CLIPP Case Objectives for pdf Learning Objectiv… · Identify the key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score

Case Learning Objectives

Case 1Identify the known benefits of feeding human breast milk to infants.

Understand the important elements of a prenatal history as they relate to the health of the unborn child, including the importance of maternal age.

Recognize factors in the perinatal and newborn history that may put a neonate at risk for medical problems.

Identify intrauterine factors that affect the growth of the fetus.

Demonstrate knowledge of the indication for newborn screening for TORCH infections, including human immunodeficiency virus (HIV).

Understand factors that affect maternal-to-fetus HIV transmission and those that play a role in the prevention of vertical HIV transmission.

Identify the key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score and Apgar score). Use weight and gestational age to categorize potential clinical problems.

Identify what medications are routinely given to all newborns (e.g., vitamin K, hepatitis B vaccine, eye infection prophylaxis).

Identify the common etiologies for small-for-gestational-age (SGA) infants.

Recognize the salient physical findings of congenital cytomegalovirus (CMV) infection and name potential long-term complications associated with this condition.


Case 2Recognize appropriate growth patterns in infants up to 9 months of age using standard growth charts.

Know the nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months, including caloric requirements, differences between formula and breast milk, and how and when to add solid foods to the diet.

Recognize the difference between expected developmental milestones (surveillance) and standardized tools (screening). Use the Parents' Evaluation of Developmental Status (PEDS) or other screening test to evaluate the developmental milestones of the patient at 2, 6, and 9 months.

Recognize the importance of prevention and anticipatory guidance during the well visits, including behavior, development, safety and immunizations.

Develop a differential diagnosis for an asymptomatic abdominal mass and formulate a plan for evaluation.


Case 3Describe the key components of a toddler well-child visit, including: the importance of identifying parent concerns in order to set priorities for the visit effectively.

Describe the key components of a toddler well-child visit, including: the role of the physician in guiding parenting skills through affirming and validating parent's efforts and recommending and facilitating modifications in parenting and behavior.

Describe the key components of a toddler well-child visit, including: nutritional assessment and recommendations for diet and feeding behaviors.

Describe the key components of a toddler well-child visit, including: assessment of dental health and common factors leading to childhood caries.

Describe the key components of a toddler well-child visit, including: methods for performing developmental assessment screening tests and developmental surveillance.

Describe the key components of a toddler well-child visit, including: methods for performing a physical examination tailored to the age and mood of the child.

Describe the key components of a toddler well-child visit, including: topics for anticipatory guidance, such as safety.

List key developmental milestones for children between the ages of 3 and 5 years old.

Identify eczema and discuss first-line therapy.

Discuss the common causes and work-up of anemia in an otherwise healthy child, as well as first-line therapy of iron-deficiency anemia.


Case 4Understand the factors that contribute to childhood obesity.

Understand health implications of childhood obesity.

Recognize the typical presentation of attention-deficit hyperactivity disorder (ADHD) in children.

Understand conditions that contribute to a child's failure in school.

Understand the initial evaluation of childhood hypertension.

Appreciate the routine components of a health maintenance visit for a school-aged child.


Case 5Understand the relevance of a health maintenance visit and know crucial issues to address when interviewing an adolescent in the setting of the emergency department, clinic, or on the inpatient service.

Interview an adolescent and parent, providing a triangle of communication between them.

Address confidentiality with the adolescent and parent, including the issues that can and cannot be broken in a confidentiality agreement.

Discuss risk-taking activities with the adolescent alone (the HEEADSSS interview). This should be completed in a nonjudgmental, non-listlike manner.

Appropriately examine an adolescent—including sexual maturity rating, scoliosis screening, and genital (male genitourinary and female pelvic) exams as needed—so as to produce the least amount of anxiety for the adolescent.

Understand the different anemias and the causes of fatigue and/or easy bruising in childhood and adolescence.


Case 6Know the objectives of the sports preparticipation examination.

