac arrest with ventricular fibrillation, probing the candidate on the pulse-based decision between defibrillation, cardioversion and pacing, the energy doses, the synchronisation function, pad placement, the shockable-arrest drug sequence, and the complications. The candidate must defend the physiology of re-entry and the vulnerable period, and the reason compressions resume immediately after the shock.

branching clinical structured oral

Developmental, cognitive and behavioural assessment tools — branching viva

A branching viva following one toddler with parental concern about speech and social engagement, through the distinction between surveillance, screening and diagnostic assessment, the screening schedule, the choice of the right tool, the standard-score model, the interpretation of a positive M-CHAT-R/F, and the urgent response to regression. The candidate must defend the three-acts principle, the M-CHAT-R/F screen-positive threshold, and the rule that a positive screen is a referral, never a diagnosis.

branching clinical structured oral

Echocardiography fundamentals for general paediatricians — branching viva

Branching viva on paediatric echocardiography fundamentals: the modalities and what each shows, the Z-score normalisation, the systematic report read, the modified Bernoulli equation, and the prostaglandin resuscitation of the duct-dependent neonate.

branching clinical structured oral

Electrocardiogram acquisition and interpretation in children — branching viva

Branching viva on paediatric ECG acquisition and interpretation: the technical conventions and electrode placement, the age-specific normal ranges, the systematic seven-step read, the QTc and long QT syndrome, and the resuscitation of the paediatric tachyarrhythmia.

branching clinical structured oral

Endotracheal intubation and emergency airway equipment — branching viva

A branching viva following one child with bacterial tracheitis and a failing airway, through the decision to secure a definitive airway, the age-based tube and blade selection, the seven-step rapid sequence intubation procedure, waveform capnography confirmation, the rapid sequence drug regimen, and the prevention of hypoxia, oesophageal intubation, right main bronchus intubation and post-extubation stridor. The candidate must defend the anatomy, the formulas and the capnography standard.

branching clinical structured oral

Gastrostomy, tracheostomy and central-line troubleshooting — viva

Branching structured oral on recognising and resolving the failure modes of the paediatric gastrostomy, tracheostomy and central venous catheter across a range of acute and ward scenarios.

branching clinical structured oral

Genetic and metabolic test selection — branching viva

Branching viva on the request-side act of choosing and interpreting genetic and metabolic tests: applying the microarray-first consensus, escalating to exome, defending rapid whole-genome sequencing in the NICU, the timing of newborn bloodspot screening, the metabolic window, and the consent for an incidental actionable secondary finding.

branching clinical structured oral

Intraosseous access — branching viva

A branching viva following one child from septic shock with failed intravenous access, through the decision to place an intraosseous needle, the proximal tibial landmark and weight-based needle, confirmation and the meaning of a failed aspirate, drug and fluid administration at intravenous doses, and the prevention of extravasation, compartment syndrome and infection. The candidate must defend the physiology, the timing rule, and the conscious-child lidocaine regimen.

branching clinical structured oral

Joint aspiration — branching viva

Branching viva on joint aspiration (arthrocentesis) in children: the septic-versus-transient-synovitis prediction rule, ultrasound-guided technique for the deep hip, synovial fluid interpretation, the relative contraindications, and the haemophilia scenario.

branching clinical structured oral

Lumbar puncture in infants and children — branching viva

Branching viva on lumbar puncture in infants and children: pre-procedure assessment, positioning and technique, the antibiotics-first rule in suspected bacterial meningitis, the opening pressure and its reliability, and the management of post-dural puncture headache.

branching clinical structured oral

Medical devices, digital health and remote monitoring — viva

Branching structured oral on the four classes of paediatric medical device, the CGM and pulse oximeter sensor physiologies, the equity and accuracy failures, and the shared-decision deployment of a remote-monitoring device with a family.

branching clinical structured oral

Nasogastric tube insertion and verification — branching viva

Branching viva on nasogastric tube insertion and verification in children: the pH verification rule at 5.5 or less, the rejection of the deprecated whoosh and bubbling tests, the age-adapted tube size and technique, the choice of an orogastric route in the neonate and after facial injury, and the immediate management of a misplaced tube, a traumatic neonatal perforation, and a Never Event.

branching clinical structured oral

Neuroimaging selection and radiation-aware practice — branching viva

Branching viva on choosing between CT, MRI, cranial ultrasound and skull radiograph in children: applying the PECARN head injury prediction rules, defending the modality of choice for the first unprovoked seizure, quantifying the attributable cancer risk of paediatric CT, and counselling a parent about radiation risk.

branching clinical structured oral

Paediatric ultrasound and point of care ultrasound — branching viva

Branching viva on paediatric point-of-care ultrasound: probe selection and image-quality controls, the lung ultrasound artefact repertoire and the BLUE protocol, the focused assessment with sonography in trauma and its limited sensitivity in children, the intussusception and pyloric sonographic signs, ultrasound-guided vascular access, and focus-assessed cardiac ultrasound in shock.

branching clinical structured oral

Paediatric venepuncture and peripheral intravenous access — viva

Branching structured oral on paediatric venepuncture and peripheral intravenous cannulation across routine and difficult-access scenarios, covering site and gauge selection, the comfort bundle, ultrasound-guided access and complications.

branching clinical structured oral

Point-of-care glucose, ketone and urinalysis testing — branching viva

A branching viva following one scenario through the three core paediatric point-of-care tests: the capillary blood glucose meter and its inaccuracy in the neonate from the high haematocrit and the galactose or maltose interference with the glucose dehydrogenase strips, the blood beta-hydroxybutyrate ketone meter as the preferred measure over the urine acetoacetate in diabetic ketoacidosis with the ISPAD thresholds, and the urine dipstick with the leukocyte esterase and nitrite performance and the rule that the dipstick screens and the culture confirms. The candidate must defend the choice of test, the confirmation step, and the falsely reassuring results.

branching clinical structured oral

Procedural consent, preparation and child-life support — branching viva

Branching viva on procedural consent, preparation and child-life support: the consent-permission-assent framework and the Appelbaum capacity domains, the structured preparation conversation by developmental age, the bedside comfort bundle (topical anaesthesia, oral sucrose as absolute volume, breastfeeding, comfort positioning and distraction), the fear-tension-pain cycle, the restraint-versus-comfort-position distinction, the doctrine of necessity, and the management of needle fear and vasovagal episodes.

branching clinical structured oral

Procedural pain: topical anaesthesia, preparation, distraction and non-pharmacological support — branching viva

Branching viva on the multi-modal comfort bundle for procedural pain in infants and children: pre-procedure assessment, agent choice and timings, the methaemoglobinaemia risk of EMLA in the young infant, the sucrose dose, comfort positioning versus restraint, and when to escalate to procedural sedation.

branching clinical structured oral

Radiation protection and imaging stewardship — branching viva

Branching viva on the three pillars of radiological protection, the linear-no-threshold paediatric risk model, the CT and fluoroscopy dose quantities and the diagnostic reference level, the optimisation levers, the modern gonadal-shielding guidance, and the counselling of a parent about radiation risk and consent for imaging.

branching clinical structured oral

Safe paediatric procedural sedation — branching viva

Branching viva on safe paediatric procedural sedation: the sedation depth continuum, the pre-sedation assessment, fasting and monitoring, the pharmacology of ketamine and nitrous oxide, the management of laryngospasm and oversedation, and the recovery and discharge criteria.

branching clinical structured oral

Simple laceration repair and wound management — branching viva

A branching viva following a frightened four-year-old with a clean facial laceration, probing the structured assessment, the topical-first analgesia with LET, the choice of closure method by tension and site, the local anaesthetic maximum doses, and the transition to a contaminated dog bite to the hand that must not be closed primarily. The candidate must defend the physiology, the dosing, and the child-centred approach.

branching clinical structured oral

Suprapubic aspiration and urinary catheterisation: Viva

Branching clinical structured oral on suprapubic aspiration and urinary catheterisation covering the urine collection methods and their contamination rates, the suprapubic aspiration landmark and technique, the role of the point-of-care ultrasound, the paediatric catheter sizing, and the catheter-associated urinary tract infection prevention bundle.

branching clinical structured oral

Umbilical venous and arterial catheterisation — branching viva

A branching viva following one sick preterm infant from the decision to place umbilical venous and arterial catheters, through the vessel anatomy and courses, the Shukla birth-weight depth formula, the high and low arterial positions with the high preferred, the venous target at the diaphragm, and the radiographic confirmation of the tip, to the recognition and management of a white limb, renal artery thrombosis with hypertension, and line sepsis, with the dwell-time limits of five days for arterial and fourteen days for venous catheters.

branching clinical structured oral

Abdominal wall and umbilical disorders — branching viva

Branching viva from a newborn with bare bowel beside a normal cord, through the distinction of gastroschisis from omphalocele, the embryology, the resuscitation and the surgical pathway, with a pivot to a six-month-old ex-preterm infant with an irreducible groin mass and a question on the umbilical granuloma.

branching clinical structured oral

Acute abdominal pain in children: Viva

Branching structured oral on the child with acute abdominal pain: separating the surgical abdomen from medical mimics, the migration of pain and the Pediatric Appendicitis Score, ultrasound-first imaging and radiation stewardship, early analgesia that does not mask the diagnosis, intussusception recognition and enema reduction, and the time-critical gonadal torsions in the adolescent.

branching clinical structured oral

Acute gastroenteritis and infectious diarrhoea — branching viva

Branching viva from a toddler with watery diarrhoea and vomiting, through the clinical grading of dehydration, the mechanism of fluid loss and why oral rehydration solution works through the intact sodium-glucose co-transporter, the design of oral rehydration therapy and the place of nasogastric and intravenous fluids, the adjuncts of zinc and ondansetron, and a pivot to a child with bloody diarrhoea in whom antibiotics and haemolytic uraemic syndrome must be considered.

branching clinical structured oral

Acute liver failure: Viva

Branching clinical structured oral on paediatric acute liver failure: recognising the diagnosis without an encephalopathy requirement, empirical N-acetylcysteine, and the dynamic transplant pathway including why King's College Criteria are not validated in children.

branching clinical structured oral

Acute vomiting in infants and children: Viva

Branching structured oral on the vomiting child: recognising bilious vomiting as a surgical emergency, building the age-based differential, grading dehydration and choosing a rehydration route, the selective use of ondansetron, and the dangerous non-gastrointestinal mimics of DKA, sepsis and raised intracranial pressure.

branching clinical structured oral

Appendicitis and surgical abdomen — branching viva

Branching viva from a nine-year-old with migratory right iliac fossa pain, anorexia and tenderness, through the Pediatric Appendicitis Score, the ultrasound-first imaging pathway with magnetic resonance imaging as the radiation-sparing second line, resuscitation and analgesia that do not delay diagnosis, laparoscopic appendicectomy as the standard against the non-operative antibiotic option chosen by shared decision, and a pivot to a three-year-old likely perforated and a bilious vomit that must never be reassured.

branching clinical structured oral

Ascites and peritoneal disease: Viva

Branching clinical structured oral on ascites and peritoneal disease in children: recognising the clinical signs of ascites, calculating and interpreting the serum-ascites albumin gradient, diagnosing and managing spontaneous bacterial peritonitis, and the stepwise management of cirrhotic ascites.

branching clinical structured oral

Bilious vomiting and intestinal obstruction — branching viva

Branching viva from a term neonate with sudden bilious vomiting, through the recognition of malrotation with midgut volvulus, the anatomy of the narrow mesenteric base, the resuscitation and urgent upper gastrointestinal contrast study, the Ladd procedure, and a pivot to a distended newborn with delayed passage of meconium testing the approach to low obstruction.

branching clinical structured oral

Breastfeeding medicine and lactation support — branching viva

Branching viva from a mother with a hot, tender breast and fever, through the recognition of the mastitis spectrum and its stepwise management, the physiology of prolactin and oxytocin and the supply-equals-demand principle, the distinction between perceived and true low supply, and a pivot to a late-preterm infant at risk of poor transfer, hypoglycaemia and failing to thrive.

branching clinical structured oral

Chronic and recurrent abdominal pain: Viva

Branching clinical structured oral on chronic and recurrent abdominal pain: distinguishing functional from organic disease, the alarm-feature approach, targeted investigation, and evidence-based biopsychosocial management.

branching clinical structured oral

Chronic liver disease, cirrhosis and portal hypertension: Viva

Branching clinical structured oral on chronic liver disease, cirrhosis and portal hypertension in children: recognising the presentation of portal hypertension, the classification of causes, the acute variceal bleeding management bundle, primary prophylaxis, spontaneous bacterial peritonitis, and hepatopulmonary syndrome.

branching clinical structured oral

Coeliac disease — branching viva

Branching viva from the definition and pathogenesis of coeliac disease through the classic toddler, the adolescent with refractory iron deficiency, the child with type 1 diabetes, and the atypical presentation, testing the ESPGHAN 2020 no-biopsy pathway, the gluten-on-board rule and the selective immunoglobulin A deficiency trap.

branching clinical structured oral

Constipation and faecal incontinence: Viva

Branching clinical structured oral on childhood constipation and faecal incontinence: distinguishing functional constipation from organic causes, recognising red flags for Hirschsprung disease, and the disimpaction and maintenance regimen with behavioural support.

branching clinical structured oral

Dysphagia and oesophageal disorders — branching viva

Branching viva from a teenager with a food bolus impaction and atopy through the recognition and diagnosis of eosinophilic oesophagitis, its Th2 mechanism, the treatment ladder, and a pivot to a child with progressive dysphagia to solids and liquids in whom achalasia must be confirmed on high-resolution manometry and treated, and a final safety branch on the oesophageal button battery emergency.

branching clinical structured oral

Enteral feeding tubes and home enteral nutrition — branching viva

Branching viva from the principles of enteral feeding and device selection through the child with cerebral palsy referred for a gastrostomy, the nasogastric tube whose pH will not confirm, the non-functioning gastrostomy with buried bumper syndrome, and the dislodged tube at home, testing position verification, complication recognition and the home programme.

branching clinical structured oral

Feeding assessment and paediatric dysphagia — branching viva

Branching viva from the definition and swallow phases of paediatric dysphagia through the cough-free child with cerebral palsy, the premature infant who desaturates with feeds, and the child with a structural airway anomaly, testing the limitation of the clinical feeding evaluation, the choice between the videofluoroscopic swallow study and fibreoptic endoscopic evaluation of swallowing, and the multidisciplinary management.

branching clinical structured oral

Food protein-induced enterocolitis and enteropathy — branching viva

Branching viva from the definition and the 2017 consensus diagnostic criteria of food protein-induced enterocolitis syndrome through the infant with a delayed pallid vomiting collapse, the faltering formula-fed infant with chronic FPIES, the substitute-feed choice, the oral food challenge, and the natural history of tolerance.

branching clinical structured oral

Formula feeding and complementary feeding — branching viva

Branching viva from the principles of safe formula feeding and the timing of complementary feeding through the developmental readiness for solids at around six months, the early introduction of allergens, the never-before-twelve-months hazards, and the work-up of the infant with faltering growth.

branching clinical structured oral

Functional abdominal pain and irritable bowel syndrome: Viva

Branching clinical structured oral on functional abdominal pain and irritable bowel syndrome: applying the Rome IV criteria, subtyping IBS, distinguishing functional from organic disease, targeted investigation, and evidence-based biopsychosocial management.

branching clinical structured oral

Gastro-oesophageal reflux and reflux disease — structured oral (viva)

Branching structured oral on an unsettled thriving infant with posseting, testing the distinction between physiologic reflux and disease, the conservative-first ladder, exclusion of cow's milk protein allergy, and the evidence against acid suppression.

branching clinical structured oral

Gastrointestinal bleeding — branching viva

Branching viva from a toddler with painless bright rectal bleeding, through the upper versus lower split at the ligament of Treitz, the Meckel diverticulum and its scan, a pivot to an infant with intussusception, and a closing on the child with liver disease and variceal bleeding.

branching clinical structured oral

Hirschsprung disease — branching viva

Branching viva from a term neonate with delayed passage of meconium, through the recognition of Hirschsprung disease, the embryology of neural crest cell migration, the suction rectal biopsy with calretinin staining, the pull-through operations, and a pivot to a child presenting with enterocolitis testing the emergency recognition and treatment.

branching clinical structured oral

Inflammatory bowel disease: Viva

Branching clinical structured oral on paediatric inflammatory bowel disease: recognising the growth-centred presentation, the ESPGHAN revised Porto diagnostic criteria, induction with exclusive enteral nutrition, and stepwise escalation to immunomodulators and biologics.

branching clinical structured oral

Intussusception — branching viva

Branching viva from a seven-month-old with rhythmic colicky screaming and a sausage-shaped mass, through the recognition of the telescoping pattern, the ultrasound target sign, resuscitation before reduction, air enema as first-line therapy and surgery for failure and peritonitis, and a pivot to a four-year-old in whom a pathological lead point and the rotavirus vaccine risk-benefit must be considered.

branching clinical structured oral

Liver transplantation in children: Viva

Branching clinical structured oral on paediatric liver transplantation: the indications and graft types, the PELD score for allocation, tacrolimus-anchored maintenance immunosuppression, the diagnosis and treatment of acute cellular rejection, the recognition of hepatic artery thrombosis, and the long-term risks of post-transplant lymphoproliferative disorder and adolescent non-adherence.

branching clinical structured oral

Malnutrition: nutritional rehabilitation and monitoring — branching viva

Branching viva from a wasted 16-month-old with severe acute malnutrition, through the anthropometric criteria and the complicated-versus-uncomplicated disposition decision, the WHO phased rehabilitation from F-75 stabilisation to F-100 catch-up, the mechanism and prevention of refeeding syndrome through phosphate and potassium monitoring and thiamine, the choice of ReSoMal over standard oral rehydration solution for the dehydrated malnourished child, and a pivot to a high-resource adolescent with anorexia nervosa to test the general refeeding-syndrome safeguard.

branching clinical structured oral

Malrotation and volvulus — branching viva

Branching viva on malrotation and volvulus: recognising bilious vomiting in a previously well neonate as a midgut volvulus until proven otherwise, choosing the upper gastrointestinal contrast study over a reassuring plain film, the whirlpool and corkscrew signs, resuscitation and when to bypass imaging for immediate laparotomy, describing the Ladd procedure, and then branching to the older child with intermittent volvulus and the incidental finding of asymptomatic malrotation.

branching clinical structured oral

Micronutrient deficiencies — branching viva

Branching viva from the definition and mechanisms of micronutrient deficiency through the iron-deficient toddler, the rachitic infant, the breastfed infant of a vegan mother with B12 deficiency, and the malnourished child with vitamin A and zinc deficiency, testing the laboratory workup, the replacement regimens and the region-aware prevention.

branching clinical structured oral

Non-alcoholic fatty liver disease in children — branching viva

Branching viva from the definition and new nomenclature of paediatric fatty liver disease through the overweight child found on screening, the obese adolescent with persistent enzyme elevation, the child with type 1 diabetes and steatosis, and the rare decompensated presentation, testing the sex-specific alanine aminotransferase thresholds, the exclusion of mimics, the limited role of vitamin E from the TONIC trial, and the cardiovascular-predominant prognosis.

branching clinical structured oral

Normal nutritional requirements across childhood: Viva

Branching clinical structured oral on normal nutritional requirements across childhood: assessing whether a child is meeting requirements, the energy and protein needs by age, the micronutrient supplementation rules, and the staged delivery of nutrition from infancy to adolescence.

branching clinical structured oral

Nutritional management of chronic disease — branching viva

Branching viva from the definition of disease-related malnutrition through the four mechanisms of increased demand, decreased intake, loss and restriction, testing the cystic fibrosis child on enzymes and fat-soluble vitamins, the chronic kidney disease child on the KDOQI protein and mineral plan, the cardiac infant on high calorie fortified feeds, and the oncology child on stepped support, with the malnutrition diagnosis on z-scores and the refeeding precautions.

branching clinical structured oral

Oesophagitis, caustic ingestion and oesophageal injury — branching viva

Branching viva across paediatric oesophageal injury: the definition and classification, the oesophageal button-battery emergency, the caustic ingestion pathway, and the child with dysphagia and eosinophilic oesophagitis.

branching clinical structured oral

Paediatric feeding disorder: nutritional and gastrointestinal management — branching viva

