Paeds Vivas · clinical-assessment-and-reasoning
Multimorbidity and diagnostic overshadowing in children — branching viva
A branching viva following one multimorbid child from a behavioural label through baseline, diagnostic pause, pain search, polypharmacy safety, residual-risk handover and disposition.
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Study tools
Target exams
RACP General PaediatricsRACP DCERCPCH Progress+MRCPCH ClinicalABP General PediatricsACGME PediatricsRCPSC Pediatrics
Prompt
A school-age child with intellectual disability, epilepsy, GORD and polypharmacy presents with new self-injury. The examiner releases information in stages. The candidate must define frames, refuse premature closure, search for medical drivers, reconcile medicines and hand over residual risk.
Branching cross-examination
This is a MedVellum formative viva. It is not an official RACP, MRCPCH, ABP, ACGME or RCPSC station, mark scheme, duration or pass standard. Release each update only after the candidate states the frame, immediate action and residual risk. [14] [20]
Candidate brief
You are the paediatric registrar in a mixed ED and short-stay service. Speak as you would at the bedside. Keep known diagnoses on the table without letting them close the case. [1] [10]
References12ShowHide
- [1]Reiss S, Levitan GW, Szyszko J Emotional disturbance and mental retardation: diagnostic overshadowing. American journal of mental deficiency, 1982.PMID 7102729
- [3]Dell'Armo K, Tassé MJ Diagnostic Overshadowing of Psychological Disorders in People With Intellectual Disability: A Systematic Review. American journal on intellectual and developmental disabilities, 2024.PMID 38411245
- [6]Romano I, Buchan C, Baiocco-Romano L, et al. Physical-mental multimorbidity in children and youth: a scoping review. BMJ open, 2021.PMID 34016659
- [10]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity. Pediatrics, 2016.PMID 27940731
- [11]Feinstein JA, Orth LE Making Polypharmacy Safer for Children with Medical Complexity. The Journal of pediatrics, 2023.PMID 36252865
- [13]Hauer J, Houtrow AJ Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System. Pediatrics, 2017.PMID 28562301
- [14]Bordini BJ, Stephany A, Kliegman R Overcoming Diagnostic Errors in Medical Practice. The Journal of pediatrics, 2017.PMID 28336147
- [16]Croskerry P, Singhal G, Mamede S Cognitive debiasing 1: origins of bias and theory of debiasing. BMJ quality & safety, 2013.PMID 23882089
- [17]Mills E, Lin P, Asghari-Jafarabadi M, et al. Association between caregiver concern for clinical deterioration and critical illness in children presenting to hospital: a prospective cohort study. The Lancet. Child & adolescent health, 2025.PMID 40451224
- [18]Cook S, Mauskar S, Berry JG Discriminating Against Children With Medical Complexity. Pediatrics, 2023.PMID 37357723
- [20]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program. The New England journal of medicine, 2014.PMID 25372088
- [24]Yekezare M, Handley P, Clough S Diagnostic overshadowing: self-injurious behaviour as a manifestation of pain in the head and neck. British dental journal, 2024.PMID 38877248