Demonstrate an approach to the adolescent patient that respects privacy and confidentiality.

Be familiar with creatine and its risks and benefits in teenage athletes.

Perform the two-minute orthopedic exam as part of the sports preparticipation clearance.

Perform Tanner staging and recognize its importance in adolescent preparticipation evaluation.

Formulate a differential diagnosis and recognize the common causes of benign fainting in the healthy adolescent age group.

Be aware of the key historical questions and physical exam findings that should prompt an evaluation for serious causes of syncope in the adolescent age group.

Formulate a differential diagnosis and recognize the common cause of chest pain in the healthy adolescent age group.

Discuss key issues of health maintenance related to sports, including injury prevention and health promotion, nutrition, personal habits, testicular self-exam, and high-risk behavior counseling.


Case 7Obtain a neonatal history using appropriate sources: hospital chart, mother, nursing staff.

Complete the physical examination of the newborn, including using the growth chart to assess gestational age.

Recognize the symptoms of respiratory distress.

Develop a differential diagnosis for neonatal respiratory distress.

Determine appropriate investigations to evaluate neonatal respiratory distress.

Recognize the effects of maternal diabetes on the neonate.

Identify and manage neonatal hypoglycemia.

Recognize the factors that determine the neonate's readiness for discharge from the hospital.


Case 8Develop the knowledge and skills necessary to diagnose, manage, and refer newborn infants presenting with jaundice, including: recognizing a newborn with jaundice and understanding bilirubin physiology, including metabolism and toxicity.

Compare and contrast the important findings and laboratory data helpful in evaluating a newborn with jaundice with the following diagnoses: physiologic jaundice, hemolytic (Rh or ABO incompatibility, red cell membrane or enzyme defects, infection), hematomas and bruising, breastfeeding-associated jaundice, liver disease (biliary atresia, neonatal hepatitis), metabolic disease (hypothyroidism, hypoglycemia, galactosemia).

Identify treatment options for hyperbilirubinemia.

Become familiar with the American Academy of Pediatrics’ practice guideline, "Management of Hyperbilirubinemia in the Healthy Term Newborn."

Complete a nutritional assessment of a breastfed infant.

Be familiar with nutritional advice related to breastfeeding, including the advantages and common difficulties of breastfeeding.


Case 9Create a neonatal history using appropriate sources: hospital chart, mother, nursing staff.

Develop a list of factors in the maternal and newborn history that may put a newborn at risk for medical problems.

Describe possible complications of a home delivery and how they can be minimized.

Construct a diagnostic approach to a newborn with lethargy.

Compare and contrast the clinical manifestations of congenital hypothyroidism relative to a normal newborn.

Describe core diseases screened for by neonatal blood screening.

Develop a strategy for educating families on the value of early treatment/management of conditions that are included in the newborn screen.


Case 10Meningitis must be considered in the differential diagnosis of any febrile infant, regardless of the presence or absence of meningeal signs.

The only reliable way to rule out meningitis in a febrile infant less than 12 months of age is with a lumbar puncture.

Urinary tract infections should be considered in the differential diagnosis of any febrile infant with a non-focal history and physical examination.

The only reliable method of diagnosing a urinary tract infection in an infant is a urine culture from a catheterized specimen (urine cultures obtained from bag specimens are unreliable).

Empiric antibiotic therapy for an infant or young child with an uncomplicated urinary tract infection should cover predominantly enteric gram-negative bacilli, particularly Escherichia coli. Infants with severe symptoms should receive parenteral antibiotics.

It is recommended that children with a second febrile urinary tract infection should have a voiding cystourethrogram (VCUG) to evaluate for vesicoureteral reflux.


Case 11Identify the features needed to make a diagnosis of Kawasaki disease.

Discuss the acute management of Kawasaki disease.

List complications associated with Kawasaki disease.

Recognize common viral exanthems.

Develop a differential diagnosis for fever and rash.

Develop a differential diagnosis for unilateral cervical adenopathy.