Branching viva from the consensus definition and four domains of paediatric feeding disorder through the child with reflux and food refusal, the tube-dependent former premature infant, the autistic child with food selectivity, and the distinction from avoidant/restrictive food intake disorder, testing the stepped multidisciplinary management and the gastrointestinal drivers.

branching clinical structured oral

Pancreatitis and pancreatic disorders — branching viva

Branching viva from the definition and pathophysiology of paediatric pancreatitis through the acute attack, the child on valproate, the child with hereditary pancreatitis, the child with exocrine insufficiency, and the decision about total pancreatectomy with islet autotransplantation, testing the NASPGHAN criteria, early aggressive hydration, early enteral feeding, the genetic workup and the enzyme replacement dose.

branching clinical structured oral

Parenteral nutrition and refeeding syndrome — branching viva

Branching viva from a malnourished adolescent with anorexia nervosa admitted for refeeding, through the definition and risk stratification of refeeding syndrome, the insulin-driven biochemistry, the thiamine and conservative-calorie prevention, the daily electrolyte monitoring, and on to a premature infant on long-term parenteral nutrition with a rising conjugated bilirubin where the composition streams, the glucose infusion rate, the lipid strategy and the prevention of intestinal failure-associated liver disease are probed.

branching clinical structured oral

Peptic disease and Helicobacter pylori — viva

Branching structured oral on peptic disease and H. pylori in children.

branching clinical structured oral

Persistent and chronic diarrhoea — branching viva

Branching viva from the duration definitions and mechanism classification of chronic diarrhoea through the thriving toddler, the infant with cow's milk protein allergy, the school-age child with coeliac disease, and the adolescent with inflammatory bowel disease, testing the osmotic-versus-secretory distinction and the stool-directed workup.

branching clinical structured oral

Polyps and inherited gastrointestinal cancer syndromes: Viva

Branching structured oral on paediatric gastrointestinal polyps: separating a benign isolated juvenile polyp from juvenile polyposis, familial adenomatous polyposis, and Peutz-Jeghers syndrome, the genes and cancer risks, and the surveillance, prophylactic surgery, and genetic-testing plan.

branching clinical structured oral

Short-bowel syndrome and intestinal failure — branching viva

Branching viva from a premature neonate with a high-output jejunostomy after necrotising enterocolitis, through the definition and classification, the sodium principle, intestinal adaptation and the trophic role of glucagon-like peptide 2, IFALD prevention and the lipid strategy, and on to an older child on home parenteral nutrition where teduglutide, serial transverse enteroplasty and the indications for transplant are probed.

branching clinical structured oral

Viral, autoimmune and metabolic hepatitis — branching viva

Branching viva from the aetiological classification of paediatric hepatitis through the faecal-oral acute viruses, the perinatally infected hepatitis B child and the immune-tolerant phase, the curable hepatitis C, the adolescent with autoimmune hepatitis and the simplified score, and the child with acute liver failure and Coombs-negative haemolysis who is a Wilson disease transplant emergency.

branching clinical structured oral

Aboriginal and Torres Strait Islander child health — branching viva

Structured oral on cultural safety, ACCHO partnership, ear and lung inequities, racism as exposure, and ARF reasoning.

branching clinical structured oral

Adolescent preventive health care — branching viva

Branching viva on time alone, confidentiality, HEADSS/HEEADSSS, screens, safety overrides and transition.

branching clinical structured oral

Air pollution, tobacco smoke and vaping — branching viva

Structured oral on SHS, third-hand smoke, youth vaping, household air pollution and acute EVALI principles.

branching clinical structured oral

Cardiovascular risk screening in childhood — branching viva

Viva on paediatric BP technique, lipid policy and FH.

branching clinical structured oral

Catch-up immunisation — branching viva

Viva on uncertain history, invalid doses, live-vaccine spacing and multi-visit catch-up.

branching clinical structured oral

Childcare exclusion and infection prevention — branching viva

Structured oral on exclusion principles, hygiene evidence, gastroenteritis outbreaks and CMV counselling.

branching clinical structured oral

Childhood injury prevention — branching viva

Structured oral on Haddon model, age-banded anticipatory guidance, passive strategies and modern household hazards.

branching clinical structured oral

Climate change, heat and child health — branching viva

Structured oral on heat-stroke cool-first care, sports prevention and climate-equity counselling.

branching clinical structured oral

Community needs assessment and child-health advocacy — branching viva

Viva on needs assessment, multi-level advocacy, partnership ethics and acute social-crisis branching.

branching clinical structured oral

Developmental and behavioural screening — branching viva

Branching viva on screening programme design, M-CHAT pathway, behavioural screening, equity and conversion.

branching clinical structured oral

Drowning prevention and water safety — branching viva

Structured oral on drowning definition, age-specific risk, layered prevention and rescue priorities.

branching clinical structured oral

Environmental health and children's exposure risks — branching viva

Structured oral on childhood vulnerability, CH2OPD2 history, wells, pesticides and PEHSU escalation.

branching clinical structured oral

Global child health and sustainable paediatric care — branching viva

Viva on global under-five packages, equity coverage and sustainable care prioritisation.

branching clinical structured oral

Housing insecurity, food insecurity and child health — branching viva

Structured oral on Hunger Vital Sign, housing domains, marginal food security and closed-loop care.

branching clinical structured oral

Immunisation principles and national schedule comparison — branching viva

Branching viva on vaccine platforms, valid doses, herd immunity, visit safety and national schedule comparison.

branching clinical structured oral

Indigenous child health and culturally safe care — branching viva

Structured oral on cultural safety, racism as a determinant, clinic partnership and emergency priorities.

branching clinical structured oral

Infant health supervision 3–6 months — branching viva

Structured oral on the 4–6 month visit: growth, milestones, safe sleep, maternal mood and feeding.

branching clinical structured oral

Infant health supervision 6–12 months — branching viva

Branching structured oral on 6–12-month well-child visit structure, complementary feeding and iron, developmental red flags, safe sleep, and conversion of a well visit to acute care.

branching clinical structured oral

Infant health supervision birth to 3 months — branching viva

Branching viva from day-5 weight loss and jaundice to safe-sleep counselling, screening loop-closure and maternal depression action.

branching clinical structured oral

Lead exposure and poisoning prevention — branching viva

Structured oral on no-safe-level principle, screening, source control and TLC trial limits.

branching clinical structured oral

Māori child health, Te Tiriti and culturally safe care — branching viva

Structured oral on Te Tiriti principles, cultural safety, Hui Process, SUDI equity and ARF/ear pathways.

branching clinical structured oral

Newborn bloodspot screening for inherited metabolic disease and follow-up — branching viva

Branching viva from incomplete bloodspot cards through critical CH result, galactosaemia feed safety, MCADD education and parental refusal.

branching clinical structured oral

Newborn hearing screening — branching viva

Branching viva from bilateral refer counselling through NICU modality choice, high-risk pass surveillance, cCMV progressive risk and lost-to-follow-up recovery.

branching clinical structured oral

Newborn preventive care and screening — branching viva

Branching viva from incomplete newborn package through CCHD fail, hearing refer, vitamin K decline and rural transfer.

branching clinical structured oral

Passenger, bicycle, pedestrian and firearm safety — branching viva

Structured oral on restraint ladder, helmets, pedestrian supervision and firearm storage counselling.

branching clinical structured oral

Population health, epidemiology and prevention in paediatrics — branching viva

Viva on population definition, Rose strategy, Haddon matrix, herd immunity and low-value population testing.

branching clinical structured oral

Preschool health supervision — branching viva

Viva on preschool preventive visit structure, school readiness and referral.

branching clinical structured oral

Preventive paediatrics and the well-child visit — branching viva

Branching viva on well-child visit architecture, development pathway, social determinants and conversion to acute care.

branching clinical structured oral

Rural, regional and remote child-health inequities — branching viva

Viva on rural inequity mechanisms, readiness, telehealth versus retrieval and medical-home design.

branching clinical structured oral

Safe sleep and SUDI prevention — branching viva

Structured oral on definitions, triple-risk model, counselling and hazardous shared sleep.

branching clinical structured oral

School health and school-based care — branching viva

Viva on school health models, executable plans, anaphylaxis readiness and clinic–school integration.

branching clinical structured oral

School-age health supervision — viva

Branching viva on school-age well visits, screening tiers and anticipatory guidance.

branching clinical structured oral

Screening test principles in children — branching viva

Viva on screening criteria, low-prevalence PPV, consent and false-positive pathways.

branching clinical structured oral

Sun protection and skin cancer prevention — branching viva

Structured oral on layered photoprotection, childhood UV risk, indoor tanning and vitamin D.

branching clinical structured oral

Toddler health supervision: 1 to 3 years — branching viva

Viva on toddler preventive visit structure, autism screen pathway and safety counselling.

branching clinical structured oral

Vaccine contraindications, precautions and adverse events — branching viva

Branching viva on vaccine safety triage, live-vaccine rules, anaphylaxis, AEFI interpretation and special populations.

branching clinical structured oral

Vaccine hesitancy and risk communication — branching viva

Branching structured oral on hesitancy definition, 3Cs, recommendation style, myth response, refusal ethics and regional context.

branching clinical structured oral

Absence, focal and generalised epilepsies — branching viva

Branching viva on absence, focal and generalised epilepsies: classifying the seizure from the eyewitness account, confirming the syndrome with the EEG, choosing the syndrome-matched first-choice medicine, applying the valproate rule in a female adolescent, and recognising the drug-resistant focal epilepsy that opens the door to surgery.

branching clinical structured oral

Acute disseminated encephalomyelitis and demyelinating disease — branching viva

Branching viva on acute disseminated encephalomyelitis and the acquired demyelinating syndromes of childhood: recognising the first event and the mandatory encephalopathy that defines ADEM, separating the four entities on the antibody triad of MOG-IgG, aquaporin-4 IgG, and cerebrospinal-fluid oligoclonal bands, treating the acute attack with high-dose corticosteroids and escalating when steroid-refractory, and never starting a multiple-sclerosis disease-modifying therapy before the antibody status is known.

branching clinical structured oral

Acute neuromuscular respiratory failure: Viva

Branching clinical structured oral on paediatric acute neuromuscular respiratory failure covering the respiratory pump and the two mechanisms of failure, the bedside forced vital capacity, maximum inspiratory pressure, and maximum expiratory pressure monitoring with the Lawn twenty-thirty-forty thresholds and the Durand and Sharshar predictors, the airway decision between non-invasive ventilation and intubation, the avoidance of suxamethonium and use of rocuronium, the differential across the motor unit, the disease-specific therapy for Guillain-Barre syndrome, myasthenic crisis, and infant botulism, and the long-term ventilation decision in chronic disease.

branching clinical structured oral

Antiseizure medicines: selection, adverse effects and monitoring — branching viva

Branching viva on antiseizure medicine selection, adverse effects and monitoring: classifying the drug by spectrum and mechanism, choosing the syndrome-matched first-choice medicine, recognising the adverse-effect signature of each agent, applying the valproate pregnancy prevention programme, and managing the lamotrigine rash and the carbamazepine hyponatraemia scenarios.

branching clinical structured oral

Ataxia in children: Viva

Branching clinical structured oral on ataxia in children: applying the acute-versus-chronic framework, performing the bedside localisation, screening for the red flags that demand urgent imaging, and defending the diagnosis and management of Friedreich ataxia with the omaveloxolone evidence.

branching clinical structured oral

Autoimmune encephalitis: Viva

Branching clinical structured oral on paediatric autoimmune encephalitis covering the Graus diagnostic criteria, the anti-NMDAR presentation and its age-related variations, the pathophysiology of cell-surface versus intracellular antigen syndromes, the first-line and second-line immunotherapy ladder with doses and timing, the ovarian teratoma association, the post-herpes trigger, and the Titulaer outcome data.

branching clinical structured oral

Brain death, death by neurological criteria and organ donation: Viva

Branching clinical structured oral on brain death and death by neurological criteria in a child, covering the definition and the whole-brain versus the brainstem concept, the prerequisites and the confounders, the bedside examination of the absent brainstem reflexes, the apnoea test with the PaCO2 thresholds, the two clinical evaluations separated by the observation period, the ancillary tests, and the donation after brain death pathway.

branching clinical structured oral

Cerebral vascular malformations: Viva

Branching clinical structured oral on cerebral vascular malformations covering the classification, the neonatal high-output cardiac failure of the vein of Galen malformation, the Bicetre neonatal evaluation score, the transarterial embolisation, and the differentiation from the arteriovenous malformation and the cavernous malformation.

branching clinical structured oral

Concussion and mild traumatic brain injury — branching viva

Branching viva across three children presenting after a head injury: a fourteen-year-old rugby player dazed after a tackle who returned to play, testing sideline recognition, the imaging decision, and the graduated return to activity; an eighteen-month-old infant who fell and is now vomiting and clingy, testing the PECARN rule for the under-two age band and the safeguarding awareness; and an eleven-year-old girl with symptoms persisting beyond six weeks, testing the definition of persistent post-concussion symptoms and the active rehabilitation that replaces rest.

branching clinical structured oral

Congenital myopathies and muscular dystrophies: Viva

Branching clinical structured oral on paediatric congenital myopathies and congenital muscular dystrophies covering the creatine kinase as the first diagnostic fork, the merosin-deficient LAMA2 form with white matter changes, the dystroglycanopathies of Walker-Warburg with cobblestone lissencephaly, the collagen VI spectrum of Ullrich and Bethlem, the LMNA form with cardiac conduction disease, the central core RYR1 disease with malignant hyperthermia risk, the nemaline and centronuclear myopathies, the next-generation sequencing muscle panel, and the multidisciplinary management of respiratory, nutritional, orthopaedic, and cardiac care.

branching clinical structured oral

Developmental regression and neurodegeneration — branching viva

Branching viva on developmental regression and neurodegeneration: recognising regression as a red flag, distinguishing true progressive regression from plateau and static loss, grouping the causes by bedside pattern and tempo, deploying a tiered neuro-investigation anchored on the developmental history, brain MRI, sleep EEG and genomic sequencing, and never accepting a degenerative label until the treatable causes - autoimmune encephalitis, epileptic encephalopathies, GLUT1 deficiency, cerebral adrenoleukodystrophy - have been actively excluded.

branching clinical structured oral

Duchenne and Becker muscular dystrophy: Viva

Branching clinical structured oral on Duchenne and Becker muscular dystrophy covering the creatine kinase and the genetic confirmation by multiplex ligation-dependent probe amplification, the reading-frame hypothesis and the dystrophin-associated glycoprotein complex, the glucocorticoid backbone with prednisolone or deflazacort started at the motor plateau, the cardiac and respiratory surveillance, and the appraisal of the FOR-DMD and EMBARK trials and the precision therapies.

branching clinical structured oral

Epilepsy syndromes by age — branching viva

Branching viva on naming the ILAE 2022 epilepsy syndrome from age, semiology and EEG; matching the syndrome to its first-choice antiseizure medicine; and defending the avoidance of sodium-channel blockers in Dravet and the genetic generalised epilepsies.

branching clinical structured oral

Febrile seizures: Viva

Branching clinical structured oral on febrile seizures: confirming the age-locked definition, classifying simple versus complex versus febrile status epilepticus, terminating a prolonged convulsion, applying the 2011 AAP lumbar-puncture thresholds, and defending the case against routine prophylaxis.

branching clinical structured oral

First seizure and seizure mimics — branching viva

Branching viva across three children brought after a possible first seizure: a febrile toddler whose seizure has stopped, testing the febrile-versus-meningitis decision; a school-age child with a clear first unprovoked seizure, testing classification and the recurrence-risk conversation; and an adolescent still convulsing at fifteen minutes, testing the status epilepticus ladder from benzodiazepine to second-line agent.

branching clinical structured oral

Guillain-Barré syndrome and acute flaccid paralysis: Viva

Branching clinical structured oral on paediatric Guillain-Barré syndrome and acute flaccid paralysis covering the Brighton diagnostic criteria, the albuminocytological dissociation, the subtypes AIDP, AMAN, AMSAN, and the Miller Fisher syndrome with their antibody associations, the molecular mimicry mechanism, the first-line intravenous immunoglobulin dose of 2 g per kg over two to five days and plasma exchange as alternative, the lack of benefit of corticosteroids, the respiratory monitoring with forced vital capacity thresholds, the acute flaccid paralysis differential including acute flaccid myelitis, and the Erasmus prognostic scores.

branching clinical structured oral

Headache and migraine in children: Viva

Branching clinical structured oral on headache and migraine in children: applying the ICHD-3 criteria, screening for SNNOOP red flags, building the acute abortive pathway, and defending the stepped prophylaxis in light of the CHAMP trial and the high paediatric placebo response.

branching clinical structured oral

Hydrocephalus and shunt emergencies: Viva

Branching clinical structured oral on paediatric hydrocephalus and shunt emergencies covering the Rekate functional classification, the age-specific presentation of raised intracranial pressure, the shunt series and the CT or rapid MRI head compared to baseline, the shunt tap, the hyperosmolar bridge to theatre, and the distinction of obstruction from overdrainage and infection.

branching clinical structured oral

Hypoxic-ischaemic brain injury: Viva

Branching clinical structured oral on paediatric hypoxic-ischaemic brain injury covering the primary versus secondary injury split, the THAPCA out-of-hospital and in-hospital trial results and the Bayesian reanalysis, the targeted temperature management protocol, the neurocritical care bundle, the high rate of non-convulsive seizures, and the multimodal neuroprognostication deferred to at least 72 hours.

branching clinical structured oral

Infantile spasms and developmental epileptic encephalopathy — branching viva

Branching viva on infantile spasms and the developmental and epileptic encephalopathies: applying the West syndrome triad and the ILAE 2022 IESS definition, interpreting hypsarrhythmia, building the aetiology workup with tuberous sclerosis as the leading identifiable cause, explaining the immature-cortex and CRH stress-axis mechanism, and defending the first-line vigabatrin-versus-hormonal decision driven by the TSC status.

branching clinical structured oral

Moderate and severe traumatic brain injury: Viva

Branching clinical structured oral on moderate and severe paediatric traumatic brain injury covering the Glasgow Coma Scale severity bands and the paediatric verbal modification, the pathophysiology of raised intracranial pressure and the cerebral perfusion pressure equation, the stepwise intracranial pressure management ladder with the guideline thresholds and hyperosmolar doses, the prevention of secondary brain injury, and the appraisal of the Hutchison hypothermia and DECRA decompressive craniectomy trials.

branching clinical structured oral

Movement disorders, dystonia and chorea: Viva

Branching clinical structured oral on paediatric movement disorders covering the definition and classification of chorea, dystonia, myoclonus, tics and tremor, the Albanese 2013 two-axis dystonia classification, the basal ganglia direct and indirect pathway mechanism, the empiric levodopa trial in dopa-responsive dystonia, Wilson disease screening, Sydenham chorea as a major Jones criterion with penicillin prophylaxis, the acute dystonic reversal with an anticholinergic, the status dystonicus escalation ladder, and the dystonic cerebral palsy management ladder.

branching clinical structured oral

Myasthenia gravis and neuromuscular junction disorders: Viva

Branching clinical structured oral on paediatric myasthenia gravis and neuromuscular junction disorders covering the fatigable fluctuating weakness with preserved reflexes and pupils, the acetylcholine receptor and muscle-specific kinase and LRP4 antibody subtypes and the congenital myasthenic syndromes, the complement-mediated postsynaptic injury, the ice pack test and repetitive nerve stimulation and single-fibre neurophysiology, pyridostigmine dosing, the corticosteroid transient worsening with early steroid-sparing, the intravenous immunoglobulin and plasma exchange for crisis, thymectomy after the MGTX trial, eculizumab for refractory disease, the forced vital capacity thresholds for intensive care, the subtype-specific treatment of the congenital myasthenic syndromes, and the maternal antibody syndromes.

branching clinical structured oral

Neural tube defects and spinal dysraphism: Viva

Branching clinical structured oral on paediatric neural tube defects and spinal dysraphism covering the open and closed classification, the periconceptional folic acid prophylaxis, the maternal serum alpha-fetoprotein and fetal ultrasound, the neonatal management of myelomeningocele, the Chiari II and hydrocephalus, and the tethered cord and neurogenic bladder.

