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PAEDIATRICS
Study Guide
Faculty of Medicine
King Abdulaziz University
Phase III, MBBS
2010
TABLE OF CONTENTS
Welcome letter.......................................................................................Outcomes of the medical undergraduate curriculum...Curriculum map.....................................................................................Introduction to the course............................................................Structure of the course..................................................................Master schedule...................................................................................General aims & objectives OF THE COURSE...................................RELATION OF THE COURSE.......................................................................Teachers contacts................................................................................Assessment plan......................................................................................Icons..............................................................................................................LECTURES
Growth.................................................................................................
Development.......................................................................................
Child Abuse.........................................................................................
Infant feeding......................................................................................
Rickets.................................................................................................
Fluid / Acid Base Balance...................................................................
Genetic Disorders in Children...........................................................
Vaccination......................................................................................
The Normal Newborn I.......................................................................
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The ill newborn (sepsis, seizures and Birth injuries)........................
Respiratory Distress in the newborn.................................................
Upper Respiratory Tract Infections....................................................
Lower Respiratory Tract Infections...................................................
Tuberculosis........................................................................................
Bronchial Asthma in children..............................................................
Anemia.................................................................................................
Congenital Heart Diseases...................................................................
Rheumatic Heart Disease, Endocarditis & Heart Failure..................
Cerebral Palsy......................................................................................
Seizure Disorder..................................................................................
Proteinuria & Nephrotic Syndrome/ urinary tract infections..........
Hematuria / Renal Failure...................................................................
Chronic Diarrhoea and malabsorption .............................................
Hepatobiliary Diseases.........................................................................
Diabetes Mellitus................................................................................
Thyroid & Adrenal Disorders ...........................................................
Rheumatology......................................................................................
Skin Disorders in Children.................................................................
Oncology.............................................................................................Tutorial Sessions
The Child with Fever and Rash.........................................................
The child with Pallor (Haemolytic Anaemia)....................................
Failure to Thrive................................................................................
Acute & Chronic Abdominal Pain (& Constipation).........................
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The Child with Bleeding Disorder................................................
Shock..................................................................................................
Poisoning & Environmental hazards.................................................
Inborn Errors of Metabolism.............................................................
Problem Solving Learning (PSL) Sessions
Meningitis...........................................................................................
Chronic Recurrent Cough..................................................................
Short Stature.......................................................................................
Dehydration........................................................................................
Recurrent infections (Immunodeficiency & HIV Infection)...........
Hypotonia............................................................................................
Prolonged jaundice in the newborn..................................................
Self-Directed Learning (SDL)
Selected febrile illnesses (Malaria / Leshmania/ Brucella.)...............
Enuresis............................................................................................
CLINICAL CLERKSHIP......................................................................................
APPENDIX LOGBOOK..............................................................................................
4
Welcome Letter
Welcome to the exciting world of paediatrics!! During this Paediatric Clerkship, you will be introduced to a new aspect of medical care. Children form an important and big component of our society. Whatever your career will be, you might be called upon to deal in one aspect or another with children and their families. The skills that you will learn here will prove to be invaluable. During the next 12 weeks, you will be part of the Paediatric team caring for those young infants and children. We have a dedicated medical and nursing team that is committed to help you learn the basic knowledge and practice the necessary skills to deal with children. You will be introduced to how we treat sick children whether in the ward or the ER. Also, as you rotate in the community and well baby clinics, we will share with the satisfying experience of keeping children healthy through health maintenance and watch then grow and develop! We are sure that you will enjoy this rotation and please share with us your thoughts on how we could make your stay more satisfying and your rotation more beneficial. We expect that you will perform to the best of your ability at all times and will continuously strive to improve your performance.
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So GOOD LUCK!
Undergraduate Program Learning Outcomes
CodeLearning Outcomes
KnowledgeBy the end of the program the graduate will be able to:
A1 Describe normal human development across the life-span and how these affect normal structure and function.
A2 Describe normal structure and function of the major systems and how they interrelate.
A3 Describe the molecular, biochemical and cellular basis essential for maintaining homoestasis.
A4 Demonstrate knowledge of the basic medical sciences that explain causes and mechanisms of disease.
A5 Describe the alterations in structure and function of major body systems as a result of illness or injury.
A6 Demonstrate knowledge and understanding of the pharmacological principles of treatment using drugs, their efficacy in the management and symptomatic relief of diseases, as well as their side effects.
A7 Discuss the implications of basic ethical principles, including confidentiality, informed consent, truth telling, and justice, for the care of patients.
A8 recognize the legal background of medical practiceA9 Explain the causes and mechanisms of intoxication.A10 Describe the role of family, community, and culture as factors influencing
patient presentations, interpretations of illness episodes and adherence to treatment episodes.
A11 Demonstrate knowledge and understanding of the natural history of disease and relationships with risk factors and disease prevention.
A12 Recognize and discuss the principles of disease surveillance and screening, disease prevention, communicable disease control, health promotion, and health needs assessment.
A13 Describe strategies to support life-long learning via print and electronic
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sources to assist in making diagnostic and treatment decisions and to remain current with advances in medical knowledge and practice.
A14 Demonstrate knowledge of how to use the basic medical sciences and clinical skills for clinical decision making and problem solving in the care of patients.
A15 Recognize the scientific basis of health, disease, and medicine in the management of common and high impact conditions in the society.
A16 Demonstrate knowledge of the functional approach to managing chronic conditions, including knowledge of the impact of chronic illness on function.
A17 demonstrate basic knowledge of the global health care delivery system in the community including physicians, hospitals, outpatient centres, health agencies and the role of community agencies in that system.
A18 Recognize the management of common emergencies and the initial and the life saving management steps for other emergencies.
A19 Identify the "Red flags" indicating seriousness in the different clinical presentations.