Case 12Develop a differential diagnosis based on the clinical finding of an acute cough in a 9- to 12-month-old infant.

Understand the importance of history in evaluating an infant with cough—in particular the cough’s duration, frequency, and character—and any precipitating factors.

Understand the importance of a careful physical exam in the evaluation of an infant with cough, paying particular attention to chest inspection and auscultation.

Discuss the most common causes of an acute cough in infants and toddlers.


Case 13Obtain a focused and relevant history for a chief complaint of chronic cough.

Describe the relevant physical exam findings in a complete pulmonary examination.

Discuss the relevant differential diagnosis for chronic cough in a school-aged child.

Understand the concept of atopic diathesis and its relationship to allergies and asthma.

Discuss the basics of management of allergic rhinitis.

Know the relevant work-up for a patient suspected of having asthma.

Explain the National Institutes of Health/National Asthma Education and Prevention Program (NIH/NAEPP) asthma severity criteria and stepwise management, and apply them to a patient newly diagnosed with asthma.

Understand the fundamentals of an asthma action plan, including commonly used medications, peak flow monitoring, and asthma education.

Be familiar with Web-based asthma resources for children with asthma and their families.


Case 14Identify age-appropriate approaches to the acutely ill toddler.

Identify appropriate developmental milestones and screening tools for the assessment of a toddler.

Describe findings associated with a normal tympanic membrane, acute otitis media (AOM), and otitis media with effusion (OME) using proper techniques and skills.

List management options for uncomplicated acute otitis media.

Recognize the indications and various methods for performing an age-appropriate hearing screen.

List management options for otitis media with effusion.


Case 15List the important historical and review of systems questions relevant to a preschool-aged child with vomiting and diarrhea.

List the important historical and review of systems questions relevant to an infant with vomiting.

Know the common conditions in the differential diagnosis of vomiting in an eight-week-old infant.

Order relevant laboratory tests to determine the likely cause of vomiting and to ascertain the degree and type of dehydration.

List signs and symptoms of clinical dehydration, and be able to calculate an approximate percentage of dehydration.

Know how to calculate the total fluid deficit and understand the most appropriate method for replacing the deficit, including bolus, maintenance and replacement therapy.

Know the indications for oral versus parenteral replacement therapy.

Understand how to correct the electrolyte abnormalities associated with pyloric stenosis.


Case 16For a school-aged child presenting with dehydration, estimate the percent dehydration based upon relevant physical exam findings.

For a school-aged child presenting with dehydration, discuss three types of dehydration and the appropriate rehydration method for each.

For a school-aged child presenting with dehydration, calculate the volume deficit, bolus fluids, and daily maintenance needs based on the child’s weight.

For a school-aged child presenting with dehydration, describe the impact and management of ongoing losses.

For a school-aged child presenting in diabetic ketoacidosis (DKA): list the common presenting signs and symptoms of type 1 diabetes and DKA.

For a school-aged child presenting in diabetic ketoacidosis (DKA): discuss the pathophysiology of DKA and the resulting impact on fluid, electrolyte, and acid-base status.

For a school-aged child presenting in diabetic ketoacidosis (DKA): understand the principles of early management—including rehydration, electrolyte monitoring, and insulin therapy.

For a school-aged child presenting in diabetic ketoacidosis (DKA): know the complications of DKA and DKA treatment.

For a school-aged child presenting in diabetic ketoacidosis (DKA): compare and contrast types 1 and 2 diabetes in children.

For a school-aged child presenting in diabetic ketoacidosis (DKA): describe the goals of diabetes care and the role of the multidisciplinary team in managing children with type 1 diabetes.

Discuss three normative cultural health beliefs in the Latino culture and their impact on medical care.

Understand the challenges in caring for a child of an immigrant family presenting with a chronic disease.


Case 17Be able to construct a differential diagnosis for painful limp in a pediatric patient.

Know in detail the presentation, work-up, and treatment of transient synovitis and septic arthritis of the hip.