branching clinical structured oral

Neurodegenerative and leukodystrophy disorders — branching viva

Branching viva on neurodegenerative and leukodystrophy disorders: reading the contrasted brain MRI to name the mechanism group, recognising the transplant emergency of cerebral X-linked adrenoleukodystrophy, deploying a magnetic-resonance-imaging-led tiered workup, matching disease-modifying therapy to the named disorder, and understanding that the treatable leukodystrophies are treated before symptoms begin through newborn screening.

branching clinical structured oral

Neurogenetic conditions and precision diagnosis: Viva

Branching clinical structured oral on paediatric precision diagnosis covering the tiered genomic testing ladder and its diagnostic yields, the choice between chromosomal microarray, trio exome, genome, and rapid whole-genome sequencing, the American College of Medical Genetics five-tier variant classification and the management of the variant of uncertain significance, the dominance of de novo change in sporadic severe neurodevelopmental disease, periodic reanalysis, the treatable neurogenetic conditions and their targeted therapies, and the rapid whole-genome sequencing pathway in the acutely ill infant.

branching clinical structured oral

Neurological examination across childhood — branching viva

Branching viva on the age-adapted paediatric neurological examination: holding the constant six-part framework while adapting technique to age, reading tone and reflexes through corticospinal maturation, using the Hammersmith Infant Neurological Examination and General Movements Assessment for early cerebral palsy detection, splitting the floppy infant into central and peripheral causes, and assigning a Gross Motor Function Classification System level.

branching clinical structured oral

Neurorehabilitation and acquired brain injury: Viva

Branching clinical structured oral on neurorehabilitation after acquired brain injury in children, covering the definition and the International Classification of Functioning framework, the neuroplastic recovery curve and the double vulnerability, the goal-directed multidisciplinary model, the choice between constraint-induced and bimanual therapy, the spasticity management ladder with the botulinum toxin-A dosing ceiling, the cognitive rehabilitation and the return to school, and the late-emerging executive deficits and the appraisal of the trial evidence.

branching clinical structured oral

Non-epileptic events and functional seizures — branching viva

Branching viva across three young people with non-epileptic events: a thirteen-year-old whose bizarre brief nocturnal attacks could be functional or frontal-lobe epilepsy, testing the diagnostic trap and the place of video-electroencephalogram; a fifteen-year-old with treatment-resistant spells on two antiseizure drugs, testing the positive diagnosis and the pathway of explanation, drug withdrawal and cognitive behavioural therapy; and a sixteen-year-old in a prolonged emergency-department flurry, testing the safe management of status non-epilepticus and the safeguarding history.

branching clinical structured oral

Paediatric stroke and cerebral sinovenous thrombosis: Viva

Branching clinical structured oral on paediatric stroke and cerebral sinovenous thrombosis covering the classification, the arteriopathy cause search, the imaging pathway, the antithrombotic therapy for arterial ischaemic stroke, the anticoagulation for cerebral sinovenous thrombosis, and the Thrombolysis in Pediatric Stroke trial.

branching clinical structured oral

Pain, feeding and respiratory care in severe neurodisability: Viva

Branching clinical structured oral on the three threats that dominate severe neurodisability covering the principle that a change from baseline is pain or a treatable source until proven otherwise, the observational pain tools and the head-to-toe search, the instrumental swallow study and the role of gastrostomy with reflux control, and the respiratory pathway of weak cough sialorrhoea aspiration and sleep-disordered breathing with the prevention bundle and non-invasive ventilation.

branching clinical structured oral

Peripheral neuropathies: Viva

Branching clinical structured oral on paediatric peripheral neuropathies covering the Charcot-Marie-Tooth classification with CMT1A from PMP22 duplication and CMT2A from MFN2, the nerve conduction velocity threshold of thirty-eight metres per second, the clinical phenotype of pes cavus and distal wasting, the chronic inflammatory demyelinating polyradiculoneuropathy criterion of more than eight weeks and its treatment with intravenous immunoglobulin and corticosteroids, the acquired neuropathies including diabetic and chemotherapy-induced, the vincristine precaution in suspected Charcot-Marie-Tooth disease, and the Yiu 2022 paediatric management guideline.

branching clinical structured oral

Secondary headache and raised intracranial pressure — branching viva

Branching viva across three children presenting with headache: a school-age child with a progressive morning headache and vomiting, testing red-flag recognition and the choice of imaging; an adolescent girl with obesity, papilloedema and double vision, testing the Friedman 2013 criteria and the stepwise management of idiopathic intracranial hypertension; and an infant with a full fontanelle and increasing head circumference, testing the recognition of raised pressure in the child who cannot describe a headache.

branching clinical structured oral

Sleep disorders with neurological disease: Viva

Branching clinical structured oral on sleep disorders with neurological disease: applying the four-cluster classification, building the targeted investigation pathway from polysomnography to the multiple sleep latency test and cerebrospinal fluid orexin, distinguishing nocturnal frontal lobe epilepsy from a parasomnia, and defending the stepped management built on sleep hygiene and behavioural therapy with melatonin, iron, airway support, and ventilation.

branching clinical structured oral

Spasticity, dystonia and tone management: Viva

Branching clinical structured oral on paediatric spasticity, dystonia and tone management covering the Sanger classification of hypertonia, the goal-directed principle, the Modified Tardieu Scale and the GMFCS, the four core modalities of focal botulinum toxin type A, oral baclofen, intrathecal baclofen and selective dorsal rhizotomy, the intrathecal baclofen withdrawal emergency, the dystonia pathway to GPi deep brain stimulation, and the multidisciplinary prevention of musculoskeletal complications.

branching clinical structured oral

Spinal cord compression and transverse myelitis — branching viva

Branching viva on the acute spinal cord syndrome in childhood: recognising that new back pain plus a neurological deficit is a cord emergency until an emergency whole-spine MRI proves otherwise, separating the structural compressive lesion (malignancy, epidural abscess) that needs dexamethasone and surgical decompression within twenty-four to forty-eight hours from the intrinsic inflammatory transverse myelitis that needs high-dose methylprednisolone, the Transverse Myelitis Consortium 2002 criteria, the longitudinally extensive lesion pointing to neuromyelitis optica spectrum disorder or MOG-antibody-associated disease, and the principle that ambulation at presentation is the strongest predictor of outcome.

branching clinical structured oral

Spinal muscular atrophy: Viva

Branching clinical structured oral on paediatric spinal muscular atrophy covering the SMN1 deletion genetics with the SMN2 copy number modifier and the exon 7 splicing defect, the five SMA types, the clinical picture of symmetric proximal hypotonia and areflexia with tongue fasciculations and spared intellect, the genetic diagnosis by homozygous SMN1 deletion, the three disease-modifying therapies nusinersen risdiplam and onasemnogene abeparvovec with their trial evidence, newborn screening and presymptomatic treatment, and the multidisciplinary care.

branching clinical structured oral

Status epilepticus: Viva

Branching clinical structured oral on paediatric status epilepticus covering the ILAE operational definition, the pharmacodynamic basis for declining benzodiazepine efficacy, the APLS stepwise pathway from benzodiazepine to levetiracetam or fosphenytoin to anaesthetic infusion, the trial evidence from ESETT, ConSEPT, and EcLiPSE, the reversible causes, and the role of continuous EEG after paralysis.

branching clinical structured oral

Tics and Tourette syndrome: Viva

Branching clinical structured oral on tics and Tourette syndrome: applying the DSM-5 criteria, distinguishing tics from stereotypies and other mimics, building the stepped management around Comprehensive Behavioural Intervention for Tics and alpha-2 agonists, and defending the management of the comorbid attention-deficit or hyperactivity disorder and obsessive-compulsive disorder and the favourable prognosis.

branching clinical structured oral

Transition and advance care planning in neurodisability: Viva

Branching clinical structured oral on transition and advance care planning in young people with neurodisability, covering the distinction between transition and transfer, the Got Transition Six Core Elements with the age milestones of twelve fourteen eighteen and twenty-one, the transition readiness tools and the named coordinator, the dangerous transition gap, paediatric advance care planning across the four domains of goals of care ceiling of treatment resuscitation decisions and preferred place of care, and the integration of palliative care with disease-modifying treatment across the trajectory.

branching clinical structured oral

Abusive head trauma — branching viva

Branching viva on recognising abusive head trauma, building the probability of inflicted injury, the imaging and workup strategy, safeguarding and mandatory reporting, the medical mimics and the triad debate.

branching clinical structured oral

Caregiver-fabricated or induced illness — branching viva

Branching viva on recognising caregiver-fabricated or induced illness, the child-centred definition, the RCPCH alerting features, distinguishing FII from a perplexing presentation and a genuine rare disease, and the multi-agency safeguarding response that never confronts the suspected caregiver alone.

branching clinical structured oral

Child maltreatment recognition and response — branching viva

Branching structured-oral viva on recognising and responding to child maltreatment: the sentinel injury, the TEN-4-FBCP bruising rule, the abusive-head-trauma workup, the mandatory-reporting trigger, and the toxic-stress mechanism.

branching clinical structured oral

Child sexual abuse and assault assessment — branching viva

Branching viva on the tempo of the assessment, the normal examination, finding interpretation against the Adams consensus, the acute bundle with time-limited elements, and the confidentiality and reporting duties.

branching clinical structured oral

Children in out-of-home care and foster care — branching viva

Branching viva on placement and legal-status classification, consent authority, the toxic-stress mechanism and attachment, the entry-to-care assessment bundle, a lawful confidentiality and safeguarding override, and permanency and transition planning for a care-experienced child.

branching clinical structured oral

Expert reports and court evidence in child protection — viva

Branching structured oral on expert reports and court evidence in child protection: the witness-of-fact versus expert-witness distinction, the duty to the court, the report structure, the standard of proof, the evidence chain, the contested-evidence differential, and the preparation for and conduct of cross-examination.

branching clinical structured oral

Female genital mutilation or cutting — branching viva

Branching viva on the WHO classification, the at-risk girl and prevention, acute complication management, the deinfibulation pathway for Type III, and the mandatory-reporting and safeguarding duties.

branching clinical structured oral

Homelessness and housing instability — viva

Branching structured oral on homelessness and housing instability as a paediatric health problem: the housing continuum and the vital-sign screening principle, the five domains of clustered morbidity, the toxic-stress mechanism, the portable health summary, the housing intervention evidence, safeguarding and domestic-violence screening, and the advocacy role.

branching clinical structured oral

Inflicted abdominal and thoracic injury — branching viva

Structured oral on high-specificity inflicted trunk injury patterns, the occult-injury screen, concurrent trauma-and-safeguarding management, and the CPR rib-fracture myth.

branching clinical structured oral

Inflicted burns and scalds — branching viva

Branching viva on pattern-based recognition of inflicted immersion scalds, the BuRN-Tool decision rule, co-existing injury assessment, the mandatory safeguarding pathway, and the temperature-time-skin-thickness pathophysiology.

branching clinical structured oral

Inflicted fractures and other non-accidental musculoskeletal injury — branching viva

Branching viva on the high-specificity fracture patterns, the shearing biomechanics of the classic metaphyseal lesion and the lever mechanism of the posterior rib fracture, the mandatory skeletal-survey protocol with the follow-up survey, the rickets and osteogenesis-imperfecta differentials, and the safeguarding conversion in a pre-mobile infant with a spiral femur fracture.

branching clinical structured oral

Intimate partner violence and its impact on children — branching viva

Branching viva on recognising IPV exposure in children, the toxic-stress mechanism and co-occurrence with maltreatment, the trauma-informed assessment and safety bundle, the management and referral of the non-offending parent, and regional reporting thresholds.

branching clinical structured oral

Intra-oral injury and occult trauma — branching viva

Branching viva on recognising inflicted intra-oral injury, the TEN-4 FACES-B bruising rule, the occult-trauma screen (skeletal survey, neuroimaging, ophthalmology, transaminases), and the safeguarding pathway with mandatory reporting.

branching clinical structured oral

Kinship care, adoption and permanency health assessments — viva

Branching structured oral on the health assessment of children in out-of-home care: the staged assessment schedule, consent and guardianship, developmental trauma, placement stability, and the Aboriginal and Torres Strait Islander Child Placement Principle.

branching clinical structured oral

Mandatory reporting and jurisdictional child-protection frameworks — viva

Branching structured oral on mandatory reporting and jurisdictional child-protection frameworks: the reasonable-belief threshold, the recognise-to-report pathway, jurisdictional variation in obligations, barriers to reporting, and communication with children and families.

branching clinical structured oral

Medical neglect and refusal of care — branching viva

Branching viva on the omission-versus-rejection definitions, the Diekema harm-principle threshold, the four classic refusal scenarios (vaccines, vitamin K, Jehovah's Witness blood transfusion, cancer chemotherapy), separating access-based neglect from deliberate refusal, the stepped negotiate-to-escalate management, the mature-minor doctrine, and a safeguarding conversion.

branching clinical structured oral

Multidisciplinary child-protection case conference — viva

Branching structured oral on the multidisciplinary child-protection case conference: conference types and statutory purpose, the paediatrician's written report and verbal presentation, information-sharing principles, decision-making biases, and the prepare-present-plan algorithm.

branching clinical structured oral

Neglect and supervisory neglect — branching viva

Branching viva on the omission-versus-commission definition, the six domains, the supervision-and-injury evidence, separating neglect from poverty, the SEEK-model prevention evidence, the support-versus-protection threshold, and a safeguarding conversion.

branching clinical structured oral

Online sexual exploitation and image-based abuse — branching viva

Branching viva on recognising online sexual exploitation, the grooming-to-sextortion mechanism, acute-suicide-risk-first assessment, evidence preservation, the dual reporting pathway, and distinguishing consensual from coerced content.

branching clinical structured oral

Perplexing presentations and diagnostic uncertainty — branching viva

Branching viva on the child whose reported symptoms do not fit any recognised disease: the RCPCH three-level escalation, the three-limb parallel differential, the judicious investigation strategy, the over-investigation spiral, the safety-netted multidisciplinary pathway, and the threshold for a child-protection referral.

branching clinical structured oral

Photodocumentation and medicolegal evidence — branching viva

Branching viva on injury photodocumentation, the three-shot rule, scale and labelling standards, secure storage and chain of custody, the fact-versus-opinion distinction, and court-statement preparation.

branching clinical structured oral

Physical abuse: bruising and sentinel injuries — branching viva

Branching viva on inflicted bruising, the TEN-4 FACES-L rule, sentinel injuries, the bleeding-disorder differential, skeletal survey and the safeguarding pathway.

branching clinical structured oral

Poisoning as maltreatment — branching viva

Branching viva on recognising poisoning as maltreatment, Rosenberg's triad, the toxicology and separation workup, the stepped multi-agency safeguarding pathway, the salt and insulin induction archetypes, and the mimics that must be excluded in parallel.

branching clinical structured oral

Poverty, food insecurity and social prescribing — branching viva

Branching viva on the classification of material hardship, the toxic-stress mechanism, universal screening with the Hunger Vital Sign, the five-step social-prescribing pathway, diagnostic overshadowing and a safeguarding override, and policy-level advocacy for children in poverty.

branching clinical structured oral

Prevention of child maltreatment and family support — branching viva

Branching structured-oral viva on preventing child maltreatment and supporting families: the three levels of prevention, the WHO INSPIRE strategies, the Nurse-Family Partnership and Triple P evidence, the toxic-stress rationale, the ACE-informed stance, recurrence prevention, and the boundary between support and protection.

branching clinical structured oral

Psychological and emotional abuse — branching viva

Branching viva on psychological and emotional abuse: Glaser's conceptual framework and the APSAC categories, the toxic-stress cascade and ACE dose-response mechanism, recognising the relational and developmental pattern, excluding concurrent maltreatment, the stepped trauma-informed safeguarding pathway, the fabricated-or-induced-illness overlap, a diagnostic-overshadowing challenge in a disabled child, and a suicide-risk interrupt.

branching clinical structured oral

Refugee, asylum-seeking and newly arrived children — branching viva

Branching viva on migration-status classification, guardianship and consent, the interpreter rule, the forced-displacement toxic-stress mechanism, the on-arrival screening bundle, the harm of immigration detention, and acculturation and transition planning for a refugee or newly arrived child.

branching clinical structured oral

Sexually transmitted infections and child sexual abuse — branching viva

Branching viva on grading an STI as evidence of sexual contact, the trauma-informed forensic evaluation, the evidence window, HIV post-exposure prophylaxis, mandated reporting and multidisciplinary safety planning.

branching clinical structured oral

Strangulation, suffocation and asphyxial injury — branching viva

Branching viva on recognising and classifying strangulation, suffocation and asphyxial injury; the infant-vulnerability anatomy and the petechial-haemorrhage reality check; resuscitation run in parallel with scene preservation and safeguarding; the safe-sleep and product-hazard prevention message; and the accidental overlay versus inflicted suffocation forensic pivot.

branching clinical structured oral

Trafficking, exploitation and forced marriage — viva

Branching structured oral on trafficking, exploitation and forced marriage: the Palermo definition and the principle that a child cannot consent to exploitation, the red-flag presentation, the trauma-informed bedside response, mandatory reporting and National Referral Mechanism referral, and the management of a forced-marriage concern.

branching clinical structured oral

Trauma-informed examination and forensic documentation — branching viva

Branching viva on the trauma-informed approach to the medical examination, the neurobiology of the threat response, the single trained forensic interview, the documentation standard that makes a record court-admissible, and the chain of custody and disposition duties.

branching clinical structured oral

Youth justice and detained young people — viva

Branching structured oral on the health of justice-involved and detained young people: the equivalence-of-care principle, the entry-screening pathway, the clustered health needs, suicide and self-harm risk, neurodisability, consent and confidentiality in custody, the post-release mortality spike, and the advocacy role.

branching clinical structured oral

Acid-base disorders in children — viva

Branching structured oral on paediatric acid-base disorders, covering the six-step systematic approach, the anion gap and albumin correction, Winters formula and the delta gap for mixed disorders, diabetic ketoacidosis as the archetypal high gap acidosis, and the evidence that bicarbonate is rarely indicated.

branching clinical structured oral

Acute kidney injury: Viva

Branching clinical structured oral on paediatric acute kidney injury: recognising the KDIGO definition and staging, the staged emergency management of hyperkalaemia, the assessment of volume status, the choice of resuscitation fluid, the indications for renal replacement therapy, and the long-term risk of chronic kidney disease.

branching clinical structured oral

Acute nephritic syndrome and glomerulonephritis — branching viva

Branching viva from the classic cola-urine presentation of post-streptococcal GN, through the complement rule and the eradication regimen, to the atypical child with persistent hypocomplementaemia or a rapidly progressive course that demands biopsy and immunosuppression, and finally to the IgA vasculitis child with nephritis.

branching clinical structured oral

Antenatal hydronephrosis and postnatal evaluation: Viva

Branching clinical structured oral on antenatal hydronephrosis and postnatal evaluation covering the grading systems, the timing of the first postnatal ultrasound, the investigation pathway, the risk stratification, and the long-term surveillance.

branching clinical structured oral

Calcium, magnesium and phosphate disorders — viva

Branching structured oral on disorders of calcium, magnesium and phosphate in children, covering the corrected calcium and ionised fraction, emergency calcium gluconate dosing, hypomagnesaemia as the cause of refractory hypocalcaemia, the biochemistry that separates vitamin D deficiency rickets from X-linked hypophosphataemic rickets, and tumour lysis and refeeding phosphate disturbances.

branching clinical structured oral

Chronic kidney disease and progression: Viva

Branching structured oral on paediatric chronic kidney disease and progression: the KDIGO definition and staging grid, the hyperfiltration mechanism of progression, the evidence for blood-pressure targets and renin-angiotensin blockade, and the longitudinal management of complications toward transplantation.

branching clinical structured oral

Congenital anomalies of the kidney and urinary tract: Viva

Branching clinical structured oral on congenital anomalies of the kidney and urinary tract covering the classification and embryology, the antenatal hydronephrosis investigation pathway, the management of posterior urethral valves and multicystic dysplastic kidney, and the long-term CKD surveillance.

branching clinical structured oral

Dehydration and oral or intravenous rehydration: Viva

Branching clinical structured oral on paediatric dehydration and rehydration: grading severity with the clinical dehydration scale, deciding between oral and intravenous therapy, the composition and principle of reduced-osmolarity oral rehydration solution, the staged intravenous protocol, the safe correction of dysnatraemia, and the prevention of cerebral oedema.