Cognitive SkillsBy the end of the program the graduate will be able to:
B1 Recognize, define and prioritize problems.B2 Demonstrate the ability to acquire new information and data. B3 Critically appraise validity and applicability of acquired information to
one’s professional decisions.B4 Organize, record, research, present, critique, and manage clinical
information.B5 Recognize the limitations of knowledge in medicine and the importance of
triangulation of evidence before reaching a decision.B6 Evaluate the patient’s medical problems.B7 Formulate accurate hypotheses to serve as the basis for making diagnostic
and treatment decisions.B8 Reflect on one’s thinking process and decisions and apply rational
processes.B9 Use appropriate intellectual strategies to deal with uncertainties when they
arise.B10 Demonstrate an understanding of research methodology.B11 Formulate research questions.B12 Draw research hypotheses.B13 Choose appropriate research methodologies and designs.B14 Select appropriate methods of data collection.B15 Analyse and interpret collected data.
Interpersonal Skills & ResponsibilityBy the end of the program the graduate will be able to:
C1 Display the personal attributes of compassion, honesty, and integrity in relationships with patients, families, communities and the medical profession.
C2 Exhibit appropriate value for the sensitive nature of the doctor/patient relationship and the importance of active listening, with attention to the patient’s familial, cultural, and spiritual circumstances.
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C3 Demonstrate professionalism and high ethical standards in all aspects of medical practice, specifically competence, honesty, integrity, respect for others, professional responsibility and social responsibility.
C4 Exhibit a capacity for self-evaluation, moral reflection and ethical reasoning to form the basis for a self-directed, lifelong engagement in the responsible, committed, compassionate practice of medicine.
C5 Apply the four principles of ethical and legal knowledge, namely respect for autonomy, beneficience, non-maleficience and justice.
C6 Demonstrate awareness and understanding of the legal and professional responsibilities; and report inappropriate medical practice.
Communication, Information Technology & Numerical SkillsBy the end of the program the graduate will be able to:
D1 work effectively as part of a health care teamD2 communicate effectively with patients, their families and colleagues, both
verbally and in writingD3 retrieve information by all means including electronicallyD4 present information clearly in written, electronic and oral formsD5 work within a changing, multi-task environment
Psychomotor SkillsBy the end of the program the graduate will be able to:
E1 Elicit accurate comprehensive and focused medical history by employing techniques that facilitate the patient’s sharing of information.
E2 Conduct a both effective and accurate comprehensive and focused physical examination.
E3 Formulate a differential diagnosis.E4 Select the appropriate laboratory tests and radiographic studies and interpret
their results and use them in making diagnostic and treatment decisions.E5 Formulate and implement a plan of care for both the prevention and
treatment of disease.E6 Educate patients about their health problems and to motivate them to adopt
health promoting behaviors.E7 Use pharmacotherapeutic agents and other therapeutic modalities
effectively.E8 Demonstrate appropriate technique for performing Basic Life Support and
Advanced Life Support.E9 Undertake tasks to initiate and be involved in the care of acutely ill patients.
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CURRICULUM MAP
YOU ARE HERE…
Year 1 Year 2 Year 3 Year 4 Year 5 Year
6Internshi
pPhase
I Phase II Phase III
Year 5
This clerkship will take place throughout the year.
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INTRODUCTION TO THE COURSE
The Paediatric rotation is a 12 weeks clerkship that aims to train the students to solve clinical problems and fulfil expectations of attitude and professional conduct, in addition to the required skills and cognitive knowledge.You will be part of the managing team for the patient and it is important for you to participate in major decisions of diagnosis and management, You are expected to act as the primary physician to the patient. So work hard, try to learn, and improve your performance.
STRUCTURE OF THE COURSE
Lectures (L) : 3/ week (Sat, Môn, Wed) 1 hour (1-2 pm)
Tutorials (T) : 1/week (8 total) 2 hour (1-3 pm)
Grand Rounds : 1/ week (Mon.) 1 hour (8:30-9:30)
Problem Solving Learning (PSL): 1 / week (7) 2 hour (1-3 pm)
Clinical clerkship : 3 block rotation: 4 weeks inpatient ward 4 weeks ambulatory unit 4 weeks
o 2 weeks ERo 1 week Nurseryo 1 week Elective rotation
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GENERAL AIM & OBJECTIVES OF THE COURSE
1. Summary of the main learning outcomes for students enrolled in the course.
Development of strategies for health promotion as well as disease and injury prevention.
Development of the attitudes and professional behaviours appropriate for clinical practice
An understanding of the approach of paediatricians to the health care of children and adolescents
An understanding of the influence of family, community and society on the child in health and disease.
Tactfully approach children and their parents Acquisition of basic knowledge of growth and development (physical,
physiologic and psychosocial) and of its clinical application from birth through adolescence.
Obtain the knowledge about the understanding of the various paediatric diseases involving different systems such as cardiovascular, renal, gastrointestinal, respiratory and central nervous systems, , and including diseases such as endocrinal and Infectious diseases.
Acquisition of the knowledge necessary for the diagnosis and initial management of common paediatric acute and chronic illnesses.
Diagnose and manage common Paediatrics diseases by history, examination and using appropriate investigations.
Development of communication skills that will facilitate the clinical interaction with children, adolescents and their families and thus ensure that complete, accurate data are obtained.
Development of competency in the physical examination of infants, children and adolescents.
Development of clinical problem-solving skills. Provide comprehensive care for healthy children using different modalities
including vaccination, anticipatory guidance and education. . Identify sick children and develop basic skills of paediatric emergency. To be familiar and to know the interpretation of basic paediatric procedures
such as lumber puncture, tuberculin testing, septic screen, phlebotomy—etc
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RELATION OF THE COURSE
As one of the core clerkships during the fifth year of medical school, paediatrics shares with family medicine, internal medicine, obstetrics/ gynaecology, psychiatry, and surgery the common responsibility of teaching the knowledge, skills and attitudes that basic to the development of a competent general physician.
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STUDENT RESPONSIBILITIES
Attendance:
The student's attendance is mandatory in the introductory week and throughout the clinical rotation. He should revue his patients prior to the morning rounds which start at 08:00 am. He should attend the handover rounds in the afternoon. In the ER rotation he should be available during the shift's hours
Absence:
In case of sickness, notify the supervisor and the the pediatric secretary Bld 10 (Ground floor room 1081) department office should be contacted. A signed sick leave should be presented within 24 hours. In the event of a prolonged absence (more than 3 days) the student may be required to make up the time at a later date. This is to ensure that the student has mastered all the required core competencies in Pediatrics. The clerkship director and secretary should be informed of any such absence. We will work with the student to find a time to make-up for such absence.