Appreciate the concept of "lethal and likely."

Be acquainted with how to tailor the physical exam to the age and complaint of a pediatric patient.

Have a general framework for completing a musculoskeletal exam.

Recognize the role of evidence-based medicine in daily medical practice.


Case 18Evaluation of a heart murmur in infancy or childhood.

Recognition of congestive heart failure in an infant.

Understanding the pathophysiology of ventricular septal defect.

Management of congestive heart failure in an infant.


Case 19List potential causes of altered mental status in a toddler.

Categorize seizures (e.g. partial, generalized, simple, complex) according to typical clinical features.

List key features to include in the history and exam in determining the etiology of a new-onset seizure.

Outline normal developmental milestones for a 16-month-old child.

Generate a differential diagnosis for a generalized seizure.

Compare and contrast the clinical features of different causes of seizures.

Discuss communication with families about lumbar puncture, including informed consent.

Compare and contrast CSF findings in bacterial vs. viral meningitis.

Distinguish simple from complex febrile seizures.

Summarize national practice guidelines for the evaluation of simple febrile seizures.

Discuss options for anticipatory guidance to families in the aftermath of a febrile seizure.

Describe the typical history, presentation, and exam findings associated with roseola (exanthem subitum).

Discuss causes, prevention, treatment, and complications of bacterial meningitis.


Case 20List key features in the history of a child with headaches.

List the elements of a thorough neurologic exam and interpret abnormalities.

Discuss the differential diagnosis of headaches in children.

Discuss the differential diagnosis of ataxia in children.

Identify signs and symptoms of increased intracranial pressure.

List things to consider when conveying difficult news to a patient and family.


Case 21Formulate a differential diagnosis for petechiae and purpura in a school-aged child.

Summarize clinical features, lab findings, natural history, and complications of Henoch-Schönlein purpura.

Outline typical clinical features of idiopathic thrombocytopenic purpura (ITP), acute lymphocytic leukemia (ALL), and intussusception.

Differentiate normal and abnormal findings on examination of the lymph nodes, liver, and spleen.

Compare and contrast features of accidental vs. non-accidental bruising.

Compare and contrast typical complete blood count (CBC) results in Henoch-Schönlein purpura (HSP), idiopathic thrombocytopenic purpura (ITP), and acute lymphocytic leukemia (ALL).


Case 22Know the ethical responsibilities in caring for adolescent patients.

Be able to conduct a focused acute-care visit for an adolescent patient.

Be able to obtain a comprehensive pain history for abdominal pain.

Be able to obtain a sexual history in an adolescent patient using the HEEADDSSS screening tool.

Review the physical examination findings suggestive of an acute abdomen.

Construct a differential diagnosis for acute abdominal pain in an adolescent.

Review the presentation of and risk factors for pelvic inflammatory disease.


Case 23How to determine if a patient is emergently ill.

The differential diagnosis of a lethargic child.

The different types of shock.

The actions needed to perform the ABCs.

The principles of choosing the right fluids.

The principles of effectively breaking bad news to a patient and a patient's parents.

The principles of phone triage.


Case 24Describe the steps for immediate emergency management of children with a toxic ingestion.

List the acute signs and symptoms of classic accidental ingestion.

Develop a logical approach to the differential diagnosis of a child with altered mental status.

Compare and contrast the acute signs and symptoms of intentional ingestions.

Elicit a complete history when evaluating an unintentional ingestion or exposure to a toxic substance.

Describe and formulate a response to the emotions that may be present in the parent, caregiver, or child at the time of ingestion.

Describe the role of the Poison Control Center and other information resources in the management of the patient with an accidental ingestion.


Case 25Formulate a differential diagnosis for an infant with apnea or apparent life-threatening event (ALTE).

Obtain an appropriate history, including social history, for an infant with suspected shaken baby syndrome.

Describe physical signs and symptoms of shaken baby syndrome.

Order appropriate laboratory and radiological studies for an infant with suspected physical abuse and shaken baby syndrome.