branching clinical structured oral

Fluid maintenance and deficit replacement — viva

Branching structured oral on fluid maintenance and deficit replacement in children, covering the Holliday-Segar rule, the move to isotonic maintenance fluids with dextrose and potassium, non-osmotic ADH and hospital-acquired hyponatraemia, the percentage deficit calculation, and the slow correction of hypernatraemic dehydration.

branching clinical structured oral

Haematuria: diagnostic approach — branching viva

Branching viva from a school-age child with cola-coloured urine, through the glomerular versus non-glomerular fork, the complement patterns of post-streptococcal glomerulonephritis and IgA nephropathy, a pivot to a child with a positive dipstick but no red cells, and a closing on the red flags that demand urgent nephrology referral.

branching clinical structured oral

Haemolytic uraemic syndrome: Viva

Branching clinical structured oral on paediatric haemolytic uraemic syndrome: recognising the STEC-HUS triad with normal coagulation, the distinction from TTP and DIC, the supportive care approach for STEC-HUS, and the urgent pathway to eculizumab for atypical HUS.

branching clinical structured oral

Hypokalaemia and hyperkalaemia — viva

Branching structured oral on hypokalaemia and hyperkalaemia in children, covering the three-axis classification, cardiac electrophysiology and ECG changes, the hyperkalaemia emergency ladder with calcium gluconate, salbutamol and insulin-dextrose, safe intravenous potassium replacement, hypomagnesaemia as a refractory cause, and the Bartter versus Gitelman distinction.

branching clinical structured oral

Hyponatraemia and hypernatraemia — viva

Branching structured oral on hyponatraemia and hypernatraemia in children, covering the water-balance physiology, the volume-status classification, brain cell volume adaptation, 3 percent hypertonic saline for severe symptomatic hyponatraemia, the correction-rate ceilings for osmotic demyelination and cerebral oedema, SIAD versus cerebral salt wasting, and diabetes insipidus.

branching clinical structured oral

Hypospadias, cryptorchidism and common male genital disorders: Viva

Branching clinical structured oral on hypospadias, cryptorchidism and the common male genital disorders covering the classification and the no-circumcision rule, the orchidopexy window and its germ-cell rationale, the retractile versus the undescended testis, and the bilateral non-palpable testis as a disorder of sex development.

branching clinical structured oral

IgA nephropathy and IgA vasculitis nephritis: Viva

Branching clinical structured oral on paediatric IgA nephropathy and IgA vasculitis nephritis: recognising synpharyngitic haematuria with a normal C3, applying the Oxford MEST-C score and prediction tool, building the treatment ladder from ACE inhibition to corticosteroids and budesonide, and managing crescentic and systemic disease.

branching clinical structured oral

Inherited tubulopathies: Viva

Branching structured oral on paediatric inherited tubulopathies: a 15-year-old with fatigue, muscle cramps and a low serum magnesium leading to Gitelman syndrome, then the renin and aldosterone and blood pressure algorithm that separates Liddle, Bartter and Gitelman, the urine calcium and magnesium splitting Bartter from Gitelman, and the segment-specific treatment of each.

branching clinical structured oral

Kidney replacement therapy and dialysis in children: Viva

Branching clinical structured oral on paediatric kidney replacement therapy: recognising the AEIOU indications in a child with acute kidney injury, choosing continuous renal replacement therapy for the unstable child, switching to peritoneal dialysis in an infant, and managing peritoneal dialysis-related peritonitis.

branching clinical structured oral

Kidney transplantation in children: Viva

Branching clinical structured oral on paediatric kidney transplantation: the rationale for preemptive living-donor transplant, the standard tacrolimus-based immunosuppression regimen with therapeutic drug monitoring, the systematic investigation of a rising creatinine, and the distinction between acute rejection, calcineurin inhibitor toxicity and BK virus nephropathy.

branching clinical structured oral

Lupus nephritis and systemic disease: Viva

Branching clinical structured oral on paediatric lupus nephritis: the ISN/RPS six-class classification, the pathophysiology behind full-house immunofluorescence and low complement, the induction-maintenance treatment paradigm, and the approach to refractory disease and reproductive counselling in adolescence.

branching clinical structured oral

Nephrolithiasis and nephrocalcinosis — viva

Branching structured oral on paediatric nephrolithiasis and nephrocalcinosis, covering the lumen-versus-parenchyma distinction, hypercalciuria and the metabolic workup, the infected obstructed system as an emergency, medical expulsive therapy with tamsulosin, the surgical ladder, prevention, and medullary nephrocalcinosis from distal renal tubular acidosis.

branching clinical structured oral

Neurogenic bladder and dysfunctional voiding: Viva

Branching clinical structured oral on the neurogenic bladder and dysfunctional voiding covering the neurological control of micturition, the urodynamic classification, the management ladder from clean intermittent catheterisation and anticholinergics to intravesical botulinum toxin and augmentation, and the distinction from the functional voiding disorders.

branching clinical structured oral

Nocturnal enuresis — branching viva

Branching viva from the definition and classification of paediatric nocturnal enuresis, through the three-systems pathophysiology, the alarm and desmopressin first-line therapy with exact doses and the fluid-restriction safety rule, the partial responder and combination therapy, and the red flags of non-monosymptomatic and organic disease.

branching clinical structured oral

Oedema and nephrotic syndrome — branching viva

Branching viva from the puffy toddler at first presentation, through the KDIGO 2021 definition and the initial prednisolone regimen, the four-week response classification that separates steroid-sensitive from steroid-resistant disease, the move to steroid-sparing therapy in the frequently-relapsing child, to the unwell nephrotic child with abdominal pain who demands recognition of peritonitis and hypovolaemia.

branching clinical structured oral

Oliguria, anuria and urinary obstruction: Viva

Branching clinical structured oral on paediatric oliguria, anuria and urinary obstruction: defining oliguria and anuria by urine output thresholds, the pre-renal, renal and post-renal classification, the emergency catheter decompression of a lower tract obstruction, the pathophysiology of obstructive nephropathy, and the recognition and fluid management of post-obstructive diuresis.

branching clinical structured oral

Polycystic kidney disease and inherited nephropathies: Viva

Branching structured oral on paediatric polycystic kidney disease and inherited nephropathies: the gene-based classification of ARPKD, ADPKD, Alport syndrome and nephronophthisis, the ciliary and basement membrane mechanisms, the disease-specific therapies of tolvaptan and early ACE inhibition, and the multidisciplinary management of hepatic fibrosis and renal replacement.

branching clinical structured oral

Polyuria and polydipsia — viva

Branching structured oral on the diagnostic approach to a child with polyuria and polydipsia, covering the glucose-first exclusion of osmotic diuresis, the urine osmolality split, the three-way split of the water diuresis, the water deprivation test and copeptin, hypernatraemic dehydration with slow sodium correction, desmopressin for central disease, the nephrogenic low-solute and thiazide regimen, and the contraindication to desmopressin in primary polydipsia.

branching clinical structured oral

Post-infectious glomerulonephritis: Viva

Branching clinical structured oral on paediatric post-infectious glomerulonephritis: recognising the acute nephritic syndrome two weeks after a sore throat, interpreting the low C3 with normal C4 that recovers within eight weeks, the supportive management and streptococcal eradication, and the atypical case in which persistent hypocomplementaemia mandates biopsy.

branching clinical structured oral

Posterior urethral valves: Viva

Branching clinical structured oral on posterior urethral valves covering the Young classification and the pathophysiology cascade, the MCUG as the diagnostic gold standard, the immediate catheter decompression and endoscopic valve ablation, the valve-bladder management, and the long-term chronic kidney disease surveillance driven by the nadir creatinine.

diagnostic-reasoning

Proteinuria: diagnostic approach — viva

A cross-table viva on the diagnostic approach to proteinuria in children, escalating from an asymptomatic adolescent found to have proteinuria at a school screen through the orthostatic classification and its long-term monitoring, to a child with heavy proteinuria and oedema, and finally to the dipstick blind spot for tubular and overflow proteins.

branching clinical structured oral

Renal tubular acidosis — viva

Branching structured oral on renal tubular acidosis in children, covering the definition as a normal anion gap metabolic acidosis, the three-type classification by potassium direction and urine pH, the urine anion gap as a surrogate for ammonium, the nephrocalcinosis mechanism in distal RTA, the alkali dose difference between distal and proximal RTA, and the safe correction of chronic acidosis.

branching clinical structured oral

Scrotal pain and testicular torsion: Viva

Branching clinical structured oral on scrotal pain and testicular torsion covering the classification and the bell-clapper pathophysiology, the TWIST score and the differentiation of torsion from its mimics, the decision between theatre and imaging, the operation with detorsion and bilateral orchidopexy, and the long-term fertility and medicolegal consequences.

branching clinical structured oral

Urinalysis, renal function and paediatric kidney assessment — branching viva

Branching viva on bedside Schwartz eGFR calculation and staging, urine collection method, dipstick-versus-sediment interpretation, the creatinine lag, and the transition of estimating equations to adult care.

branching clinical structured oral

Vesicoureteric reflux: Viva

Branching clinical structured oral on vesicoureteric reflux covering the International Reflux Study grading, the RIVUR trial evidence, the management ladder from prophylaxis to surgery, and the role of bladder and bowel dysfunction.

branching clinical structured oral

Vulvovaginal and common prepubertal gynaecological disorders: Viva

Branching clinical structured oral on the common prepubertal gynaecological disorders covering the classification and management of vulvovaginitis, the conservative approach to labial adhesions, the corticosteroid treatment of lichen sclerosus, and the red flags of foreign body and sexual abuse.

branching clinical structured oral

Acne vulgaris in adolescents — branching viva

Branching viva on acne vulgaris in the adolescent: grading the comedonal versus the inflammatory disease, building the topical retinoid and benzoyl peroxide ladder with the antibiotic stewardship, branching to the oral isotretinoin with the pregnancy prevention and the cumulative dose, the acne fulminans emergency, and the hormonal female-pattern acne of the polycystic ovary syndrome.

branching clinical structured oral

Alopecia and hair disorders in children — branching viva

Branching viva from an eight-year-old with a smooth bald patch and exclamation-mark hairs, through the recognition of alopecia areata, the autoimmune associations, the stepwise management ladder and the poor-prognostic features, with a pivot to a twelve-year-old with an irregular patch of varying-length hairs on a normal scalp for trichotillomania, and a question on distinguishing tinea capitis at the bedside.

branching clinical structured oral

Approach to rash in infants and children — viva

Branching structured oral on the approach to a rash in an infant or child.

branching clinical structured oral

Congenital melanocytic naevi and pigmentary birthmarks — branching viva

Branching viva on the congenital pigmentary birthmarks: classifying the CMN by the projected adult size, stratifying the melanoma risk, recognising the neurocutaneous-melanocytosis risk pattern, and counselling the family on the surveillance and the management, branching to the pathophysiology, the surgery, the syndromic cafe-au-lait macule, and the dermal-melanocytosis child-protection distinction.

branching clinical structured oral

Contact dermatitis — branching viva

Branching viva on contact dermatitis in children: distinguishing irritant from allergic disease, the distribution clues to a contactant, the patch-test procedure and its interpretation, and the three-pillar management.

branching clinical structured oral

Drug eruptions including DRESS and AGEP — branching viva

Branching viva on drug eruptions in children: distinguishing a benign morbilliform rash from DRESS and AGEP by timing and systemic features, the pathophysiology of each, the RegiSCAR approach, the management, and the genetic associations.

branching clinical structured oral

Epidermolysis bullosa and inherited blistering disorders — viva

Branching clinical structured oral on the classification, diagnostic biopsy and atraumatic multidisciplinary management of a neonate with inherited epidermolysis bullosa, including junctional EB generalised severe, the biopsy technique and recessive dystrophic EB complications.

branching clinical structured oral

Genodermatoses and neurocutaneous skin findings — branching viva

Branching structured-oral viva on paediatric genodermatoses and neurocutaneous syndromes: the NIH diagnostic criteria for neurofibromatosis type 1 and its café-au-lait macules, skinfold freckling and neurofibromas; the RAS-MAPK pathway biology of NF1, the mTOR pathway biology of tuberous sclerosis complex with its ash-leaf macules, angiofibromas and subependymal giant cell astrocytoma, and the role of vigabatrin and everolimus; and the somatic mosaic GNAQ biology, forehead port-wine stain, leptomeningeal angioma and glaucoma of Sturge-Weber syndrome.

branching clinical structured oral

Impetigo and bacterial skin infection — branching viva

Branching structured-oral viva on impetigo and bacterial skin infection: the non-bullous and bullous forms, the exfoliative-toxin and desmoglein-1 pathophysiology, clinical diagnosis, stepwise topical and oral treatment matched to extent and region, drainage-first abscess management, community-acquired MRSA, decolonisation, and the post-streptococcal glomerulonephritis complication with the skin-strep-versus-throat-strep distinction.

branching clinical structured oral

Molluscum contagiosum and viral warts — viva

Branching clinical structured oral on the diagnosis, pathophysiology and expectant-versus-active management of a child with molluscum contagiosum and a viral wart, including red flags for immunodeficiency.

branching clinical structured oral

Nail disorders in children — branching viva

Branching structured-oral viva on nail disorders in children: the nail unit anatomy and the site-based diagnostic principle; the common acquired disorders (onychomycosis, paronychia, ingrown toenail, trauma, trachyonychia); the inflammatory and skin-disease-associated nails (psoriasis, alopecia areata, lichen planus); the congenital and genetic disorders (pachyonychia congenita, nail-patella syndrome); longitudinal melanonychia and the nail matrix naevus; the confirm-before-treat principle for onychomycosis with weight-based terbinafine; and the red flags for urgent referral.

branching clinical structured oral

Nappy dermatitis — branching viva

Branching viva on nappy dermatitis: separating the irritant from the candidal subtype at the bedside by the fold involvement and the satellite lesions, applying the stepwise management of the general skin care and the barrier and the antifungal, using the hydrocortisone 1 percent sparingly, and branching to the persistent rash and the broader differential of seborrhoeic, atopic, allergic, psoriatic, and zinc deficiency, and the Langerhans cell histiocytosis.

branching clinical structured oral

Neonatal pustular and vesiculobullous eruptions — branching viva

Branching structured-oral viva on a neonate presenting with a blister or pustule: the morphology-based classification into benign-transient, infectious and inherited causes; the bedside smear; the decisive well-or-ill discriminator; the work-up and aciclovir treatment of neonatal herpes simplex; staphylococcal scalded skin syndrome; and the genodermatoses (incontinentia pigmenti, epidermolysis bullosa) at general-paediatric recognition and referral level.

branching clinical structured oral

Petechiae, purpura and vasculitic rashes — branching viva

Branching structured-oral viva on petechiae, purpura and vasculitic rashes in children: the sick-versus-well first split and the glass test, the emergency pathway for meningococcaemia and purpura fulminans, the ISTH disseminated intravascular coagulation score, the definition of immune thrombocytopenia and its differentiation from leukaemia, the EULAR/PRINTO/PRES criteria and renal monitoring for IgA vasculitis, and the TEN-4 FACES safeguarding assessment of bruising.

branching clinical structured oral

Psoriasis in children — branching viva

Branching structured-oral viva on psoriasis in children: the chronic plaque and guttate forms and the paediatric-specific face, scalp, nail and napkin presentations; the IL-23 and Th17 and IL-17 pathophysiology with HLA-Cw6 genetics and streptococcal and Koebner triggers; the differential from atopic and seborrhoeic dermatitis and tinea; clinical diagnosis with severity measured by body surface area and CDLQI; stepwise treatment from emollients and a potency-matched topical corticosteroid plus calcipotriol through narrowband UVB to methotrexate, cyclosporin, acitretin and the biologics; and the obesity, juvenile psoriatic arthritis and psychosocial comorbidities.

branching clinical structured oral

Scabies, lice and infestations — viva

Branching clinical structured oral on the recognition, pathophysiology and household-based management of a child with scabies, including the 2020 IACS criteria, the permethrin regimen and crusted scabies.

branching clinical structured oral

Seborrhoeic dermatitis and cradle cap — branching viva

Branching viva on infantile seborrhoeic dermatitis and cradle cap: recognising the greasy yellow scale over the scalp, face, flexures, and nappy area of the well, non-itchy infant, separating it from atopic dermatitis on the absent pruritus, managing it with the gentle scalp care on the Cochrane evidence, and branching to the ketoconazole and hydrocortisone for the refractory case, the Leiner disease erythroderma red flag, and the tinea capitis differential with the hair loss.

branching clinical structured oral

Skin manifestations of systemic disease — branching viva

Branching structured-oral viva on cutaneous manifestations of systemic disease in children: the six families of cutaneous signals (reactive erythemas, neutrophilic dermatoses, metabolic and endocrine markers, gastrointestinal and nutritional dermatoses, haematological and neoplastic markers, neurocutaneous syndromes); the mechanisms from immune complex deposition and IgA-mediated blistering through hyperinsulinaemia and zinc depletion to blast infiltration and somatic gene mutation; the targeted work-up each sign dictates; the revised neurofibromatosis type 1 and updated tuberous sclerosis diagnostic criteria; and the emergencies of meningococcal purpura, the blueberry muffin neonate and the V1 port-wine stain.

branching clinical structured oral

Stevens-Johnson syndrome and toxic epidermal necrolysis — branching viva

Branching structured-oral viva on Stevens-Johnson syndrome and toxic epidermal necrolysis: the SJS, overlap and TEN classification by body-surface-area detachment, the drug-specific CD8-positive T-cell and granulysin pathophysiology, the anticonvulsant, sulfonamide, allopurinol and nevirapine culprits and the HLA-B*15:02 and HLA-B*58:01 pharmacogenetics, SCORTEN, the distinction from staphylococcal scalded skin syndrome and Mycoplasma-induced rash and mucositis, and the supportive-care-centred management with the no-proven-benefit position on immunomodulation.

branching clinical structured oral

Tinea and fungal skin infection — branching viva

Branching viva from a five-year-old with a scaly bald scalp patch and broken hair stubs, through the recognition of tinea capitis, the oral-therapy rule, the species-guided choice of terbinafine versus griseofulvin and household carrier screening, with a pivot to a four-year-old with a painful boggy kerion after contact with a kitten and a question on tinea incognito from a steroid-containing cream.

branching clinical structured oral

Vascular birthmarks and infantile haemangioma — branching viva

Branching structured-oral viva on vascular birthmarks and infantile haemangioma: the Mulliken and ISSVA tumour-versus-malformation fork, the GLUT1-positive endothelial-proliferation biology and proliferate-then-involutive natural history, the GNAQ somatic-mosaic biology of port-wine stain and Sturge-Weber syndrome, propranolol 2 to 3 mg per kg per day as first-line therapy with topical timolol for small superficial lesions, the PHACE and LUMBAR syndrome screens, and the Kasabach-Merritt distinction from kaposiform haemangioendothelioma.

branching clinical structured oral

Acquired hypothyroidism and Hashimoto thyroiditis — viva

Branching structured oral on acquired hypothyroidism and Hashimoto thyroiditis.

branching clinical structured oral

Adrenal insufficiency and adrenal crisis — branching viva

Branching viva from the primary-versus-secondary split, through the pigmented losing-weight adolescent with autoimmune Addison disease, the steroid-withdrawn child who collapses with an infection, the cortisol-ACTH-renin work-up, and the empiric hydrocortisone-first resuscitation with a lifelong stress-dose plan.

branching clinical structured oral

Congenital adrenal hyperplasia — branching viva

Branching viva from the salt-wasting-versus-virilisation split, through the genitally normal male who collapses at two weeks, the virilised 46,XX newborn, the 17-OHP screen and its pitfalls, and lifelong replacement with stress dosing.

branching clinical structured oral

Congenital hypothyroidism — branching viva

Branching viva on congenital hypothyroidism: running the screening-to-treatment pipeline, the levothyroxine dose and timing that protect the developing brain, the primary-versus-central classification that explains which babies the TSH screen misses, and the central-disease pitfall of giving levothyroxine before hydrocortisone.