Dress Code:
All students are expected to conform to the dress code and dress in a professional manner. At all times students should wear their I.D CARD and WHITE COAT. For females the proper attire should be conformed to. It is against hospital rules to wear open-toed sandals.
Inpatient Ward Service:
The student will function as though he/she is the primary physician for the patient. This includes daily examinations of patients and writing progress notes. Students are encouraged to develop a friendly rapport with patients and their families .Each student will be assigned one or more patients on the first day of the rotation. This may be a new admission or a patient already on the ward. Each student should have a minimum of one to two new patients. In addition, the senior resident may ask a student to follow other patients on the service. The average patient load might be two to four patients per student. Students are expected to present the patients they admit at daily rounds with an initial presentation the morning following admission. You also may be asked occasionally to present your patients in other settings such as attending rounds, professor’s rounds or radiology rounds. Ideally, these presentations
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should be practiced beforehand with the senior resident or intern. You will interact with house staff and faculty. Please introduce yourself to your attending and attempt to discuss your patients with him or her when they are available.
Outpatient Service:
Depending upon the situation, the student should takea complete or focused history and physical examination on their patient. Each patient then must be presented to a senior resident or attending. The student needs to follow through on all plans for that patient. The number of patients a student sees each day will vary by the difficulty of the patient problem and the efficiency of the student. You are here to learn and need to take as much time as is necessary to be thorough. The resident or attending may structure your independent interaction with the patient in a busy clinic (i.e., student does the history or physical exam alone and the remaining components together). Students should have independent time with all of their patients.
Emergency Care:
Emergency settings, you will work with a variety of attending. Pace is often fast and focused. You will be expected to see patients while shadowing your staff as well as on your own depending on the acuity of illness. Objectives will include understanding acute care management, basis for hospital admission or consultation with a specialist. Clinical hours will be primarily morning and evenings.
TEACHERS CONTACTSDEPARTMENT STAFF
The following is a list of the faculty members and staff of the Department of Pediatrics. Students are welcome to contact any of the members of the department to answer any inquiries.
NAME / STATUS POSITION Office Extension E-mail Chairman of Pediatrics Bldg.10 G-1083 18329 [email protected]
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(Prof. Jameela Kari)
Pediatric Secretary Bldg.10 G-1081 18327 [email protected] / 20208 [email protected]
1. Prof. Tahir S. Toonisi Professor G-1031 18058
2. Prof. Jameela Kari Professor 1-1069 18371 [email protected]
3. Prof. Mohammed M.S. Jan Professor 1- 1051 21232
4. Prof. Nadia Fida Professor 2-1058 18363
5. Dr. Saad Al Saedi Assoc Prof. 1-1034 18202
6. Dr. Abed Al Hazmi Assoc Prof. 1-1036 18204 [email protected]
7. Dr. Soad Jaber Assoc.Prof. 2-1041 18384
8. Dr. Rima Bader Assoc.Prof. 1-1062 18368 [email protected]
9. Dr. Mohamed A/fattah Assoc. Prof. G-1060 1833
10.Dr. Hussein M. Al Saggaf Assist Prof. G-1093 18290 [email protected]
11.Dr. Mohd F. Farouq Assist Prof. G-1062 18340
12. Dr. Wafaa Abulaenin Assist.Prof 1-1062 18368
13.Dr. Dhuha Al Amawi Assist.Prof. - - [email protected]
14.Dr. Hayat Kamfar Assist.Prof. 1-1045 18379
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15.Dr. Mohd Muzaffer Assist Prof. G-1049 18337 [email protected]
16.Dr. Jameel Al Ata Assist Prof. G-1042 18412
17.Dr. Fayza Al Siny Assist.Prof. 2-1067 18369 [email protected]
18.Dr. Fatma Al Zahrani Assist. Prof. 1-1667 18369
19.Dr. Abdulmoein Agha Assist Prof. G-1037 18306 abdulmoein@dr-
agha.com
20.Dr. Omar Saadah Assist Prof. G-1048 18335 [email protected]
21.Dr. Norah Al Khathlan Assist. Prof - -
22. Dr. Nawaf Al-Dajani Assist Prof. [email protected]
23.Dr. Ahmed Azhar Assist Prof.
24. Dr. Wasim Anshasi Consultant 1-1047 18205
25.Dr. Hussein Bamashmous Consultant 1-1049 18206
26.Dr. Amal Al Dabbagh Consultant 1-1047 1837
27.Dr. Maha Bamehrez Consultant
28.Dr.Zaher Faisal Zaher Consultant
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ASSESSMENT PLAN
The overall evaluation consists of 100 marksContinuous assessment 50 MarksMid rotation examination 10 MarksFinal Examination 40 Marks
Continuous assessment (50 Marks)1. Formative : In each block rotation there will be clinical
assessment with feedback2. Summative : Mini-Clinical Exam with evaluation forms3. Logbook : Each student will have list of encounters and
performance c checked (45 marks)4. Case write up : One final well written long case with full
history, examination, growth chart differential diagnosis, plan of management including investigation, treatment, social symptoms and other disciplinary involvement. (5 marks).
Mid Rotation Examination (10 Marks).
Consists of a written MCQ It will be on Saturday of 7th week. (1 hour) It will cover knowledge in the lectures, tutorials, Problem
solving, etc.
Final Examination (40 Mark)s
Written MCQ OSCE
The student is expected to received a pass mark in both the final exam and logbook independently.
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Icons (standards)The following icons have been used to help you identify the various experiences you will be exposed to.
Learning objectives
Content of the lecture
Independent learning from textbooks
Independent learning from the CD-ROM. The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Problem-Solving Learning
Self- Assessment (the answer to self-assessment exercises will be discussed in tutorial sessions)
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The main concepts
20
Topic Outlines
21
Lecture 1: GROWTH
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Identifying terminology of different age group in paediatrics.
