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VAQ 7 Don Liew and Ian Summers

VAQ 7 Don Liew and Ian Summers. A 3 year-old girl presents with lethargy and bruising around her face. a. Describe and interpret her CT scan (30%). b . Outline the key features in your examination of this child (70%). Describe- the 7/10 answer (3 minutes).

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VAQ 7 Don Liew and Ian Summers

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  1. VAQ 7Don Liew and Ian Summers A 3 year-old girl presents with lethargy and bruising around her face. a. Describe and interpret her CT scan (30%). b. Outline the key features in your examination of this child (70%).

  2. Describe- the 7/10 answer (3 minutes) • Large bilateral frontal hypo-dense crescentic density frontal to parietal lobes • Single non contrast slice at level of lateral ventricles anterior horn • Compressed ventricles, lack of sulci and grey white differential - raised ICP DDx can be normal for age • Relevant negatives • no fractures • no scalp heamatoma, • no acute bleed or midline shift • Interpret • In clinical setting: chronic subdural, new bruise • Assess and manage as NAI • Craniotomy/drainage urgency depends on GCS- immediate consult neurosurgery

  3. Pass/fail this section • Chronic or sub-acute subdural • Any feature of cerebral oedema or raised ICP • either positive or negative! And somewhere in your overall answer you had to say NAI (……and that was it!)

  4. Part B- 70% or 7.5 minutes the 7/10 answer • Assess for urgency of neurosurg intervention • GCS (and airway risk) • Pupils • Coning-hypertension/bradycardia • Complications • Face injuries- fractures, BOS, jaw, eye injuries • C-spine • Abdo or chest trauma

  5. NAI confirmation • High specific injuries • Burns eg cigarette • Belt buckle or other imprint bruising • Fractures/deformities to limbs • Signs of neglect • Poor hygiene • Old untreated injuries • Growth or emotional retardation- weight • Poor bonding/relationship to parents

  6. Pass/fail this section • GCS or AVPU or any neurological assessment • Face injuries • Any injuries specific for NAI • Any sign of neglect The pass/fail criteria were very generous!

  7. Results • Cannon to right of them,
Cannon to left of them,
Cannon behind them
  Volley'd and thunder'd;
Storm'd at with shot and shell,
While horse and hero fell,
They that had fought so well
Came thro' the jaws of Death,
Back from the mouth of Hell,
All that was left of them,
  Left of six hundred. • The Charge of the Light Brigade , Alfred Tennyson.


  8. Why Did People Fail This Q? • Mainly from insufficient part B. It’s worth 70% of marks. • Ignoring the clinical stem • Failure to assess for neurotrauma and/or facial injuries. • Failure to seek signs of neglect.

  9. Time allocation

  10. Tips THINK BEFORE WRITING Use the clinical stem. It’s highly relevant. Think broadly, especially if the stem says “outline” Manage time appropriately- the question overall, and the 30/70 split If you did these things you were rewarded

  11. And finally.. • Good luck in the real thing • Hope this helped

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