branching clinical structured oral

Constitutional delay and familial short stature — branching viva

Branching viva on the short child: reading the growth-chart trajectory and bone age to distinguish familial short stature from constitutional delay, excluding the pathological mimics, and managing the distressed adolescent — then branching to the short girl with a delayed bone age and the risk of missing Turner syndrome.

branching clinical structured oral

Cushing syndrome in children — branching viva

Branching viva from the growth-arrest discriminator, through the three-test confirmatory work-up, the ACTH localisation fork, inferior petrosal sinus sampling, transsphenoidal surgery, and the adrenally insufficient child who has just been cured.

branching clinical structured oral

Delayed puberty and hypogonadism in adolescents — branching viva

Branching viva on delayed puberty: confirming the timing thresholds, splitting the differential with gonadotrophins, separating constitutional delay from permanent congenital hypogonadotropic hypogonadism, recognising Klinefelter and Turner, and delivering pubertal induction with escalating sex steroids over 18 to 24 months.

branching clinical structured oral

Diabetes insipidus and polyuria-polydipsia — viva

Branching structured oral on diabetes insipidus and the polyuria-polydipsia syndrome in children, covering the vasopressin-aquaporin-2 axis, the central versus nephrogenic versus primary polydipsia split, copeptin testing, desmopressin safety, and the post-surgical triphasic response.

branching clinical structured oral

Diabetic ketoacidosis — branching viva

Branching viva on paediatric diabetic ketoacidosis: diagnosing and grading DKA, delivering the ISPAD fluid and insulin protocol with the potassium and glucose logic, recognising and treating cerebral oedema at the bedside, and defining resolution and transition to subcutaneous insulin.

branching clinical structured oral

Disorders of sex development — branching viva

Branching viva on disorders of sex development: excluding a salt-wasting adrenal crisis before reaching for a label, classifying with the Chicago framework built from the karyotype, confirming with a karyotype and a 17-hydroxyprogesterone first, deferring non-consent cosmetic surgery, and managing both the neonatal emergency and the adolescent presentation of complete androgen insensitivity.

branching clinical structured oral

Endocrine emergencies: integrated approach — branching viva

Branching viva from the shared recognition and resuscitation framework, through the undiagnosed young child with DKA and cerebral oedema, the steroid-withdrawn child with secondary adrenal crisis, the adolescent with thyroid storm, and the seizing child with SIADH — testing the bedside triage, the empiric life-saving treatment before confirmatory endocrine tests, and the cross-cutting pitfalls of the insulin bolus, missed cortisol and rapid sodium correction.

branching clinical structured oral

Endocrine late effects of cancer treatment — branching viva

Branching viva on the endocrine late effects of childhood cancer treatment: recognising the survivor with growth hormone deficiency after cranial irradiation and the survivor with combined hypothalamic-pituitary deficits, confirming with axis-specific stimulation tests, delivering hormone replacement in the correct order of hydrocortisone before levothyroxine before sex steroids with recombinant growth hormone only after magnetic resonance imaging, and counselling on the paradoxical central precocious puberty of lower-dose cranial radiation and the primary gonadal failure of alkylating chemotherapy.

branching clinical structured oral

Growth hormone deficiency and excess — branching viva

Branching viva on growth hormone deficiency and excess: recognising the short child crossing centiles downward and the overgrowing child accelerating upward, confirming with a stimulation test at the 6.7–10 ng/mL cutoff or an oral glucose suppression test, delivering recombinant growth hormone titrated to IGF-1 for deficiency, and transsphenoidal surgery with somatostatin analogue or pegvisomant for excess.

branching clinical structured oral

Hypercalcaemia and hyperparathyroidism — branching viva

Branching viva from the PTH fork, through the urine calcium-to-creatinine clearance ratio that separates FHH from PHPT, the saline-first resuscitation, the calcitonin-then-bisphosphonate drug logic, the hereditary syndromes, and the hypotonic hypercalcaemic neonate.

branching clinical structured oral

Hyperthyroidism and Graves disease — branching viva

Branching viva on distinguishing thyrotoxicosis from hyperthyroidism, confirming Graves disease through a suppressed TSH, raised free T4 and a positive TSH-receptor antibody, delivering the beta-blocker bridge and carbimazole-first-line strategy, holding propylthiouracil for thyroid storm and first-trimester pregnancy, recognising transient neonatal thyrotoxicosis, and reaching definitive radioactive iodine or surgery for relapse.

branching clinical structured oral

Hypocalcaemia and hypoparathyroidism — viva

Branching structured oral on hypocalcaemia and hypoparathyroidism in children, covering the calcium-PTH axis, PTH-led classification, acute management, neonatal hypocalcaemia, and the hypoparathyroidism versus pseudohypoparathyroidism split.

branching clinical structured oral

Hypoglycaemia in diabetes — branching viva

Branching viva on hypoglycaemia in diabetes: recognising the confused or seizing child with type 1 diabetes as hypoglycaemic until proven otherwise, classifying severity by the ISPAD/ADA levels, explaining counter-regulatory failure and HAAF, delivering the rule of 15 and glucagon or intravenous dextrose for severe events, and preventing recurrence with continuous glucose monitoring and hybrid closed-loop therapy.

branching clinical structured oral

Hypopituitarism and pituitary lesions — branching viva

Branching viva from a child with short stature and a falling height velocity, through the order of hormone loss, the dynamic tests that confirm each axis, the imaging of a suprasellar lesion and the germ-cell markers for a thickened stalk, to the safe replacement order and the neonatal presentation of congenital hypopituitarism.

branching clinical structured oral

Lipid disorders and familial hypercholesterolaemia — branching viva

Branching viva from the LDL-C threshold, through the asymptomatic school-age child with a family history, the adolescent with xanthomas and homozygous FH, the statin-first drug ladder and its safety evidence, and the cascade-screening and contraception counselling that complete the plan.

branching clinical structured oral

Monogenic diabetes and neonatal diabetes — branching viva

Branching viva from the six-week-old with persistent hyperglycaemia, through the antibody-negative twelve-year-old mislabelled type 1, the glucokinase-MODY child found on a screening glucose, and the multi-system HNF1B-MODY with renal cysts, to the genetic testing pathway and the genotype-matched drug choice.

branching clinical structured oral

Obesity: assessment, complications and treatment — branching viva

Branching viva on BMI-for-age classification with adult crossover, systematic comorbidity screening across six systems, selective secondary-cause exclusion, staged treatment from lifestyle through pharmacotherapy to surgery, and parallel comorbidity-directed care.

branching clinical structured oral

Osteoporosis and fragility fractures in children — branching viva

Branching viva on osteoporosis and fragility fractures in children: the ISCD definition that needs low bone mass plus a fragility fracture, the glucocorticoid-exposed and non-ambulant child, the foundation-first and bisphosphonate pathway with zoledronic acid first-line, and the safeguarding interface with non-accidental injury.

branching clinical structured oral

Phaeochromocytoma and endocrine hypertension — branching viva

Branching viva from the hypertensive adolescent with spells, through the metanephrines-first diagnostic rule, the alpha-before-beta preoperative trap and the hereditary genetics, to the hypokalaemic child with suppressed renin and aldosterone whose gene dictates the drug.

branching clinical structured oral

Precocious puberty — branching viva

Branching viva on precocious puberty: recognising early sexual development, splitting central from peripheral on gonadotropins and clinical consonance, confirming with bone age and GnRH stimulation, choosing the imaging and treatment, and branching to the boy with a hypothalamic hamartoma, the girl with McCune-Albright, and the family weighing a GnRH analog — defending the central-against-peripheral distinction at every step.

branching clinical structured oral

Rickets and metabolic bone disease — branching viva

Branching viva on rickets and metabolic bone disease: the calcipenic-versus-phosphopenic classification that the biochemistry reveals, the emergency management of the hypocalcaemic infant, the definitive treatment of nutritional and hereditary forms, and the monitoring of healing.

branching clinical structured oral

Short stature and poor linear growth — viva

Branching structured oral on the assessment, differential and management of the short child.

branching clinical structured oral

SIADH and disorders of water balance — viva

Branching structured oral on SIADH and disorders of water balance in children, covering the ADH axis, the volume-status approach to hyponatraemia, hypertonic saline, cerebral salt wasting, and the sodium correction rate.

branching clinical structured oral

Tall stature and overgrowth syndromes — branching viva

Branching viva on tall stature and overgrowth syndromes: redistributing the tall child from the familial normal variant to the pathological cause using a structured assessment, recognising the Beckwith-Wiedemann tumour-risk fingerprint, distinguishing the syndromic overgrowth disorders, and managing the marfanoid child and the child with growth-hormone excess.

branching clinical structured oral

Thyroid nodules, goitre and thyroid cancer — viva

Branching viva on paediatric thyroid nodule risk-stratification, FNA/Bethesda triage and multidisciplinary risk-adapted management.

branching clinical structured oral

Type 1 diabetes: diagnosis and initial management — branching viva

Branching viva from the alert child with new hyperglycaemia — through the diagnostic glucose thresholds, the bedside exclusion of ketoacidosis, the autoantibodies and C-peptide that name the type, the first subcutaneous basal-bolus insulin regimen and family education, the honeymoon phase and the never-stop-insulin rule, to the infant under six months and the antibody-positive relative in the screening era.

branching clinical structured oral

Type 1 diabetes: insulin therapy, technology and ambulatory care — branching viva

Branching viva from the principle that insulin is never stopped, through the sick-day child whose insulin was omitted, the pump-treated child with ketones and a normal-looking site, the hybrid closed-loop child with post-breakfast highs, and the adolescent with loss of hypoglycaemia awareness, to the targets, the transition plan, and the equity of technology access.

branching clinical structured oral

Type 2 diabetes and metabolic syndrome in youth — branching viva

Branching viva from the acanthosis clue and the metabolic cluster, through the fourteen-year-old girl with insulin resistance and polycystic ovary syndrome, the thirteen-year-old boy whose metformin is failing, the antibody and C-peptide split between type 2 and type 1, and the comorbidity and complication care that defines the disease as faster and more dangerous than its adult counterpart.

branching clinical structured oral

Acute and chronic rhinosinusitis — branching viva

Branching structured-oral viva on acute and chronic rhinosinusitis: the distinction of acute viral from acute bacterial rhinosinusitis by the AAP criteria of persistence, double worsening and severe onset; the high-dose amoxicillin-clavulanate regimen with saline irrigation and intranasal corticosteroid; the chronic form and its predisposing conditions; the pathophysiology of ostial obstruction and spread through the lamina papyracea and valveless diploic veins; the Chandler classification of orbital complications; the intracranial complications and Pott puffy tumour; the contrast CT indication; and the medical-versus-surgical decision for the medial subperiosteal abscess.

branching clinical structured oral

Acute otitis media — branching viva

Branching viva on diagnosing acute otitis media from a bulging tympanic membrane, applying the age-and-laterality antibiotic matrix, choosing first-line amoxicillin and its alternatives, and recognising acute mastoiditis.

branching clinical structured oral

Ankyloglossia and infant feeding — branching viva

Branching viva from a two-week-old breastfed infant with poor weight gain, a painful clicking latch and a mother with cracked nipples and engorgement, through the functional assessment and the conservative-first principle, with a pivot to a suspected posterior tongue-tie testing the contested diagnosis and the frenotomy decision, and a final probe on a six-week-old whose mother wants a mild asymptomatic tie snipped, testing the overdiagnosis pitfall and the counselling that not every tie needs division.

branching clinical structured oral

Cleft lip and palate — branching viva

Branching viva on cleft lip and palate: recognising the cleft at birth and classifying by Veau, the embryology of facial-process and palatal-shelf fusion, the feeding principle of the squeeze bottle, Pierre Robin sequence with airway obstruction, the near-universal otitis media with effusion and grommets, the rule of ten and the staged surgical timeline, and the syndromic associations of Van der Woude, Stickler and 22q11 deletion.

branching clinical structured oral

Congenital ear anomalies and microtia — branching viva

Branching viva on congenital ear anomalies and microtia: distinguishing a deformational deformity from a true microtia at the newborn check, grading by Marx, the embryology that explains why the inner ear is spared and the loss is conductive, the urgency of early bone-conduction hearing in bilateral aural atresia, the newborn molding window, the Jahrsdoerfer CT grading for atresiaplasty, and the syndromic associations of Treacher Collins, hemifacial microsomia and branchio-oto-renal.

branching clinical structured oral

Dental caries and oral-health prevention — branching viva

Branching viva from a three-year-old with brown, cavitated upper front teeth and a bedtime bottle, through the case definition and pattern of early childhood caries and the fluoride, diet and dental-home prevention ladder, with a pivot to the age-specific fluoride toothpaste and varnish guidance, and a final stem on a four-year-old with a swollen face and trismus from a necrotic molar testing the emergency recognition of spreading odontogenic infection and its airway-first, source-control management.

branching clinical structured oral

Dental trauma and avulsed teeth — branching viva

Branching viva from an eight-year-old who has just knocked out a permanent upper central incisor on the playground, through the IADT 2020 scene first-aid protocol, the storage media and the prognostic role of extra-alveolar dry time, with a pivot to the definitive dental management of splinting, root canal treatment and antibiotics, and a final stem on a three-year-old who has knocked out a primary incisor testing the never-replant-a-primary-tooth rule and the safeguarding consideration of oral injury.

branching clinical structured oral

Drooling, dysphagia and upper-aerodigestive disorders — branching viva

Branching viva on separating anterior from posterior drooling, recognising an unsafe swallow, applying the stepwise drooling ladder with glycopyrrolate and botulinum toxin, distinguishing oropharyngeal from oesophageal dysphagia, and protecting the airway in a child with neurodisability.

branching clinical structured oral

Epistaxis in children — branching viva

Branching viva from a four-year-old with an active profuse nosebleed brought in tilted backward, through correct first-aid technique and the common errors, the stepwise escalation to cautery and packing, with a pivot to a seven-year-old with recurrent epistaxis, bruising and a family history of bleeding testing the bleeding-disorder work-up, and a final probe on an adolescent boy with unilateral progressive epistaxis and obstruction pointing to juvenile nasopharyngeal angiofibroma.

branching clinical structured oral

Facial swelling and odontogenic infection — branching viva

Branching viva on recognising a paediatric facial swelling of dental origin, applying the principle of source control, and recognising and managing Ludwig angina as an airway emergency.

branching clinical structured oral

Hearing assessment and childhood hearing loss — branching viva

Branching viva from the definition and the conductive-versus-sensorineural classification through the newborn screening programme and the 1-3-6 milestones, congenital CMV as the commonest acquired cause, the glue-ear grommet decision with the Paradise evidence, and the audiological emergency of post-meningitis hearing loss.

branching clinical structured oral

Mastoiditis and otogenic complications — branching viva

Branching structured-oral viva on mastoiditis and otogenic complications: acute mastoiditis as the commonest suppurative complication of acute otitis media through the valveless aditus ad antrum, the coalescent and masked forms, the postauricular signs and the down-and-out pinna, the routes of otogenic spread to intratemporal and intracranial complications, the Gradenigo triad and lateral sinus thrombosis with otitic hydrocephalus, the causative organisms, the coalescent CT finding, the intravenous antibiotic regimen, and the myringotomy and cortical mastoidectomy decisions.

branching clinical structured oral

Nasal foreign body and button-battery injury — branching viva

Branching viva from a two-year-old with a missing remote-control battery and a disc seen against the nasal septum, testing the emergency-removal decision and the alkaline-electrolysis mechanism, through the stepwise removal of an inert object and the instrument choice for a smooth bead, with a pivot to a four-year-old with unilateral foul discharge testing the diagnostic maxim and the contraindicated manoeuvre, and a final probe on the battery-versus-coin distinction and the complications to surveil after removal.

branching clinical structured oral

Neck masses in children — branching viva

Branching viva on classifying a paediatric neck mass by location and aetiology, recognising a thyroglossal duct cyst, distinguishing reactive from suppurative and mycobacterial lymphadenitis, and escalating the persistent or supraclavicular node to biopsy and paediatric oncology referral.

branching clinical structured oral

Oral manifestations of systemic disease — branching viva

Branching viva from a pale tired six-year-old with swollen bleeding gums and palatal petechiae (acute leukaemia), through the urgent full blood count and neutropenic-sepsis safety, with a pivot to a child with chalky symmetrical dental enamel defects and faltering growth (coeliac disease) and a final stem on a child shedding primary incisors years too early with a low alkaline phosphatase (hypophosphatasia) and the periodontitis of Papillon-Lefevre and cyclic neutropenia.

branching clinical structured oral

Oral ulcers and mucosal disease — branching viva

Branching viva from a febrile drooling two-year-old with diffuse painful anterior gingival ulceration, through the hydration-first assessment and early oral aciclovir within 72 hours, with a pivot to a school-age child with recurrent scarring major aphthae testing the deficiency and coeliac work-up and the differential of systemic aphthosis, and a final stem on an infant with thrush and an oncology child with mucositis.

branching clinical structured oral

Otitis externa — branching viva

Branching viva from an eight-year-old swimmer with otalgia, otorrhoea and tragal tenderness, through the canal-versus-middle-ear distinction and the analgesia-led, topical-first stepwise management, with a pivot to a too-swollen canal requiring an ear wick, and a final stem on an immunocompromised child with severe otalgia and a facial palsy testing the recognition of necrotising otitis externa, its inflammatory-marker and imaging work-up, and prolonged systemic antipseudomonal therapy.

branching clinical structured oral

Otitis media with effusion and grommet decisions — branching viva

Branching structured-oral viva on otitis media with effusion and grommet decisions: the definition and distinction from acute otitis media, the Eustachian tube pathophysiology, the tympanogram types, the three-month duration threshold, the grommet criterion of bilateral OME with documented hearing difficulty, the Paradise developmental evidence, the limited role of antibiotics and the place of adenoidectomy, the at-risk child, and the Aboriginal and Torres Strait Islander context.

branching clinical structured oral

Pharyngitis, tonsillitis, peritonsillar abscess and deep neck infection — branching viva

Branching viva on applying the McIsaac score to a paediatric sore throat, confirming GAS before treating, choosing first-line penicillin, and recognising a peritonsillar abscess and a deep neck infection as emergencies.

branching clinical structured oral

Salivary gland disorders — branching viva

Branching viva from an under-immunised child with bilateral tender parotid swelling, through the diagnosis of mumps, the supportive management and the five-day exclusion, with a pivot to a child with recurrent unilateral parotid swelling testing juvenile recurrent parotitis and sialendoscopy, and a final stem on a neonate with suppurative parotitis.

branching clinical structured oral

Tinnitus, vertigo and balance disorders in children: Viva

Branching clinical structured oral on dizziness and vertigo in children: classifying the vertigo by tempo, applying the head impulse, nystagmus, test of skew rule to separate a peripheral from a central cause, recognising and treating the curable positional vertigo, and defending the diagnosis and management of vestibular migraine with the role of vestibular rehabilitation.

branching clinical structured oral

Acute behavioural disturbance and agitation — branching viva

Branching viva on classifying acute agitation by severity and cause, the least-restrictive ladder, verbal de-escalation, oral and parenteral pharmacotherapy grounded in the PEAChY trials, excluding organic causes, and minimising and recovering from restraint.

branching clinical structured oral

Anxiety disorders in children and adolescents — branching viva

Branching viva on distinguishing disorder from normal fear, multi-informant assessment, stepped care, CAMS and Cochrane evidence, SSRI dosing and suicidality monitoring.

branching clinical structured oral

Attachment disorders and relational trauma — branching viva

Branching viva on the two-disorder DSM-5-TR structure, caregiving-history assessment, the autism differential, the BEIP / ABC / Child-Parent Psychotherapy evidence, no first-line medication, no holding therapy, and a safeguarding conversion.

branching clinical structured oral

Avoidant restrictive food intake disorder — branching viva

Branching viva on holding the ARFID versus anorexia nervosa boundary, classifying the driver pattern, protecting medical safety and refeeding risk, delivering evidence-based CBT-AR or FBT, and stopping coercion.

branching clinical structured oral

Child and adolescent suicide and self-harm assessment — branching viva

Branching viva on distinguishing non-suicidal self-injury from suicidal self-harm, structured risk stratification, safety planning, means restriction and disposition.

branching clinical structured oral

Children of parents with mental illness or substance use — branching viva

Branching viva on the heightened-but-probabilistic offspring-risk picture, the gene-environment-interplay mechanism, the Weissman STAR*D-child evidence, the family-focused-prevention options, the young-carer trap, and a safeguarding conversion when parental intoxication places a child at acute risk.