2. Recognizing normal growth patterns in paediatrics.
3. Describe different abnormal growth patterns in weight, height and head circumference.
4. Discuss the different diagnosis of abnormal growth.
5. Use growth chart to plot growth.
Content of the Lecture:
1. Differentiation between premature, neonate, infant, child and adolescent age groups.
2. Illustrate the normal gain in weight for different age groups.
3. Illustrate the normal gain in height for different age groups.
4. Illustrate the normal growth of the head circumference.-Tabulate the expected rate of weight gain at different age groups-Tabulate the expected rate of gain in height at different age groups.
Student Notes: .
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Independent learning from:
Nelson: Textbook of Paediatrics
Independent learning from the CD-ROM.
AAP Internet
Self-assessment:List causes of microcephaly.
23
Lecture 2: DEVELOPMENT
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Describe the four developmental domain of childhood as defined by Denver Developmental scale.
2. Describe how abnormal findings on development screening tools would suggest a diagnosis of developmental delay
3. Describe the initial evaluation of a patient with developmental delay or abnormality.
Content of the lecture:
1. Explanation of the four domain of childhood development (gross motor, fine motor , language and social.)
2. Overview of normal development in children.3. Define developmental delay.4. List of the risk factor.5. Illustrate screening methods to assess motor,
language, psychosocial development in a patient.
6. Outline management and intervention.
Independent learning from textbooks
Student Notes: .
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Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Outline the main developmental milestone in the first year of life.
Lecture 3: Child Abuse
Learning Objectives:
Student Notes:
25
By the end of this lecture, the student should be able to:
1. Define Child abuse and Non Accidental Injury NAI.2. Differentiate between types of Child abuse.3. List the features in the history that should alert the
physician to suspect child abuse.4. List the features in clinical examination that should
raise the suspicion of child abuse and NAI.5. Discuss the approach to discussing NAI with the
family.6. Describe, briefly, the legal repercussion of diagnosis of
NAI.
Lecture Content
1. Case scenarios for describing different types of child abuse such as physical, emotional and child neglect.
2. Outlining the history & physical examination findings of abused children highlighting the specific red flags which raise the suspicion of abuse and /or neglect using photographs and X-rays.
3. The approach to workup of a child presenting with injury will be outlined while stressing on having a high index of suspicion, real life case history will be used.
4. Showing a video of a meeting between the Physician and the parents during which the suspected diagnosis of NAI is introduced.
5. Examples of legal outcomes concerning abused children will be provided from real case histories.
Suggested Reading Material
References:Nelson textbook of Pediatrics, W.B. Saunders Company; Robert M. Kliegman, MD 18th edition
Student Notes
Lecture 4: INFANT FEEDING
Student Notes: .
26
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define the calorie requirement for growth.2. Describe the advantage of breast feeding.3. Compare between breast- formula– cow’s milk.4. Recognize the content of formula feeding and
its indication.5. Define weaning.6. Identify the different types of fluid items
needed for growth.
Content of the lecture:
1. Fluid requirement in childhood.2. Calorie requirement for growth.3. Advantage of breast feeding4. Table containing the difference between
breast milk, and cow’s milk.5. Different types of formula milk and its uses.6. Weaning.7. Calculation of calories of different age groups.
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Suggested Reading Material.
Essential Nelson Ilustated Peadiatric
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Self-assessment:
Which of the following is present in higher amount in human milk than in bovine milk:1. Phosphorous2. Casein3. Lactoalbumin4. Vit. D35. Iron
Student Notes: .
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Lecture 5: Rickets
objectives:
By the end of this lecture, the student should be able to:
1. Define Rickets2. Discuss types of Rickets.3. Recognize clinical features of Rickets.4. Recognize the complication of Rickets.5. Discuss the investigation tools.6. Discuss the treatment
Content of the lecture:
1. Diagrammatic Explanation of pathophysiology of rickets.
2. Types of Rickets.3. Causes of nutritional rickets.4. Clinical presentation.5. Complication.6. Laboratory investigation.7. Radiological findings.8. Management9. The difference between Vit. D3 and one alpha.
Student Notes: .
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Independent learning from
Nelsons text book of paediatrics.
Independent learning from the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
4.Transferable skills:
Recognition of other nutritional problem associated with nutritional rickets.
Self-assessment:
Discuss the radiological findings of nutritional rickets.
Student Notes: .
Lecture 6: Fluid/ Acid-Base Balance
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Learning objectives:By the end of this lecture, the student should be able to:
1. Recognize normal acid base regulation2. Recognize the clinical acid-base relationship.3. Outline the causes of respiratory acidosis4. Outline the causes of respiratory alkalosis5. Outline the causes of metabolic acidosis6. Outline the causes of metabolic alkalosis7. Discuss the role of the kidney in handling the HCO3.
Content of the lecture:
1. Physiology of acid base balance.2. Case of respiratory acidosis (asthma).3. Case of metabolic acidosis (Diabetic keto acidosis ,
renal tubular acidosis)4. Example of metabolic alkalosis5. Example of respiratory alkalosis
Independent learning from: Pediatrics Nelson textbook & llustrated
textbook of Pediatrics (Tom Lissauer/Graham Clayden).
Transferable skills:
The ability to recognize different types of acidosis and to identify alkalosis and to differentiate is it respiratory or metabolic.
Student Notes:
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Self Assessment:
Ahmed is 12 months old boy who was noticed to have failure to thrive. On examination both weight and height were below 3 centile. He had signs of Rickets with wide wrists and chest rosary. His blood tests showed Ph 7.2, HCO3 12 mmol/L, Cl 115 mmol/L (high), K 2.9 mmol/l, Na 135 mmol/L. The child demonstrates:
a. Metabolic acidosisb. Metabolic alkalosisc. Respiratory acidosisd. Respiratory alkalosise. Hyperkalemia
Student Notes:
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Lecture 7: Genetic Disorder in Children
Learning objectives:
By the end of this lecture, the student should be able to:
1. Appreciate that malformations are a common and significant
health burden.
2. Recognize abnormal variation.
3. Recognize the red flags that signify a potential underlying genetic
syndrome necessating a genetic referral.
4. Define malformations, their types and causes; recognize that they
may be isolated or part of a larger spectrum and appreciate their
medical implications.