Discuss the ethical and legal responsibility of health care workers to report suspected child abuse to the Department of Human Services.


Case 26Identify abnormal infant growth patterns using standard growth charts.

Define failure to thrive in infancy and discuss its causes.

Apply knowledge of feeding options and of infant nutritional requirements to the management of an infant who has poor weight gain.

Explain why cystic fibrosis causes malnutrition.

List and discuss the most common clinical characteristics of infants who have cystic fibrosis.

Discuss the basic genetics of cystic fibrosis.


Case 27Take a thorough history for abdominal pain.

Understand and demonstrate the approach to the physical exam in a patient with abdominal pain.

Demonstrate the proper use of growth charts.

Understand the differential diagnosis for chronic abdominal pain.

Understand the differential diagnosis of intestinal blood loss.

Recognize critical findings ("red flags") that differentiate functional from pathological abdominal pain.

Order and interpret appropriate laboratory studies as part of the evaluation of abdominal pain.

Understand the role of radiological studies in the evaluation of abdominal pain.

Understand the pathophysiology of anemias.

Understand the basis of therapy for inflammatory bowel disease.


Case 28Perform an initial developmental screening examination.

Interpret information obtained from parents about childhood development.

List common causes of developmental delay in children.

Outline an organized approach to evaluating a child with developmental delay using history, physical, and laboratory assessments.

Identify unique features of the neurological examination in children and findings that are "pathological" and warrant further investigation.

Review factors related to prematurity that impact growth and development in children.

Review the multidisciplinary approach to a child with developmental delay. Name the healthcare providers who provide services to children with developmental delay.

Summarize the definition and types of cerebral palsy. Differentiate these conditions from other causes of mental retardation.


Case 29Recognize the common physical findings in Down syndrome.

Understand the epidemiology of Down syndrome.

Identify the common complications of Down syndrome.

Identify the laboratory tests used to confirm the diagnosis of Down syndrome.

Recognize appropriate "anticipatory guidance" in the management of children with Down syndrome.


Case 30Discuss appropriate communication with the child, the family, and the health care team, especially regarding issues of chronic disease.

Describe the signs of respiratory distress.

Describe health maintenance and expected course for children with sickle cell disease.

Recognize the complications of sickle cell disease that may lead to additional morbidity and mortality, including sepsis, vaso-occlusive crises, acute chest syndrome (ACS), cholecystitis, stroke, and others.

Describe the management of acute chest syndrome.

Work through a differential diagnosis of a child with sickle cell disease with fever and/or cough and/or chest pain.

Identify immunization priorities in children with sickle cell disease.


Case 31Use the history and physical exam findings to limit the differential diagnosis for periorbital edema.

Use the history and physical exam findings to limit the differential diagnosis for generalized edema.

Discuss the differential diagnosis for proteinuria.

State the characteristic laboratory findings seen with nephrotic syndrome.

Discuss how the pathophysiology of nephrotic syndrome results in the characteristic laboratory findings.

Discuss the appropriate evaluation and initial management of a 5-year-old child who presents with her first episode of nephrotic syndrome.

Discuss the prognosis for a 5-year-old girl who presents with her first episode of nephrotic syndrome.

Discuss common complications of nephrotic syndrome, both in terms of the disease itself and management.


Case 32Describe both primary dermatological lesions and secondary changes commonly seen in pediatric patients in a systematic manner using appropriate medical terminology.

Outline the key history and physical findings associated with the following common pediatric dermatologic conditions: Urticaria, seborrheic dermatitis, contact dermatitis, acne, superficial fungal infections, and scabies.

List a prioritized differential diagnoses for an urticarial rash.

Discuss the diagnosis and management of acne.

Discuss the general approach to choosing a topical steroid and the common side effects associated with their use.

Discuss treatment options for common warts.

List at least three conditions in the differential diagnosis of diaper rash.

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CLIPP Case Objectives for pdf Learning Objectiv… · Identify the key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score