branching clinical structured oral

Chronic fatigue and post-viral fatigue syndromes — branching viva

Branching viva on recognising post-exertional malaise, applying the paediatric three-month threshold, validating the illness, excluding mimics once, building a function-first energy-management plan with CBT, defending the graded-exercise controversy, and avoiding diagnostic overshadowing.

branching clinical structured oral

Collaborative care with child and adolescent mental-health services — branching viva

Branching viva on defining collaborative care, classifying the four models, the treatment-gap rationale, stepped-care tiers, shared assessment and consent, acute-risk overrides, and regional service architecture.

branching clinical structured oral

Conduct disorder and antisocial behaviour — branching viva

Branching viva on the rights-violation definition, the Moffitt taxonomy, the callous-unemotional specifier, risk and safeguarding, the role of comorbid ADHD, and the NICE CG158 stepped-care ladder led by evidence-based parenting programmes.

branching clinical structured oral

Delirium in children and adolescents — branching viva

Branching viva on the DSM-5-TR diagnosis of paediatric delirium, CAPD screening, the benzodiazepine causal link, the ABCDEF bundle, and antipsychotics as last resort.

branching clinical structured oral

Depressive disorders in children and adolescents — branching viva

Branching viva on criteria-based diagnosis, the bipolar screen, suicide-risk assessment, stepped care, fluoxetine as first-line SSRI, and the black-box warning.

branching clinical structured oral

Disruptive mood dysregulation disorder — branching viva

Branching viva on the criteria-clock diagnosis of DMDD, the bipolar and ODD rule-outs, the behaviour-therapy-first stepped plan, the adjunctive use of medication for comorbidity, and the meta-analytic evidence base.

branching clinical structured oral

Early-onset psychosis and mania — branching viva

Branching viva on the psychosis-mania gate: distinguishing psychosis, mania and mimics, organic exclusion, duration of untreated psychosis, cannabis risk, TEOSS and the paediatric mania trials, and antipsychotic metabolic monitoring.

branching clinical structured oral

Emergency mental-health assessment and disposition — branching viva

Branching viva on classifying the emergency mental-health presentation on two independent axes, performing a structured suicide-risk assessment with a validated tool, synthesising a risk stratum, matching the level of care to risk, building a safety plan with means restriction, and managing boarding, intoxication and capacity.

branching clinical structured oral

Family assessment and family interventions — branching viva

Branching viva on systematic family assessment, the three named mechanisms (coercive cycle, expressed emotion, chronic stress), intensity-matched intervention selection across parent training, structured family therapy and multisystem care, and a safeguarding conversion when family violence surfaces.

branching clinical structured oral

Functional neurological symptoms in children — branching viva

Branching viva on the positive diagnosis of paediatric FND, PNES versus epilepsy, the 3-Ps formulation, iatrogenic perpetuation, the validating diagnosis conversation and stepped multidisciplinary management.

branching clinical structured oral

Grief, bereavement and adjustment disorder in children — branching viva

Branching viva on separating normal grief from prolonged grief disorder and adjustment disorder, the two-trigger/two-clock distinction, grief-versus-MDD-versus-PTSD, suicide and safeguarding assessment, CBT for PGD and TF-CBT evidence, no first-line medication, and a suicidality conversion.

branching clinical structured oral

Mental state examination in children and adolescents — branching viva

Branching structured oral on the conditions for the examination, the seven domains, developmental adaptation, validated screens, a positive mood and suicide finding, a medical mimic, and confidentiality.

branching clinical structured oral

Obsessive-compulsive disorder in children — viva

Branching viva on paediatric OCD recognition, differential, stepped CBT-with-ERP care and refractory escalation.

branching clinical structured oral

Pica and rumination disorder — branching viva

Branching viva on running the harm gate before the label, separating pica and rumination from their mimics, treating reversible drivers, replacing the behaviour without punitive restraint, and managing the high-risk adolescent and autism subgroups.

branching clinical structured oral

Post-traumatic stress disorder and trauma responses — branching viva

Branching viva on the trauma-response continuum, trauma-informed assessment, risk factors, stepped care with trauma-focused CBT first-line, debriefing, pharmacotherapy, and safeguarding disposition.

branching clinical structured oral

Psychological impact of chronic illness and disability — branching viva

Branching viva on the biopsychosocial, resilience-oriented model of the psychological impact of chronic illness and disability: the adjustment-to-disorder continuum, routine screening, the disability-stress-coping cascade and coping as the modifiable mediator, stepped family-centred and school-inclusive care, diagnostic overshadowing, and a suicide-risk interrupt.

branching clinical structured oral

Psychopharmacology and psychotropic medicines in children and adolescents — branching viva

Branching viva on developmental pharmacokinetics, choosing and monitoring the major paediatric psychotropic classes (stimulants, non-stimulants, SSRIs, antipsychotics, mood stabilisers, melatonin), the FDA black-box suicidality warning, antipsychotic metabolic monitoring, valproate teratogenicity, and the psychotropic emergencies (serotonin syndrome, NMS).

branching clinical structured oral

Selective mutism — viva

Branching viva on selective mutism recognition, the hearing-first differential, behavioural-intervention-first care and SSRI escalation.

branching clinical structured oral

Somatic symptom and related disorders — branching viva

Branching viva on the DSM-5 principle that symptoms need not be medically unexplained, validation, single red-flag screen, the symptom-amplification reframe, a function-first interdisciplinary plan, school reintegration, conversion disorder, and a safeguarding challenge.

branching clinical structured oral

Substance intoxication, withdrawal and use disorders in youth — branching viva

Branching viva on separating intoxication, withdrawal and the use disorder, CRAFFT screening, SBIRT stepped care, the buprenorphine pathway, and the cannabis-psychosis link.

branching clinical structured oral

Acute monoarthritis and septic arthritis — branching viva

Branching viva on acute monoarthritis and septic arthritis: applying the Kocher criteria, interpreting the synovial fluid, choosing the age-stratified empiric antibiotic, recognising the septic hip as a surgical emergency, and the culture-negative Kingella kingae presentation of the under-four.

branching clinical structured oral

ANCA-associated and other childhood vasculitides — branching viva

Branching viva on ANCA-associated and other childhood vasculitides: classifying the vasculitides by vessel size and recognising the pulmonary-renal syndrome of granulomatosis with polyangiitis, then branching to the pauci-immune mechanism and the remission-induction framework, to the absent pulse and hypertension of Takayasu arteritis, to the asthma and eosinophilia of eosinophilic granulomatosis with polyangiitis, and to the Kawasaki cross-link.

branching clinical structured oral

Angular, rotational and gait variants — branching viva

Branching viva on the common physiologic variants of the growing lower limb: placing the child on the Salenius and Vankka developmental curve, applying the Staheli rotational profile to the three causes of intoeing, separating the physiologic variant observed from the pathologic limb referred for Blount disease or rickets, and counselling the family on the natural history and the no-device rule.

branching clinical structured oral

Back pain in children and adolescents — branching viva

Branching viva on back pain in children and adolescents: running the red-flag screen, recognising back pain under five as a red flag for discitis, applying the age-stratified differential from spondylolysis to Scheuermann kyphosis, choosing the imaging that fits the suspected diagnosis, and managing each subtype from the pars-rest to the empirical intravenous antibiotics.

branching clinical structured oral

Bone pain and malignancy red flags — branching viva

Branching viva on paediatric bone pain and malignancy red flags: running the red-flag screen that separates benign limb pain from leukaemia, osteosarcoma, and Ewing sarcoma; applying the Jones features to distinguish leukaemia from juvenile idiopathic arthritis; reading the radiographic signatures; and enforcing the never-biopsy-outside-a-specialist-centre rule and the spinal-cord-compression emergency.

branching clinical structured oral

Clubfoot and congenital limb anomalies: Viva

Branching clinical structured oral on the clubfoot and the congenital limb anomalies, covering the four classical deformities and the CAVE mnemonic, the Ponseti method with the percutaneous Achilles tenotomy and the foot-abduction brace, the Pirani and the Dimeglio scores, the idiopathic-versus-syndromic distinction, the relapse and the anterior tibialis tendon transfer, and the classification and the disposition of the congenital limb anomalies.

branching clinical structured oral

Common paediatric fractures and growth-plate injury — branching viva

Branching viva on common paediatric fractures and growth-plate injury: reproducing the Salter-Harris classification and its prognosis, distinguishing the greenstick, buckle and plastic-bowing patterns, applying the Gartland classification and the emergency percutaneous pinning of the supracondylar with lateral-entry pins, the FORCE-trial soft-bandage evidence for the torus fracture, and the safeguarding duty of the classic metaphyseal lesion in the non-mobile infant.

branching clinical structured oral

Concussion and return to learn or play — branching viva

Branching viva on sport-related concussion in the child and adolescent: recognising the concussion with the age-banded tool, running the red-flag screen, rejecting prolonged strict rest in favour of the twenty-four to forty-eight hours of relative rest and early activity, driving the return-to-learn pathway before the six-stage return to sport, and managing the persistent post-concussive symptoms.

branching clinical structured oral

Developmental dysplasia of the hip — branching viva

Branching viva on developmental dysplasia of the hip: performing the Ortolani and Barlow tests, grading the infant hip with the Graf ultrasound, choosing the age-stratified management, and catching the late-presenting toddler whose painless limp declares a hip that screening missed.

branching clinical structured oral

Heat illness, exertional collapse and sudden death prevention — branching viva

Branching viva on heat illness, exertional collapse and sudden death prevention: running the field-side collapse protocol from the pulse check to the rectal temperature, recognising exertional heat stroke, applying the cold-water immersion and the cool-first-transport-second rule, separating exercise-associated collapse from exercise-associated hyponatraemia, and framing the four-pillar prevention and the emergency action plan.

branching clinical structured oral

IgA vasculitis — branching viva

Branching viva on IgA vasculitis (Henoch-Schonlein purpura): recognising the classic tetrad and applying the EULAR/PRINTO/PRES criteria, then branching to the corticosteroid evidence and the renal monitoring, to the intussusception and the surgical interface, and to the nephrotic presentation and the immunosuppression.

branching clinical structured oral

Juvenile dermatomyositis — branching viva

Branching viva on juvenile dermatomyositis: the clinical diagnosis of heliotrope rash and Gottron papules with proximal weakness, the classification criteria, the myositis-specific antibody phenotypes, first-line treatment with corticosteroids and methotrexate, and the prevention and management of calcinosis.

branching clinical structured oral

Juvenile idiopathic arthritis: Viva

Branching clinical structured oral on juvenile idiopathic arthritis, covering the ILAR classification with the seven categories and the oligoarticular dominance, the chronic anterior uveitis and the three-monthly slit-lamp screening in the high-risk child, the methotrexate at ten to fifteen milligrams per square metre per week, the etanercept and adalimumab biologics, the Wallace clinically inactive disease criteria, and the treat-to-target TREAT trial.

branching clinical structured oral

Musculoskeletal examination and the limping child — branching viva

Branching viva on the paediatric musculoskeletal examination and the limping child: performing the pGALS screen, applying the Kocher and Caird prediction rules to an irritable hip, recognising the age-stratified differential, and catching the slipped capital femoral epiphysis that hides behind knee pain.

branching clinical structured oral

Nursemaid's elbow and common upper-limb injury — branching viva

Branching viva on nursemaid's elbow and the common paediatric upper-limb injuries: recognising the classic traction history, reducing by hyperpronation on the Macias and Aksel evidence, omitting the radiograph in the classic case and reserving it for the atypical guarding arm, counselling to prevent recurrence, and branching to the Gartland-graded supracondylar with the lateral-entry pinning and the volar pulseless hand.

branching clinical structured oral

Osteomyelitis and discitis — branching viva

Branching viva on paediatric acute haematogenous osteomyelitis and discitis: the metaphyseal pathophysiology, the age-stratified microbiology including Kingella kingae, magnetic resonance imaging as the diagnostic gold standard, and the intravenous-to-oral antibiotic switch strategy.

branching clinical structured oral

Pain amplification, juvenile fibromyalgia and complex regional pain syndrome: Viva

Branching clinical structured oral on amplified musculoskeletal pain, juvenile fibromyalgia and complex regional pain syndrome, covering the central sensitization mechanism, the 2010 American College of Rheumatology criteria, the Budapest clinical criteria, the red flags that mandate re-investigation, and the multidisciplinary management.

branching clinical structured oral

Performance-enhancing substances in young athletes — branching viva

Branching viva on performance-enhancing substances in the young athlete: the WADA prohibited list and strict liability, the recognition of anabolic-androgenic steroid use through the physical signs and the confidential history, the cardiovascular growth and psychiatric harms including the suicidal withdrawal, the counselling-first management, and the contaminated-supplement inadvertent-doping scenario.

branching clinical structured oral

Periodic fever and autoinflammatory syndromes — viva

Branching structured oral on the clockwork fever signature, the five periodic fever syndromes, the inflammasome mechanism and the pathway-targeted therapy.

branching clinical structured oral

Perthes disease — branching viva

Branching viva on Legg-Calve-Perthes disease: the four radiographic phases of idiopathic avascular necrosis, the Herring lateral pillar classification, the containment principle, and the age-and-pillar-guided surgical decision, including the older child at onset and the high-risk lateral pillar C head.

branching clinical structured oral

Pre-participation sports evaluation — branching viva

Branching viva on the pre-participation sports evaluation: reproducing the AHA 14-element cardiovascular history and examination, recognising the exertional syncope and family-history red flags, weighing the history-versus-ECG screening debate, staging the elevated blood pressure, and framing the clearance decision and the emergency action plan with defibrillator access.

branching clinical structured oral

Primary immunodeficiency with rheumatic manifestations — branching viva

Branching viva on the rheumatic-immune overlaps in children: recognising that autoimmunity and immunodeficiency are two faces of one failing immune system, gating the overlap, classifying by the immune arm into the four patterns (CVID arthritis, CGD colitis, classical complement-deficient lupus, and immune dysregulation or Blau syndrome), confirming each with its matched test, and treating both the immune defect and the rheumatic manifestation in parallel while deferring biologics and live vaccines until the immune screen is back.

branching clinical structured oral

Reactive arthritis and post-infectious inflammatory syndromes: Viva

Branching clinical structured oral on reactive arthritis and the post-infectious inflammatory syndromes, covering the one-to-four-week latency and the trigger organisms, the HLA-B27 and the molecular mimicry, the distinction of the post-streptococcal reactive arthritis from the acute rheumatic fever with the 2015 Jones criteria, the naproxen and ibuprofen first-line treatment, the intra-articular triamcinolone hexacetonide, and the anti-tumour-necrosis-factor escalation.

branching clinical structured oral

Relative energy deficiency in sport and athlete nutrition — branching viva

Branching viva on relative energy deficiency in sport and athlete nutrition: defining energy availability and the disruption threshold, distinguishing the Female Athlete Triad from RED-S, recognising the bone stress injury and the absent cycle, reporting the bone density with the Z-score, and managing the athlete with energy restoration as the first-line treatment and the high-risk return-to-play clearance.

branching clinical structured oral

Scleroderma, mixed connective-tissue disease and overlap syndromes: Viva

Branching clinical structured oral on the paediatric scleroderma, covering the distinction between the localised scleroderma (morphea) and the juvenile systemic sclerosis, the Zulian morphea classification with the linear subtype commonest, the PReS and ACR provisional criteria for the juvenile systemic sclerosis, the anti-U1-RNP overlap of the mixed connective-tissue disease, the methotrexate first-line therapy, the scleroderma renal crisis and the pulmonary hypertension that drive the prognosis.

branching clinical structured oral

Scoliosis and spinal deformity — branching viva

Branching viva on scoliosis and spinal deformity: defining the Cobb angle, staging the maturity, running the red-flag screen that separates the idiopathic from the non-idiopathic curve, applying the observe-brace-surgery ladder, defending bracing with the BrAIST trial, and recognising the early-onset curve that threatens the developing lung.

branching clinical structured oral

Slipped capital femoral epiphysis — branching viva

Branching viva on slipped capital femoral epiphysis: the Loder stability classification, the Southwick angle grading, the Klein's line and the frog-lateral radiograph, the single-screw in-situ pinning for the stable slip, the urgent reduction strategy for the unstable slip, and the endocrine work-up for the atypical age-weight presentation.

branching clinical structured oral

Sports injury prevention and overuse injuries — branching viva

Branching viva on overuse and preventable sports injuries in children and adolescents: separating the overuse (microtrauma) injury from the acute injury, naming the traction apophysitides and their age bands, applying the injury-risk triad of specialization, training volume and inadequate recovery, delivering load management with relative rest and a graded return to play, and screening for the stress-fracture and relative energy deficiency in sport red flags.

branching clinical structured oral

Systemic juvenile idiopathic arthritis and macrophage activation syndrome: Viva

Branching clinical structured oral on systemic juvenile idiopathic arthritis and macrophage activation syndrome, covering the ILAR classification, the 2016 MAS criteria, the interleukin-one and interleukin-six blockade, the paradoxical MAS under the tocilizumab, and the refractory escalation to etoposide and emapalumab.

branching clinical structured oral

Systemic lupus erythematosus: Viva

Branching clinical structured oral on childhood-onset systemic lupus erythematosus: the EULAR/ACR 2019 weighted classification criteria, the type I interferon and immune-complex pathophysiology, the hydroxychloroquine backbone with retinopathy screening, and the stepwise escalation to mycophenolate, belimumab, and anifrolumab for refractory disease.

branching clinical structured oral

Transient synovitis and the irritable hip — branching viva

Branching viva on transient synovitis and the irritable hip: excluding septic arthritis with the Kocher criteria, interpreting the ultrasound effusion and the inflammatory markers, choosing between watchful waiting and aspiration, recognising the Kingella kingae mimic in the under-four, and applying the safety-net review for the persistent limp.

branching clinical structured oral

Acute nociceptive pain management — branching viva

A branching viva following one postoperative child through the stepwise, multimodal management of acute nociceptive pain: the scored pain assessment, the WHO two-step ladder adapted for children, the scheduled paracetamol and ibuprofen foundation, the titrated morphine by patient-controlled analgesia with sedation-score monitoring, and the recognition and naloxone response to opioid-induced respiratory depression.

branching clinical structured oral

Care in the last days of life — branching viva

Branching viva on care in the last days of life: definition and ethical standard, classification, stepwise plan, contested escalation, and family or sibling support.

branching clinical structured oral

Chronic primary and secondary pain in children: Viva

Branching clinical structured oral on chronic primary and secondary pain in children, covering the framing of chronic primary pain and central sensitisation, the biopsychosocial assessment and red-flag screen, the interdisciplinary rehabilitation plan, the avoidance of opioids, and the special scenarios of juvenile fibromyalgia, complex regional pain syndrome, functional abdominal pain and chronic secondary pain in serious illness.

branching clinical structured oral

Grief, bereavement and sibling support — branching viva

Branching viva on grief, bereavement and sibling support: definition and ethical standard, classification, stepwise plan, contested escalation, and family or sibling support.

branching clinical structured oral

Neuropathic pain in children: Viva

Branching clinical structured oral on neuropathic pain in children: applying the IASP and NeuPSIG definition and grading system, recognising the bedside signs of allodynia and hyperalgesia, distinguishing complex regional pain syndrome and excluding dangerous structural lesions, and defending the rehabilitation-first stepped plan with gabapentinoids and amitriptyline as off-label adjuncts.

branching clinical structured oral

Opioid stewardship and complex analgesia — branching viva

A branching viva following one postoperative child through the setup of a morphine patient-controlled analgesia device, the weight-based and PCA dosing with the sedation-score monitoring, the multimodal opioid-sparing backbone, the recognition and titrated naloxone reversal of opioid-induced respiratory depression, and the planned rotation to an oral opioid with the incomplete cross-tolerance reduction.

branching clinical structured oral

Organ and tissue donation in children — branching viva

Branching viva on organ and tissue donation in children: definition and ethical standard, classification, stepwise plan, contested escalation, and family or sibling support.

branching clinical structured oral

Paediatric palliative care principles and referral — branching viva

Branching viva on the principles and referral of paediatric palliative care: the WHO definition and parallel-care model, the four Together for Short Lives (ACT) categories with worked examples, the Paediatric Palliative Screening Scale (PaPaS), the relationship between the palliative referral and the resuscitation decision, the under-recognised suffering of group 4 children, and bereavement follow-through.