Content of the lecture: 1. Congenital malformations: definition, types, examples, common
causes, clinical approach, (history, physical examination, base line
investigations, broad outline for prevention and management).
Learn the obligation of all practioners to identify and make
appropriate Clinical Genetic referrals for assessment of potential
underlying disorders and genetic counselling.
2. Dysmorphology: Definition, why diagnose a genetic syndrome,
examples of common syndromes. (e.g. Down Syndrome)
3. Definition of: Deformation, Disruption, Dysplasia, Sequence, Syndrome, Association.
Student Notes:
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Suggested Reading Material:
Medical Genetics 4th edition 2006 (Jorde, Carey, Bamshad,
White) by Mosby
Emery's Elements of Medical Genetics 13th edition 2007 by
Turnpenny and Ellard
Thompson and Thompson Genetics in Medicine 7th edition
2007.
• http:// medgen.genetics.utah.edu/
• http:// www.dnalc.org/
Student Notes:
Lecture 8: Vaccination Student Notes:
.
34
Learning objectives:
By the end of this lecture, the student should be able to:
Immunization:1. Recognize types of immunization.2. Recognize the current vaccine schedule of KSA3. Recognize types of compulsory vaccines. 4. Discuss valid and invalid contraindications of
vaccination5. Discuss indications and administration of
vaccines6. Recognize adverse effects vaccines.7. .Discuss use of vaccines in special
circumstances.
Content of the lecture:
1. Epidemiology of preventable diseases by vaccine.
2. Type of immunization.3. Compulsory vaccine schedule in KSA 4. Indication of each type of immunization.5. General and specific side effects of each
vaccine.6. Contraindication to each vaccine.
Suggested readings:
Red book page 9-66www.cdc.govIllustrated pediatric text book by Lissauer
Independent learning
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from the CD-ROM. The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Outline the general contraindication of live attenuated vaccine.
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Lecture 9: NORMAL NEWBORN
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define the normal gestational age, preterm and post term
2. Recognize the normal growth parameter of newborn.
3. Recognize the Normal vital signs.4. Recognize the normal transient skin change.5. Describe normal neonatal reflexes.6. Discuss the significance of normal reflexes.7. Discuss the significance of absent normal
reflexes.
Content of the lecture:
1. Definition of newborn.2. Normal measurements of newborn.3. Slide show for video show of normal
newborn reflexes.4. Significance of absent neonatal reflexes.5. Slide show of transient neonatal skin
change.
Independent Reading
Essential Nelson: Pediatrics textbookIllustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden)
Student Notes: .
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Mention 3 important neonatal reflexes in regard of time of appearance, disappearance and its significance of persistence beyond six months.
Lecture 10: The Ill Newborn (Sepsis, Seizures and Birth injuries)
Student Notes:
38
Learning Objectives:
By the end of this lecture, the student should be able to:
Neonatal sepsis:1. Define neonatal sepsis.2. Classify neonatal sepsis.3. List the risk factors.4. Identify the causative organisms.5. Describe the clinical features.6. Discuss the important of laboratory
investigations.7. Outline the differential diagnosis.8. Discuss the treatment.
Neonatal seizure:
1. Differentiate neonatal seizure from seizures in older children.
2. Describe clinical types.3. Discuss the aetiology of neonatal seizures.4. Discuss management and prognosis.5. Different between Jittleness and seizures.
Birth injuries:
1. Describe common birth injuries (Cephalohematoma, Erb’s palsy, Fracture clavicle.
2. Discuss risk factor.3. Discuss the management.
Content of Lecture
.
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Neonatal sepsis:
1. Definition2. Classification 3. Risk Factors4. Causative organisms5. Clinical features6. Investigations7. Differential Diagnosis8. Antimicrobial Treatment
Neonatal seizure:1. Difference between neonatal seizures and seizures
in older children.2. Clinical Types3. Aetiology4. Management and prognosis.5. Difference between jittleness and seizures.
Birth Injuries:1. Risk Factors2. Common birth injuries3. Cephalohematoma4. Common birth injuries5. Erb’s Plasy6. Fracture clavicle
Independent Reading
Essential Nelson: Pediatrics textbookIllustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden)
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Self AssessmentA mother of 2 days old boy rushed to your clinic in a panic state because while feeding her baby she noticed a swelling on the back of his head. Physical examination revealed an active, well looking infant. There is a swelling over the left tempo- parietal area of the head. It is not tender and fluctuating. It does not cross the skull sutures.
The most likely diagnosis is:A. Caput succedaneumB. CephalohematomaC. Subgaleal hematomaD. EncephaloceleE. The site of a scalp electrodes
The most appropriate step in managing this infant will be:A. An urgent consultation to the neurosurgeonB. MRI of the brainC. CBCD. Reassure the mother that this swelling well
disappear and there is no need for intervention
E. Stick a needle in the swelling to aspirate the blood.
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Lecture 11: Respiratory Distress Syndrome
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define Respiratory Distress Syndrome (HMD).2. Identify Risk Factor.3. Describe pathophysiology HMD.4. Discuss the clinical feature5. Discuss the investigation.6. Discuss the management.7. List the complication.8. Recognize the preventive measures.
Student Notes: .
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Content of the lecture:
1. Introduction2. Illustration of pathophysiology3. Risk Factors4. Clinical Feautres5. Investigations6. Management7. Complications8. Preventive measures
Independent Reading
Essential Nelson: Pediatrics textbookIllustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden)
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Self AssessmentMention the complication of HMD.
Lecture 12: Upper Respiratory Tract Infection
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define the anatomy of upper respiratory tract.2. List the clinical condition.3. Recognize the clinical presentation of upper
respiratory infection.4. Discuss the pathophysiology of Otitis Media.5. Define the causative agent Otitis Media.6. Discuss the clinical presentation of acute and
chronic Otitis Media.7. Recognize the test used to diagnose acute
Otitis Media.8. Differentiate between streptococcal pharyngitis
from viral cause.9. Recognize the importance of correct diagnosis
of streptococcal pharyngitis.10.Discuss epiglottitis and its management.11.Discuss viral Croup and its management.12.List differential diagnosis of Stridor.
Student Notes: .
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Content of the Lecture:
1. Introduction to URTIs.2. Acute viral rhinitis.3. Acute otitis media4. Acute pharyngitis.5. Acute stridor syndromes.
Independent learning from textbooks
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Self-assessment
1. Describe the clinical features of acute epiglotitis and its management.
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46
Lecture 13: Lower Respiratory Tract
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Describe the pathophysiology. 2. Recognize the most important pathogenic
cause of bacterial pneumonia in child less than 6 months.
3. Describe physical findings of pneumonia (lobar pneumonia and bronchopneumonia in child less than 10 years).
4. List the differential diagnosis of atypical pneumonia in school age child.
5. Identify possible adjuvant approach to clinical finding of infant with severe bacterial pneumonia.
6. Discuss the investigation and treatment of pneumonia less than 5 years.
7. Discuss the approach to diagnosis and treatment of pneumonia.
8. Recognize the common cause of broncholitis9. Describe the clinical features of broncholitis10. List risk factors in patient with acute
broncholitis.11.Discuss the approach and management of
broncholitis.12.Identify the indication of hospitalization of
broncholitis.
Content of the lecture:
1. Clinical feature of pneumonia (according to age)
2. Classifications (anatomical, causative organism {according to age}.
3. Investigation4. Complication5. Management6. Viral broncholitis (Causes, clinical features,
Student Notes: .
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investigation and management.
References:
1. Nelson textbook of Pediatrics , 17th Edition2. Pneumonia by Benjamin Gaston. Pediatric in
review vol 23 no 4 pp 111-151, 2002
List the causative organism of pneumonia according to age.
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Lecture 14: TUBERCULOSIS
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Identify the cause of tuberculosis in children2. Identify the relevant epidemiological features
of TB infection in children3. Describe the clinical features of the different
pulmonary forms of TB infection4. Describe the clinical features of TB adenitis5. Describe the clinical features of
neurotuberculosis6. List the different tools to diagnose TB7. Describe the value and limitations of PPD skin
testing in the diagnosis of TB8. Outline thee different principles used in the
treatment of tuberculosis in children .
Content of the lecture:
1. Causes of T.B. in children.2. Epidimiological features of TB in children.3. Clinical findings of pulmonary TB.4. Clinical findings of TB adenitis.5. Clinical findings of Neurotuberculosis.6. Role and limitation of PPD7. Tools used in diagnosis.8. Treatment of TB.
Student Notes: .
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Outline the Clinical feature of primary T.B
Lecture 15: Bronchial Asthma in ChildrenLearning Objectives:
By the end of this lecture, the student should be able to:
1. Define Bronchial asthma.2. Describe the pathophysiology .3. Identify the risk factors (precipitating).4. Discuss the diagnostic tools of asthma.
Student Notes: .
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5. List the differential diagnosis.6. Classify asthma according to severity.7. Discuss the guideline for asthma management
in child more than 5 years.8. Recognize the side effects of long term use of
steroid.9. Discuss the management of acute
exacerbation.10.Recognize other factor to improve quality of life
in asthma.11.Identify the national protocol and for asthma
prevention and management.
Content of the Lecture:
1. Definition of Bronchial asthma.2. Risk factors3. Clinical Features4. Classifications5. Investigations6. Management (acute and chronic)
References:
Nelson textbook of Pediatrics , 17th edition Gina website- guidelines and resources,
( pocket guidelines of asthma management and prevention in children)
www.ginasthma .com
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Self-assessment
Discuss the management of acute bronchial asthma.
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Lecture 16: ANEMIA Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define anemia.2. Recognize mechanism of anemia.3. Recognize the clinical presentation.4. Discuss Iron deficiency anemia.5. Recognize other nutritional anemia (Vit B12 and
Folate).6. Discuss causes of Hemolytic anemia.7. Recognize clinical presentation of Sickle cell
anemia.8. Recognize clinical presentation of Thalassemia.9. Recognize clinical presentation of G6PD
deficiency.10.List causes of neonatal anemia.11.Discuss the management.
Content of the Lecture:
1. Diagrammatic illustration of hemoglobin production.
2. Classification of anemia.3. Symptoms and Signs of anemia.4. Definition, pathophysiology and management of
physiological anemia.5. Nutritional anemia (Iron, Folate and Vit.B12).6. Pathophysiology, clinical presentation, diagnosis,
complication and management of SCD.7. Pathophysiology, clinical presentation,
complication and management of beta thalasemia.8. Pathophysiology, S&S diagnosis, complication and
management of G6PD9. List of causes of neonatal anemia.
Student Notes: .
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References:Nelsons textbook of pediatric.
Self-assessment
Describe the difference in presentation between sickle cell anemia and Thalasemia in first year of life.
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Lecture 17: Congenital Heart Disease
Objectives:
By the end of this lecture, the student should be able to:
1. Identify cardiovascular anatomy and function.
2. Discuss the role of PDA and patent foramen ovale.
3. Discuss the possible cause of CHD.4. Recognize clinical feature of acyanotic CHD
with Left to right shunt.5. Discuss VSD, ASD, PDA.6. Discuss common cyanotic congenital heart
disease (Tetralogy of Fallot, TGA).7. Discuss tools of investigation.8. Discuss the complication of CHD.9. Outline the principles of management.
Content of the lecture:
1. Cardiovascular anatomy and function.2. Role of PDA and PFO during fetal life and after
delivery.3. Pathophysiology of acyanotic L-R shunt and
example VSD, ASD, PDA.4. Pathophysiology of cyanotic R-L shunt and
example of (Tetralogy of Fallot, TGA).5. Tools of investigation. (ECG, CXR, ECHO,
Cardiac catheter)6. Complication of CHD (Cyanotic and acyanotic).7. Principle of management.
Suggested Reading Material:
Nelson: Pediatrics textbook
Student Notes: .
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Pediatric Cardiology for the practitioners, by Myung K. Park
Self-assessment:
Discuss the X-Ray Findings of Tetralogy of Fallot.
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Lecture 18: Rheumatic Heart Disease / Endocarditis/ Heart Failure
Learning Objectives:
By the end of this lecture, the student should be able to:
Rheumatic Heart Disease1. Recognize acquired heart lesion.2. Clinical features.3. Outline the investigation.4. Outline the treatment of phophylaxis.5. List the complications.