branching clinical structured oral

Pain assessment across developmental and cognitive abilities — branching viva

Branching viva on paediatric pain assessment: self-report as the gold standard with the Faces Pain Scale-Revised and the Numerical Rating Scale; FLACC for the two-month to seven-year-old; the revised FLACC and the Non-communicating Children's Pain Checklist for cognitive impairment; COMFORT-behaviour in the PICU; the under-assessment traps of the quiet, freeze, habituated, sedated and paralysed child; and pain as the fifth vital sign with reassessment against the predicted response.

branching clinical structured oral

Palliative care in cancer — branching viva

Branching viva on palliative care in childhood cancer: the World Health Organization definition and the concurrent parallel model, the early referral at the high-risk diagnosis, the World Health Organization analgesic ladder and the opioid stewardship, the goals-of-care and advance care planning conversation, the anticipatory medicines for the last days of life, and the bereavement follow-up and the sibling support.

branching clinical structured oral

Palliative care in neurodisability and genetic disease — branching viva

Branching viva on palliative care in neurodisability and genetic disease: definition and ethical standard, classification, stepwise plan, contested escalation, and family or sibling support.

branching clinical structured oral

Symptom control in serious paediatric illness — branching viva

Branching viva on symptom control in serious paediatric illness: the WHO two-step ladder and weight-based morphine dosing, the breakthrough opioid fraction, safe opioid rotation and incomplete cross-tolerance, the central mechanism of opioid relief of breathlessness, antiemetic matching to the emetic pathway, terminal agitation and delirium with exclusion of reversible causes, anticholinergic choice for death rattle, the subcutaneous route and syringe driver, anticipatory prescribing for home, and proportionate palliative sedation for refractory symptoms.

branching clinical structured oral

Withholding and withdrawing life-sustaining treatment — branching viva

Branching viva on withholding and withdrawing life-sustaining treatment: definition and ethical standard, classification, stepwise plan, contested escalation, and family or sibling support.

branching clinical structured oral

Acute rheumatic fever and rheumatic heart disease — branching viva

Branching viva on acute rheumatic fever and rheumatic heart disease: applying the revised Jones criteria, recognising subclinical carditis on echo, confirming the streptococcal link with serology, the Sydenham chorea serology-negative presentation, the secondary prophylaxis regimen and duration, and the RHD-in-pregnancy must-not-miss.

branching clinical structured oral

Adult congenital heart disease transition — branching viva

Branching viva on the transition of the adolescent with congenital heart disease to lifelong adult ACHD care: defining transition as a process, building and measuring readiness, matching surveillance to complexity, preventing loss to follow-up, and counselling on contraception, pregnancy risk by the modified WHO classes, and targeted infective endocarditis prophylaxis.

branching clinical structured oral

Aortic and pulmonary stenosis — branching viva

Branching viva on aortic and pulmonary stenosis: classifying the obstruction by anatomic level, grading severity by echo peak gradient, recognising the duct-dependent critical neonate, matching the intervention to the lesion, and identifying the syndromic associations from bicuspid aortic valve through Noonan and Williams syndromes.

branching clinical structured oral

Atrial septal defect and partial anomalous pulmonary venous return — branching viva

Branching viva on atrial septal defect and partial anomalous pulmonary venous return: recognising the wide fixed split second heart sound, confirming and quantifying the shunt with echocardiography, the device-versus-surgery closure decision, the contraindication in Eisenmenger physiology, and the scimitar syndrome must-not-miss.

branching clinical structured oral

Atrioventricular septal defect — structured oral (viva)

Branching structured oral on a four-month-old girl with Down syndrome and a complete atrioventricular septal defect, testing anatomy, the ECG, timing of surgery, and the long-term valve problem.

branching clinical structured oral

Bradyarrhythmias, heart block and pacing — branching viva

Branching viva on paediatric bradyarrhythmias, atrioventricular block and pacing: the ECG classification of AV block and the Mobitz I versus Mobitz II distinction, congenital complete heart block from maternal anti-Ro antibodies and its permanent fibrosis, the resuscitation of the unstable bradycardic child with transcutaneous pacing, the permanent pacemaker indications and the seven-to-ten-day post-operative rule, and the choice of epicardial, transvenous, and leadless systems.

branching clinical structured oral

Cardiac transplantation and ventricular assist devices — branching viva

Branching viva from the definition of transplantation and ventricular assist devices through the three-axis classification, the INTERMACS urgency profiles, the Berlin Heart EXCOR evidence, the denervated transplanted heart, and the complications that dominate each stage.

branching clinical structured oral

Cardiogenic shock and mechanical circulatory support — branching viva

Branching viva from the school-age child who presents in compensated cardiogenic shock after a viral illness, through the cautious-fluid and inotrope resuscitation and the SCAI staging, the escalation to venoarterial extracorporeal membrane oxygenation when shock becomes refractory, the framing of fulminant myocarditis as a bridge to recovery, and the adolescent on a durable ventricular assist device awaiting transplant, whose device choice, goals of support and anticoagulation complication burden are tested.

branching clinical structured oral

Cardiomyopathies in children — branching viva

Branching viva from the definition and morphological classification of the paediatric cardiomyopathies, through the hypertrophic sudden-death lane, the dilated heart-failure and transplant lane, the tachycardiomyopathy trap, and the family cascade-screening and surveillance strategy.

branching clinical structured oral

Cardiovascular examination and murmur assessment — branching viva

Branching viva on the systematic paediatric cardiovascular examination, the innocent-versus-pathological murmur decision, the four-limb blood pressure and pre- and post-ductal saturation, the duct-dependent neonate and prostaglandin E1 resuscitation, and the hypercyanotic spell bundle.

branching clinical structured oral

Coarctation and interrupted aortic arch — branching viva

Branching viva from the neonate who collapses on day three of life with weak femoral pulses, through the prostaglandin-E1-first resuscitation rule, the ductal-dependent mechanism, the echocardiographic confirmation and the surgical plan, to the older girl with coarctation, Turner syndrome and a bicuspid aortic valve whose lifelong surveillance is set by her genetics.

branching clinical structured oral

Congenital coronary anomalies and ALCAPA — branching viva

Branching viva on congenital coronary anomalies: the recognition and pathophysiology of ALCAPA in the infant, the echocardiographic definition of coronary origin and course, the surgical re-establishment of dual coronary flow, and the risk stratification and exercise restriction of anomalous aortic origin in the young athlete.

branching clinical structured oral

Cyanotic newborn and critical congenital heart disease screening — branching viva

Branching viva on the cyanotic newborn: interpreting the pulse-oximetry screen, starting prostaglandin E1 before the echocardiogram, separating cyanotic congenital heart disease from pulmonary and sepsis mimics, and escalating to a cardiac centre.

branching clinical structured oral

Duct-dependent congenital heart disease: Viva

Branching clinical structured oral on duct-dependent congenital heart disease: recognising a well baby collapsing on day 3 with cyanosis and shock, the two-pathway split, emergency prostaglandin E1 with its apnoea and pyrexia traps, and the pulse oximetry screening programme.

branching clinical structured oral

Ebstein anomaly and tricuspid valve disease — branching viva

Branching viva from the cyanosed neonate with a wall-to-wall heart, through the prostaglandin-E1-first resuscitation rule, the GOSE-scored severity triage and the cone-versus-Starnes surgical decision, to the adolescent with previously undiagnosed Ebstein presenting with palpitations, pre-excitation and an accessory pathway whose lifelong surveillance is set by the arrhythmia risk.

branching clinical structured oral

Exercise evaluation and sports participation in heart disease — branching viva

Branching viva on exercise evaluation and sports participation in heart disease: the red-flag exertional history and family history that halt clearance, the Mitchell dynamic x static sport classification, the layered workup from history and examination through ECG, echocardiography and cardiopulmonary exercise testing, the three eligibility tiers applied across innocent murmurs and repaired lesions through bicuspid valve and repaired tetralogy to hypertrophic cardiomyopathy, channelopathy and anomalous coronary artery, and venue safety with a written emergency action plan and an accessible AED.

branching clinical structured oral

Heart failure in infants and children — branching viva

Branching viva from the definition of paediatric heart failure through the modified Ross classification, the three mechanisms, the four-to-eight-week overcirculation window, the carvedilol evidence, and the escalation to mechanical support and transplantation.

branching clinical structured oral

Hypertension in children — branching viva

Branching viva from the school health check with an elevated blood pressure, through the confirmation rule and the ambulatory study, the primary-versus-secondary stratification, the target-organ screen and the lifestyle-versus-drug decision, to the child who arrives in the emergency department with hypertensive encephalopathy and demands controlled intravenous reduction.

branching clinical structured oral

Hypoplastic left heart syndrome — branching viva

Branching viva from the neonate who collapses on day three of life with uniformly weak pulses, through the prostaglandin-E1-first resuscitation rule, the ductal-dependent mechanism, the echocardiographic confirmation and the staged palliation, to the interstage infant and the Fontan survivor whose lifelong surveillance is set by the single-ventricle circulation.

branching clinical structured oral

Infective endocarditis — branching viva

Branching viva from the febrile child with a new murmur and congenital heart disease, through the Modified Duke criteria and the culture-before-antibiotic discipline, the empirical and targeted antibiotic regimens, the surgical triggers of heart failure and abscess, to the neonate with staphylococcal bacteraemia and a central line whose right-sided endocarditis tests the principle of line removal.

branching clinical structured oral

Innocent murmurs and normal paediatric cardiovascular variants — viva

Branching structured oral examination on a child referred with a heart murmur.

branching clinical structured oral

Kawasaki disease and coronary complications — branching viva

Branching viva on Kawasaki disease: the clinical criteria and incomplete disease, the ten-day IVIG and aspirin window, IVIG-resistant disease and its escalation, coronary z-score grading and anti-thrombotic management, and the long-term risk of stenosis and myocardial infarction.

branching clinical structured oral

Long-QT syndrome and channelopathies — branching viva

Branching viva on long-QT syndrome and channelopathies: the three cardinal genotypes and their triggers, the Schwartz diagnostic score and manual QTc measurement, the beta-blocker-first management with genotype-dependent efficacy, the escalation to LCSD and ICD, and the related entity CPVT with its structurally normal heart and normal resting ECG.

branching clinical structured oral

Myocarditis and pericarditis — branching viva

Branching viva from the school-age child with acute chest pain and a raised troponin after a viral illness, through the diagnostic triad of troponin, electrocardiogram and echocardiogram with cardiac magnetic resonance confirmation, the supportive-first management with selective immunomodulation, the fulminant-myocarditis escalation to mechanical circulatory support, to the adolescent with recurrent pericarditis and the friction rub whose colchicine regimen and corticosteroid-avoidance principle are tested.

structured-oral

Patent ductus arteriosus — viva

A structured oral (viva) on the congenital patent ductus arteriosus: the closing murmur, the management ladder, and the Eisenmenger boundary, with examiner prompts and model answers.

branching clinical structured oral

Postural orthostatic tachycardia syndrome — branching viva

Branching viva from the definition and the standing-test threshold, through the cardiac-exclusion step and the ECG-for-every-child rule, to the three phenotypes and the stepwise management ladder, and finally to the trap of the athletic boy who collapses sprinting and the post-COVID orthostatic-intolerance presentation.

branching clinical structured oral

Pulmonary hypertension in children — branching viva

Branching viva on pulmonary hypertension in children: the haemodynamic definition, the WHO classification, the echocardiographic and catheter-based diagnosis, the three drug pathways, the Eisenmenger threshold, and the surgical escalations.

branching clinical structured oral

Supraventricular tachycardia — branching viva

Branching viva on paediatric supraventricular tachycardia: the mechanisms and classification, the acute termination ladder, the ECG hallmarks of AVNRT and WPW, long-term management and catheter ablation, and the risk stratification of Wolff-Parkinson-White syndrome.

branching clinical structured oral

Syncope and orthostatic intolerance — branching viva

Branching viva from the adolescent who faints in assembly with a classic prodrome, through the cardiac red-flag screen and the ECG-for-every-child rule, to the boy who collapses sprinting with a family history of sudden death and the girl with chronic daily orthostatic symptoms meeting POTS criteria.

branching clinical structured oral

Tetralogy of Fallot — branching viva

Branching viva on tetralogy of Fallot: the unifying embryologic fault, the hypercyanotic spell and its management, the diagnostic strategy, primary repair and the transannular patch dilemma, and the late burden of pulmonary regurgitation and sudden cardiac death.

branching clinical structured oral

Total anomalous pulmonary venous connection — branching viva

Branching viva on total anomalous pulmonary venous connection: the cyanosed neonate with pulmonary oedema, the Darling classification, the echocardiographic diagnosis, the obstructed emergency, the role of the atrial septum, and the surveillance for recurrent pulmonary venous obstruction.

branching clinical structured oral

Transposition of the great arteries — branching viva

Branching viva on transposition of the great arteries: the parallel-circulation problem in the neonate, the resuscitation trio of prostaglandin E1, balloon atrial septostomy and arterial switch, the surgical decision-making for the VSD and LVOTO subtypes, and the long-term legacy of the atrial-switch era.

branching clinical structured oral

Truncus arteriosus and single-ventricle physiology — branching viva

Branching viva from the four-week-old cyanotic infant who has developed heart failure with bounding pulses and a single second sound, through the truncus bedside diagnosis, the falling-pulmonary-resistance mechanism, the complete neonatal repair and the 22q11.2 testing; then on to the staged Fontan pathway, the interstage infant, and the long-term Fontan survivor whose lifelong surveillance is set by the passive circulation.

branching clinical structured oral

Ventricular arrhythmias and sudden cardiac death — branching viva

Branching viva on ventricular arrhythmias and sudden cardiac death in children: the rhythm classification and four SCD cause families, the acute resuscitation of pulseless VT and VF, the synchronised cardioversion versus amiodarone approach for sustained VT, post-arrest targeted temperature management, the ICD and cascade screening strategy, and the related entity commotio cordis.

branching clinical structured oral

Ventricular septal defect — branching viva

Branching viva from the recognition of the VSD murmur through the anatomic and haemodynamic classification, the four-to-eight-week heart-failure physiology, the device-versus-surgery decision, and the Eisenmenger management with family and pregnancy counselling.

branching clinical structured oral

Acute severe and life-threatening asthma — branching viva

Branching viva on acute severe and life-threatening asthma: grading severity, delivering and escalating the stepwise pathway, recognising the danger signs of impending respiratory failure, managing the child failing intravenous therapy, and planning safe discharge and prevention.

branching clinical structured oral

Aspiration, swallowing dysfunction and chronic lung injury — branching viva

Branching viva on recognising chronic and silent aspiration, characterising the route with instrumental swallow assessment, running the multidisciplinary bundle of feeding modification, saliva control and reflux management, and protecting the lung from bronchiectasis.

branching clinical structured oral

Asthma diagnosis and long-term control — branching viva

Branching viva from the definition and objective confirmation of childhood asthma through the phenotype and control classification, the inflammatory pathophysiology, the stepwise controller ladder and the anti-inflammatory reliever evidence, to the poorly controlled adolescent and the diagnostic mimics.

branching clinical structured oral

Behavioural insomnia and circadian rhythm disorders — branching viva

Branching viva from the classification of behavioural insomnia of childhood and the circadian rhythm disorders, through the two-process and melatonin physiology, the sleep history and diary, behavioural treatment of the toddler, the delayed-phase adolescent with school refusal, and the child with autism and chronic insomnia.

branching clinical structured oral

Bronchiectasis in children — structured oral (viva)

Branching structured oral on a child with a chronic wet cough, testing the suppurative lung disease continuum, the vicious cycle, the aetiological work-up, and the management of childhood bronchiectasis.

branching clinical structured oral

Bronchiolitis and viral lower respiratory tract infection — branching viva

Branching viva on grading bronchiolitis severity, delivering supportive care, justifying why bronchodilators and steroids are withheld, recognising apnoea and the tiring infant, and escalating oxygen and breathing support.

branching clinical structured oral

Central sleep apnoea and hypoventilation syndromes — branching viva

Branching viva from a neonate who hypoventilates in sleep with normal heart and lungs, through the recognition of a central control-of-breathing disorder, the ventilate-not-oxygenate rule, PHOX2B confirmation of congenital central hypoventilation syndrome and the ladder of home ventilation, to a school-aged child with rapid-onset obesity and hypoventilation whose ROHHAD diagnosis and tumour search are tested.

branching clinical structured oral

Chronic cough in children — structured oral (viva)

Branching structured oral on a preschool child with a chronic wet cough, testing definition, classification, specific pointers, protracted bacterial bronchitis management, and escalation.

branching clinical structured oral

Community-acquired pneumonia — branching viva

Branching viva on grading childhood pneumonia severity, justifying oral amoxicillin and restrained imaging, choosing the route of therapy, recognising atypical pneumonia and empyema, and escalating oxygen and support for severe disease.

branching clinical structured oral

Congenital lung and airway malformations — structured oral (viva)

Branching structured oral on a large antenatally detected lung lesion progressing toward hydrops, testing antenatal risk stratification, fetal therapy, neonatal stabilisation and definitive surgery.

branching clinical structured oral

Croup — branching viva

Branching viva on grading croup severity, giving corticosteroid to every child, the role and limits of nebulised adrenaline, recognising the deteriorating airway, and distinguishing croup from its dangerous mimics.

branching clinical structured oral

Cystic fibrosis: diagnosis and screening — branching viva

Branching viva on interpreting a positive newborn screen, arranging and reading the confirmatory sweat test, applying the diagnostic criteria and thresholds, recognising clinical triggers such as meconium ileus and pseudo-Bartter, and handling the equivocal CRMS/CFSPID result.

branching clinical structured oral

Cystic fibrosis: pulmonary and multidisciplinary management — branching viva

Branching viva on structuring the four pillars of cystic fibrosis pulmonary care, eradicating a first Pseudomonas isolate, managing a pulmonary exacerbation and its emergencies, and the role of CFTR modulators and the multidisciplinary team.

branching clinical structured oral

Epiglottitis and bacterial tracheitis: Viva

Branching clinical structured oral on paediatric infective airway obstruction: distinguishing croup, epiglottitis, and bacterial tracheitis, the do-no-harm approach, controlled airway management, and anti-staphylococcal antibiotic selection for tracheitis.

branching clinical structured oral

Exercise-induced bronchoconstriction — branching viva

Branching viva from the definition and objective confirmation of exercise-induced bronchoconstriction through its osmotic mechanism, the stepwise management that controls the underlying asthma first, the competitive athlete, and the inducible laryngeal obstruction that must not be treated as asthma.

branching clinical structured oral

Foreign-body aspiration — branching viva

Branching viva from the definition and phases of foreign-body aspiration through the choking basic-life-support algorithm, the imaging caveats, rigid bronchoscopy, and the missed retained foreign body presenting as recurrent pneumonia.

branching clinical structured oral

Interstitial lung disease in children — structured oral (viva)

Branching structured oral on an infant with persistent tachypnoea and diffuse lung disease, testing the chILD syndrome, the age-based classification, the surfactant-dysfunction and NEHI paradigms, and the diagnostic and management pathway for children's interstitial lung disease.

branching clinical structured oral

Laryngomalacia, tracheomalacia and vocal-cord dysfunction: Viva

Branching structured oral on dynamic airway collapse: localising the noisy airway by respiratory phase, the barking cough that does not respond to salbutamol, the spontaneously breathing bronchoscopy that diagnoses tracheomalacia, and the adolescent with exertional inspiratory stridor treated with breathing retraining.

branching clinical structured oral

Narcolepsy and hypersomnolence — branching viva

Branching viva from a school-aged child with new excessive daytime sleepiness and emotion-triggered loss of muscle tone, through the recognition of cataplexy and narcolepsy type 1, the mechanism of orexin neuron loss, the confirmatory polysomnography, multiple sleep latency test and cerebrospinal fluid orexin, the layered management of sleepiness and cataplexy, and a pivot to an adolescent with sleepiness but no cataplexy in whom secondary and idiopathic hypersomnolence must be excluded.