Infective Endocarditis1. Define infective endocarditis vs subacute
infection.2. List risk factors.3. Discuss the clinical presentation.4. Discuss the investigation.5. Discuss the management.6. Discuss the complication.7. Role of prophylaxis.
Heart Failure1. Define heart failure.2. List the risk factors.3. Discuss the clinical presentation.4. Discuss the investigation.5. Outline the management.
Content of the lecture:
Student Notes:
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Rheumatic Heart Disease1. The role of B-hemolytic streptococcal infection
in Rheumatic heart disease.2. John’s criteria in diagnosis.3. Clinical features4. Investigation5. Complication6. Treatment and prophylaxis
Infective Endocarditis1. Definition2. Risk factors3. Causative agents4. Clinical feature5. Investigation6. Complication7. Treatment8. Role of prophylaxis
Heart Failure1. Definition2. Risk factors3. Clinical presentation of heart failure in infancy
and childhood.4. Investigation5. Management
Suggested Reading Material
Pediatric Cardiology for the practitioners, by Myung K. ParkNelson: Pediatrics textbook
Student Notes
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Self-assessment:
1. List John’s criteria. 2. Discuss the prophylaxis if infective endocarditis.3. Discuss the clinical feature of heart failure in a 6
months old child.
Lecture 19: CEREBRAL PALSY
Learning Objectives:By the end of this lecture, the student should be able to:
1. Define Cerebral Palsy.2. Recognize the risk factors.
Student Notes: .
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3. Classify morphological types of C.P.4. Recognize associated disabilities.5. Recognize the difference between C.P. and
neurodegenerative disorder.6. Discuss the investigation7. Discuss the management.
Content of the lecture:
1. Definition of CP.2. Epidemiology of CP.3. Clinical presentation.4. Types of spastic CP.5. Prenatal risk factors.6. Perinatal risk factors.7. Post natal risk factors.8. List of differential diagnosis.9. Laboratories tests and their interpretation.10.Imaging tests and their significance.11.Other tests if indicated.12. Logarithmic illustration of the multidisciplinary
treatment.
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Independent learning from ` Forfar text book of paediatrics.
Jan MM. Manual of Pediatric Neurology. Problem based approach to common pediatric neurological disorders. Jan MM (ed). 1st Edition, Scientific Publishing Center, King Abdulaziz University Press, Jeddah, Saudi Arabia, 2009.
Independent learning from
the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
Self-assessment:
1. List the postnatal causes of CP.
Student Notes: .
Lecture 20: Seizure Disorder
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Objectives:
By the end of this lecture, the student should be able to:
1. Define seizures.2. Classify seizure.3. List causes of generalized seizures.4. List causes of partial seizure 5. Discuss febrile seizure (clinical presentation
investigation and treatment)6. Discuss the investigation7. Define status epilepticus.8. Discuss the management of status epilepticus.9. Recognize common antiepileptic drugs and
indication.
Content of the lecture:
1. Definition of seizures.2. Definition of epilepsy.3. Table contains classification of epilepsy.4. Diagrammatic illustration of the path
physiology of epilepsy.5. Table explains the main differences between
different types of epilepsy.6. Table contain the investigations and their
interpretation.7. Logarithmic illustration of status epileptics
presentation ,investigation and treatment)8. Table contain the differences between simple
and complex febrile seizures.
9. Classification, causes, clinical presentation and investigation of neonatal seizures.
10.Table contains different anti epileptics ,indication, mode of action, doses and complication)
11. List of prognostic factors of epilepsy.
Student Notes: .
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Independent learning from
Nelsons text book of paediatrics.
Independent learning from
the CD-ROM.
look at the following web sites: American Academy of Paediatrics
E medicine
Self-assessment:
Outline the management of status epilepticus.
Student Notes: .
Lecture 21 : Proteinuria, Nephrotic Syndrome and
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Urinary Tract Infection
Learning objectives:
By the end of this lecture, the student should be able to:
Nephrotic Syndrome1. Define proteinuria.2. Classify proteinuria.3. Define nephrotic syndrome4. Recognize the clinical presentation5. Discuss the causes6. Discuss the investigation7. List the complications.
UTI1. Define UTI.2. List the risk factors3. List the clinical presentation.4. Recognize how to investigate radiologically.5. Outline the radiological investigations required.6. Discuss the management.
Content of the lecture:
1. Definition of proteinuria. 2. Methods of urine collection of urine analysis, 24
hours collection of urine and urine albumin/creatinine ratio.
3. Steroid sensitive nephrotic syndrome (investigation, treatment and complications).
4. UTI (presentation at different ages, investigation and treatment).
5. Congenital renal tract abnormalities (V-U-reflux).
Independent learning from:
Student Notes:
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Self Assessment:
A 2-year-old boy presented with a high temperature (390
C) and irritability. No focus of infection was found on examination. His urine culture proved the diagnosis of urinary tract infection and his micturating cystogram revealed a grade four (III) vesicuo-uretral reflux (VUR). In the above condition which of the following is true:a. Treatment with prophylactic antibiotics is advisable
for the following 3 years or until the VUR disappearb. The commonest organism is candida albicansc. Surgery is indicated in all cases d. Renal scaring is not a recognizable complication e. This boy most likely will suffer from severe learning
disability
Which of the following statements is correct concerning proteinuria in childhood:
a. The normal urinary albumin concentration is above 300 grams per liter
b. Postural proteinuria is a benign conditionc. Proteinuria associated with febrile illness is a serious
conditiond. Proteinuria associated with exercise is usually lasts
for a year or longere. Proteinuria of 150mg/dl causes a nephrotic
syndrome
Student Notes:
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Lecture 22: Hematuria / Renal Failure
Learning objectives:
By the end of this lecture, the student should be able to:
Hematuria
1. Define hematuria.2. List types of hematuria.3. Recognize cause of microscopic hematuria.4. Recognize cause of macroscopic hematuria.5. Discuss investigation of hematuria.