branching clinical structured oral

Neuromuscular respiratory failure and airway clearance — branching viva

Branching viva from a boy with Duchenne muscular dystrophy with morning headaches and recurrent chest infections, through the recognition of the two-part pump-and-cough failure, the monitoring of vital capacity, peak cough flow and nocturnal carbon dioxide, the two parallel treatments of non-invasive ventilation and mechanical insufflation-exsufflation, and the chest-infection rule to clear secretions and ventilate rather than merely oxygenate, to an infant with spinal muscular atrophy whose acute management and anticipatory plan are tested.

branching clinical structured oral

Non-invasive ventilation and home respiratory support — branching viva

Branching viva from the definition and modalities of non-invasive ventilation, through choosing CPAP versus bilevel, the neuromuscular child with a weak cough, the infant with bronchiolitis on high-flow, the child with central hypoventilation, and planning a safe discharge home on ventilation.

branching clinical structured oral

Obstructive sleep apnoea in children — branching viva

Branching viva from the definition and severity classification of paediatric OSA, through the diagnostic role of polysomnography and oximetry, adenotonsillectomy and the CHAT trial, the high-risk peri-operative airway, and the obese and syndromic child with residual disease.

branching clinical structured oral

Oxygen therapy and home oxygen in children — branching viva

Branching viva from a hypoxaemic child with pneumonia, through the principle of prescribing oxygen to a saturation target band, the limits of the pulse oximeter, the meaning of a rising oxygen requirement and the rule to ventilate rather than merely oxygenate, to an ex-preterm infant being assessed for home oxygen whose readiness criteria, safety and weaning are tested, and finally the neonatal oxygen target.

branching clinical structured oral

Paediatric sleep investigations: polysomnography, sleep-study interpretation and MSLT — branching viva

Branching viva that moves from choosing the right sleep investigation for a snoring child, through interpreting a polysomnogram and its apnoea-hypopnoea index, into the role of carbon dioxide in detecting hypoventilation, and on to the prerequisites and interpretation of the multiple sleep latency test in a sleepy adolescent worked up for narcolepsy.

branching clinical structured oral

Pleural effusion and empyema — branching viva

Branching viva on recognising a parapneumonic effusion, choosing ultrasound over a plain film, staging with Light's criteria, giving antibiotics to every child, and deciding between intrapleural fibrinolytics and VATS for empyema.

branching clinical structured oral

Pneumothorax and air-leak syndromes — viva

Branching structured oral on recognising tension physiology and managing pneumothorax and air-leak syndromes across childhood.

branching clinical structured oral

Primary ciliary dyskinesia — branching viva

Branching viva from the definition and classification of primary ciliary dyskinesia, through the diagnostic pathway and cystic fibrosis exclusion, the pathophysiology of failed clearance and laterality, the multidisciplinary management with airway clearance and azithromycin, and the high-stakes heterotaxy and neonatal scenarios.

branching clinical structured oral

Pulmonary haemorrhage and haemoptysis — structured oral (viva)

Branching structured oral on an adolescent with massive haemoptysis and a child with occult alveolar haemorrhage, testing the focal-versus-diffuse split, airway-first resuscitation, the haemosiderin-laden macrophage, and corticosteroid and embolization management.

branching clinical structured oral

Recurrent pneumonia in children — structured oral (viva)

Branching structured oral on a child with recurrent pneumonia, testing the definition, the same-site versus different-site classification, the structural and systemic causes, and the staged investigation.

branching clinical structured oral

Recurrent wheeze in preschool children — branching viva

Branching viva from the definition and phenotype classification of preschool wheeze, through the Asthma Predictive Index and atopy risk stratification, the phenotype-matched preventive pharmacology and its trial evidence, the acute severe attack, and the exclusion of the red-flag mimics.

branching clinical structured oral

Respiratory distress and failure in children — viva

Branching structured oral on recognising the continuum from respiratory distress to failure and escalating support.

branching clinical structured oral

Respiratory manifestations of systemic disease — structured oral (viva)

Branching structured oral on a child with juvenile dermatomyositis and evolving breathlessness, testing recognition of connective tissue interstitial lung disease, the disease-specific reflex, and the danger of the anterior mediastinal mass.

branching clinical structured oral

Spirometry and paediatric pulmonary-function testing — branching viva

Branching viva from the definition of spirometry and the FEV1, FVC and ratio through the physiology of flow limitation, the obstructive and restrictive patterns, bronchodilator reversibility, the Global Lung Function Initiative z-score interpretation that has replaced fixed cut-offs, and the quality and safety of testing in children.

branching clinical structured oral

Tracheostomy care and emergencies: Viva

Branching clinical structured oral on paediatric tracheostomy care and emergencies: tube types, the blocked and displaced tube algorithm, the false passage risk of a fresh stoma, and the decannulation pathway.

branching clinical structured oral

Upper-airway obstruction and stridor — branching viva

Branching viva from the definition and localisation of stridor through the Westley grading and management of croup, the do-not-distress approach to the toxic airway, the inhaled foreign body, and the chronic stridor of laryngomalacia.

branching clinical structured oral

Adolescent chronic pain and functional symptoms — branching viva

Branching viva on validating chronic pain, screening for red flags once, reframing with central sensitisation, co-building a function-first interdisciplinary plan, school reintegration and avoiding opioid escalation.

branching clinical structured oral

Adolescent consent for research and sensitive services — branching viva

Branching viva on informed consent for research and sensitive services, assent and parental permission, waiver of parental permission, bedside capacity assessment, conditional confidentiality and lawful override.

branching clinical structured oral

Adolescent consultation, HEEADSSS and confidentiality — branching viva

Branching structured oral on visit structure, time alone, conditional confidentiality, HEEADSSS domains, validated screens, a suicide disclosure, a portal breach, and transition.

branching clinical structured oral

Adolescent health care for young people in out-of-home care — branching viva

Branching viva on classification and consent authority, the toxic-stress mechanism, the entry-to-care assessment bundle, a lawful confidentiality override, and transition planning for care-experienced adolescents.

branching clinical structured oral

Adolescent health in rural and remote settings — branching viva

Branching viva on the rural adolescent access gap, its mechanism, engineered confidentiality, the tiered service model, telehealth equity, and early retrieval activation.

branching clinical structured oral

Adolescent pregnancy and parenting — branching viva

Branching viva on pregnancy confirmation, options counselling, antenatal coordination, safeguarding, postpartum contraception and rapid repeat pregnancy prevention.

branching clinical structured oral

Adolescent risk assessment and harm minimisation — branching viva

Branching viva on harm-minimisation philosophy, HEADSS, validated screens, suicide safety, the domain harm-reduction bundle, and confidentiality overrides.

branching clinical structured oral

Adolescent sexual health and contraception — branching viva

Branching viva on private-time confidentiality, the 5 Ps, LARC-first method choice, dual protection, emergency contraception, a coercion disclosure and follow-up.

branching clinical structured oral

Adolescent substance-use screening, brief intervention and harm reduction — branching viva

Branching viva on universal substance-use screening (S2BI/CRAFFT), motivational-interviewing brief intervention, the fentanyl-era opioid harm-reduction bundle, vaping cessation, and a confidentiality decision.

branching clinical structured oral

Chronic disease self-management in young people — branching viva

Branching viva on chronic-disease self-management: adherence assessment, transition readiness, motivational interviewing, the acute non-adherence crisis, and the transfer cliff.

branching clinical structured oral

Consent and confidential care for adolescents — branching viva

Branching viva on informed consent, decision-making capacity, conditional confidentiality, lawful override and electronic-record confidentiality.

branching clinical structured oral

Digital media, gaming and cyberbullying — branching viva

Branching viva on classifying digital-media risk, cyberbullying and suicidality, internet gaming disorder, online sexual exploitation, and the harm-reduction vs abstinence-only stance.

branching clinical structured oral

Dysmenorrhoea and heavy menstrual bleeding — branching viva

Branching viva from the adolescent with primary dysmenorrhoea through the management ladder, the heavy-from-menarche adolescent and the bleeding-disease screen, the secondary-cause trap, and the acute severe bleeding scenario.

branching clinical structured oral

Eating disorders: recognition and medical instability — branching viva

Branching viva on recognising an eating disorder, applying SCOFF, quantifying medical instability, triaging red flags, and defending admission and multidisciplinary care.

branching clinical structured oral

Eating disorders: refeeding and multidisciplinary care — branching viva

Branching viva on refeeding-syndrome risk stratification, micronutrient and electrolyte management, higher-calorie refeeding evidence, family-based treatment and multidisciplinary-care discharge planning.

branching clinical structured oral

Gender diversity and gender-affirming paediatric care — branching viva

Branching viva on the four concepts, the staged reversible-first pathway, pubertal suppression at Tanner 2, bone-health and fertility surveillance, conversion-effort prohibition, and the regional guideline differences.

branching clinical structured oral

Medication adherence and treatment fatigue — branching viva

Branching viva on adherence definition and phases, multimodal measurement, treatment fatigue, the tailored intervention, and an acute transplant non-adherence scenario with a confidentiality dimension.

branching clinical structured oral

Menstrual disorders in adolescents — branching viva

Branching viva on normal cycle thresholds, PALM-COEIN classification, the heavy menstrual bleeding work-up, refractory dysmenorrhoea, amenorrhoea and confidentiality.

branching clinical structured oral

Normal puberty and adolescent development — branching viva

Branching viva on pubertal physiology, Tanner staging, the normal sequence, normal variants, and the referral thresholds for abnormal timing.

branching clinical structured oral

Obesity and body-image concerns in adolescents — branching viva

Branching viva on BMI classification with adult crossover, comorbidity and body-image screening, staged weight-neutral management, severe-obesity escalation to pharmacotherapy and surgery, and the parallel mental-health track.

branching clinical structured oral

Polycystic ovary syndrome in adolescents — branching viva

Branching viva on Rotterdam diagnostic criteria with adolescent modification, mimic exclusion, lifestyle-first management, symptom-directed pharmacotherapy, and metabolic and mental health screening.

branching clinical structured oral

School refusal, bullying and social exclusion — branching viva

Branching viva on the three overlapping drivers of adolescent school disengagement: formulation, bully-role assessment, suicide risk, graded return and SSRI evidence.

branching clinical structured oral

Sexual orientation, identity and inclusive care — branching viva

Branching structured oral on the axes of orientation and identity, the minority-stress model, affirming history-taking, behaviour-based screening, confidentiality, family acceptance and the harms of change efforts across adolescent settings.

branching clinical structured oral

Sexually transmitted infection screening and management — branching viva

Branching viva on confidential adolescent STI care: 5 P's history, site-based testing, pregnancy-aware treatment, partner services, rescreening and red-flag escalation.

branching clinical structured oral

Sleep, fatigue and circadian disorders in adolescents — branching viva

Branching viva on adolescent sleep physiology, the differential of the tired teenager, delayed sleep-wake phase disorder, insomnia, and the recognition of narcolepsy and other red flags.

branching clinical structured oral

Tobacco, vaping and nicotine dependence — branching viva

Branching viva on adolescent nicotine dependence as a biological process, the 5 A's, validated dependence grading, pharmacotherapy, EVALI recognition, and the gateway association.

branching clinical structured oral

Transition readiness and transfer from paediatric to adult care — branching viva

Viva on structured transition, readiness assessment, the transfer package and rescue of the lost young adult.

branching clinical structured oral

Youth violence, risky behaviour and injury prevention — branching viva

Branching viva on the public-health approach, prevention tiering, lethal-means counselling, dating-violence safety, and confidentiality overrides.

branching clinical structured oral

Adverse drug reactions and pharmacovigilance — branching viva

Branching viva on ADR definition and classification, paediatric epidemiology, causality and severity assessment, management of anaphylaxis and severe cutaneous reactions, and the pharmacovigilance reporting pathway.

branching clinical structured oral

Analgesics and antipyretics — branching viva

A branching viva following one febrile, uncomfortable child through the choice of analgesic and antipyretic, the weight-based calculation of a paracetamol and ibuprofen dose with the adult ceiling, the position on alternating agents, the safety restrictions on aspirin and on codeine and tramadol, and the escalation to an opioid for severe pain with the monitoring that must accompany it.

branching clinical structured oral

Cardiovascular medicines in children — branching viva

Branching viva on cardiovascular medicines in children: the prostaglandin E1 resuscitative plan for a duct-dependent neonate, the adenosine response to a compromised tachycardic child, the milrinone evidence for low cardiac output syndrome, and the carvedilol and single-ventricle enalapril trial evidence that shapes paediatric heart failure prescribing.

branching clinical structured oral

Chemotherapy and supportive pharmacology — formative viva

A MedVellum formative branching structured oral on chemotherapy and supportive pharmacology in children, following a child on a doxorubicin and cisplatin regimen through dexrazoxane cardioprotection, the antiemetic ladder, febrile neutropenia prophylaxis and management, and the non-negotiable vincristine-intravenous-only route rule. It is not an official board format.

branching clinical structured oral

Complementary, alternative and traditional medicines — branching viva

Branching oral examination on the five CAM domains, prevalence and non-disclosure, the four pathways to harm (heavy-metal contamination, herb-drug interactions, misidentification, delay of care), the bedside safety conversation, and the regional regulatory and evidence picture including homeopathy.

branching clinical structured oral

Corticosteroid therapy and adverse effects — branching viva

Branching viva on corticosteroid therapy in children: stating the equivalent-dose ladder and choosing the acute asthma dose, recognising adrenal suppression in a child on long-term prednisolone, and defending the age-banded stress-dose hydrocortisone and resuscitation of a steroid-dependent child who collapses with hypoglycaemia.

branching clinical structured oral

Developmental pharmacology and age-related pharmacokinetics — branching viva

Viva on ADME ontogeny across paediatric development, the classic neonatal toxicities, and the principles of maturation-adjusted paediatric prescribing.

branching clinical structured oral

Drug interactions and medication reconciliation — branching viva

A branching viva following one child from a new prescription through anticipating a cytochrome P450-mediated interaction, predicting the direction and timing of inhibition and induction, choosing among avoid-substitute-adjust-monitor, and reconciling every medicine at admission, transfer, and discharge.

branching clinical structured oral

Endocrine and diabetes medicines — branching viva

Branching viva on diabetic ketoacidosis insulin and fluid prescribing, a neonatal levothyroxine start, growth hormone dose and safety surveillance, and an adolescent insulin regimen at transition.

branching clinical structured oral

Immunosuppressive and biologic therapies — branching viva

A branching viva following one child from the decision to start methotrexate in juvenile idiopathic arthritis through the weekly dose and folic acid, the full-blood-count and liver-enzyme monitoring, the weekly-versus-daily distinction, and the transition to an anti-tumour necrosis factor biologic with the dual tuberculosis screen and the live-vaccine rule.

branching clinical structured oral

Inhaled therapies and device selection — branching viva

Branching viva on inhaled therapies and device selection in children: choosing the device by the age-based ladder, defending why a spacer is essential for pressurised-inhaler delivery, applying the spacer-versus-nebuliser evidence in acute asthma, and resolving a 'failing' inhaled corticosteroid by correcting the device and technique before escalating the dose.

branching clinical structured oral

Medication adherence and formulation challenges — branching viva

Branching oral examination on the dimensions of adherence, the formulation gap and palatability science, age-appropriate formulation choice, excipient safety in neonates, the stepwise formulation-and-adherence pathway, and the regional regulatory frameworks closing the formulation gap.

branching clinical structured oral

Off-label and unlicensed medicine use — branching viva

Branching oral examination on the licensed/off-label/unlicensed distinction, the paediatric evidence gap, the safe-use governance pathway, adverse drug reactions and pharmacovigilance, and the regional regulatory frameworks.

branching clinical structured oral

Opioids and acute pain medicines — branching viva

A branching viva following one child from post-tonsillectomy analgesia through the codeine contraindication and the CYP2D6 prodrug mechanism, on to building a safe weight-based morphine regimen, detecting opioid-induced respiratory depression early, and reversing it with naloxone.

branching clinical structured oral

Pharmacogenomics and precision therapeutics — branching viva

Branching viva on pharmacogenomics in children: designing a TPMT and NUDT15-guided thiopurine plan, applying the HLA-B star 15 colon 02 screen before carbamazepine in a child of Asian ancestry, and defending the codeine and CYP2D6 ultrarapid-metaboliser reasoning that governs the post-tonsillectomy analgesia decision.

branching clinical structured oral

Poisoning antidotes and toxicology pharmacology — branching viva

A branching viva following one child from a reduced level of consciousness through the toxidrome-driven antidote decision, the N-acetylcysteine regimen for paracetamol, naloxone titration for opioid toxicity, chelation pharmacology, and the early use of antivenom, with the flumazenil trap as a safety branch.

branching clinical structured oral

Procedural sedation medicines — branching viva

Viva on procedural sedation medicines in children, centred on ketamine for a painful reduction, fasting, monitoring, and an adverse event.

branching clinical structured oral

Renal and hepatic dose adjustment in children — branching viva

Branching viva on bedside Schwartz eGFR and renal dose adjustment, Child-Pugh grading and hepatic dose adjustment, vancomycin therapeutic monitoring, and the transition of estimating equations and doses to adult care.

branching clinical structured oral

Safe prescribing, administration and monitoring — branching viva

Viva on safe prescribing, administration and monitoring of medicines in children, centred on a medication error and a therapeutic level.

branching clinical structured oral

Therapeutic drug monitoring — branching viva

Branching viva on therapeutic drug monitoring in children: choosing the vancomycin area-under-the-curve target and sampling time, recognising augmented renal clearance in PICU, and defending the nonlinear Michaelis-Menten kinetics and free-fraction reasoning that govern a toxic phenytoin level in a hypoalbuminaemic child.

branching clinical structured oral

Vaccines and immunobiology — branching viva

A branching viva following one family from the routine scheduled vaccination of a premature infant, through the live-versus-inactivated distinction and the four-week spacing rule, to a catch-up plan for an older sibling with an incomplete record, the contraindications to live vaccines in immunocompromise and pregnancy, and the recognition of anaphylaxis after a vaccine.

branching clinical structured oral

Weight-based dosing, body-surface area and dose calculation — branching viva

A branching viva following one child whose calculated dose is questioned at the bedside, through the measurement of an accurate weight and height, the choice between weight-based and body-surface-area dosing, the Mosteller formula worked aloud, the application of the maximum adult-dose cap, the leading-zero and no-trailing-zero writing rules, the independent double check, and the therapeutic drug monitoring loop when the drug turns out to be a level-guided antimicrobial.

branching clinical structured oral

Advocacy, policy and health-service design for rural children — branching viva

Branching viva on advocacy, policy and health-service design for rural children.

branching clinical structured oral

Avoiding racism and institutional bias in child health — branching viva

Branching viva on avoiding racism and institutional bias in child health.

branching clinical structured oral

Child protection in small and remote communities — branching viva

Branching viva on child protection in small and remote communities.

branching clinical structured oral

Disaster, outbreak and public-health response for children — branching viva

Branching viva on disaster, outbreak and public-health response for children.

branching clinical structured oral

Environmental, occupational and agricultural child health — branching viva

Branching viva on environmental, occupational and agricultural child health.

branching clinical structured oral

Implementing culturally safe Indigenous care in rural and remote services — branching viva

Branching viva on implementing culturally safe indigenous care in rural and remote services.

branching clinical structured oral

Refugee, immigrant and humanitarian paediatrics — branching viva

Branching viva on refugee, immigrant and humanitarian paediatrics.

branching clinical structured oral

Remote prescribing and medication access — branching viva

Branching viva on remote prescribing and medication access.

branching clinical structured oral

Retrieval coordination and transfer risk — branching viva

Branching viva on retrieval coordination and transfer risk.

branching clinical structured oral

Rural developmental, disability and mental-health care — branching viva

Branching viva on rural developmental, disability and mental-health care.

branching clinical structured oral

Rural general paediatric practice and scope — branching viva

Branching viva on rural general paediatric practice and scope.

branching clinical structured oral

Rural newborn and acute paediatric care — branching viva

Branching viva on rural newborn and acute paediatric care.

branching clinical structured oral

Stabilisation with limited paediatric resources — branching viva

Branching viva on stabilisation with limited paediatric resources.

branching clinical structured oral

Telepaediatrics and remote specialist support — branching viva

Branching viva on telepaediatrics and remote specialist support.

branching clinical structured oral

Age-specific normal vital signs and physiological ranges — viva