Renal Failure1. Define Renal Failure.2. Differentiate between acute and chronic renal
failure .3. Discuss causes of acute renal failure.4. Recognize the clinical presentation of acute renal
failure.5. Discuss the diagnostic test of ARF.6. Recognize clinical presentation of CRF.7. Discuss the diagnostic test of CRF.8. Describe the management of ARF and CRF.
Content of the lecture: Hematuria1. Diagramatic explanation of renal system.2. Table of causes of hematuria (glumerulus and non
glumerulus)3. Non-renal (systemic) causes.4. Stepwise approach for investigation.
Renal Failure1. Definition of R.F.2. Table containing difference between ARF and CRF.3. Explain how to differentiate between Pre-renal, renal
and post-renal causes in ARF.
Student Notes:
Student Notes:
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4. Investigation of ARF and CRF.5. Management of ARF and CRF.
Independent learning from: Pediatrics Nelson textbook & llustrated
textbook of Pediatrics (Tom Lissauer/Graham Clayden).
Self Assessment:An eight years old boy presented to the emergency department with red urine. His mother stated that he was previously well apart from sore throat 2 weeks earlier. On examination, he looked pale with peri-orbital puffiness. His blood pressure was 140/90. Urine dipsticks showed 4+ve blood, 1+ve protein and –ve nitrite and Leucocyte esterase.
The most likely helpful test to confirm the diagnosis is:
a) Complete blood countb) Thrombin timec) ASO: antistreptolysin O titerd) Serum Ig A levele) Antinuclear antibodies
Management of chronic renal failure include which of the following:
a) Erythropoietin for anaemiab) Phosphate salts as Calcium binder
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c) Prophylactic antibioticsd) In-activated vitamin D (Vit D2)
Prednisolone to reduce proteinuria
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Lecture 23 : Chronic Diarrhea and Malabsorption
Objectives:
By the end of this lecture, the student should be able to:
1. Define chronic diarrhoea.2. Describe mechanism of diarrhoea.3. Differentiate between smooth osmotic and
secretory diarrhoea.4. Differentiate between small and large bowel.5. Describe the difference between intestinal and
luminal aetiology.6. Discuss cystic fibrosis .7. Discuss celiac diseases .8. Discuss the investigation of chronic diarrhoea.
Content of the lecture:
1. Definition of chronic diarrhoea.2. Mechanism of chronic diarrhoea.3. Table contain the difference between osmotic
and secretory diarrhoea. 4. Causes of Malabsorption. 5. Cystic Fibrosis as an example of luminal
causes.6. Celiac disease as intestinal cause.7. Approach for investigation.
Student Notes: .
Independent learning from
Nelson: Pediatrics Textbook
Illustrated textbook of Pediatrics
Student Notes: .
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(Tom Lissauer/Graham Clayden),chapter 12. pages 180-183.
Self-assessment:
Which of the following investigations confirm the diagnosis of celiac diseasea. Tissue transglutaminase antibodyb. Barium meal and follow throughc. Demonstrating fat globules in the stoold. Abnormal D-Xylose teste. Small bowel biopsy
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Lecture 24: Hepatobiliary diseases
Learning objectives:
By the end of this lecture, the student should be able to:
1. Define infant cholestasis2. Classify causes of cholestasis.3. Describe the consequence of cholestasis4. Correlate the abnormalities in LFT with
cholestasis.5. Recognize feature of biliary atresia.6. Identify different causes of cholestasis.7. Recognize feature of chronic liver disease.8. Discuss autoimmune hepatitis.9. Discuss viral hepatitis.10.Discuss Wilson’s disease.11.Describe end stage of liver disease.
Content of the lecture:
1. Approach to infant cholestasis.2. Mechanism of cholestasis in infant.3. Biliaty atresia as surgical case.4. Treatable medical causes of identifying
cholestasis (Hypothyriodism Tryosinemia type I, Galactosemia).
5. Synthetic function of the liver and its correlative present of cholestasis.
6. Approach to diagnosis.7. Common causes in older children and its
management. ( Viral hepatitis, autoimmune Willson).
Student Notes:
Student Notes:
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Independent learning from textbook
Illustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden),chapter 16. pages 277-284
Nelson: Pediatrics textbook
Self-assessment:
Which of the following is considered untreatable cause for infant cholestasis biliary atresia?
a. Alpha one antitrypsin deficiencyb. Inspissated bile syndromec. Choledocal cystd. Galactosemia
Lecture 25: DIABETES MELLITUS
Student Notes:
.
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Objectives:
By the end of this lecture, the student should be able to:
1. Define D.M.2. Recognize the risk factors.3. Define types of D.M4. Discuss the clinical presentation.5. Discuss tools for investigation.6. Discuss the complications.7. Recognize types of insulin and method of
administrastion.8. Discuss the treatment of D.M.
Content of the lecture:
1. Diagrammatic Explanation of pathophysiology of D.M.
2. Tabulation of the differences between type I and Type II.
3. Causes of secondary D.M.4. Symptoms and signs of D.M5. Explanation of the Somogy and Dawn
phenomena.6. Laboratory tests.7. DKA (presentation, investigation, treatment
and complication)8. Types of insulin and methods of administration.9. Nutritional treatment.
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Independent learning from
Nelsons text book of paediatrics.
Independent learning from
the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
Transferable skills:1. How to cope in newly diagnosed D.M2. Exchange diet regimen .3. Detection of the causes of insulin failure in
D.M
Self-assessment:In 6years old boy presented with DKA discuss your managements approach.
Student Notes: .
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Lecture 26: THYROID / ADRENAL DISORDER
Objectives:
ThyroidBy the end of this lecture, the student should be able to:
1. Recognize the importance of thyroid hormone.2. Discuss the causes of hypothyroidism.3. Describe the clinical presentation and
complication of congenital hypothyroidism.4. Recognize autoimmune thyroidism5. Discuss causes of hyperthyroidism.6. Discuss investigation of thyroid disorder.7. Discuss the use of stimulation and suppression
test8. Discuss the treatment of thyroid disorder.
Adrenal
1. Define anatomy and physiology of adrenal gland.
2. Classify congenital adrenal disorder.3. Discuss congenital adrenal hyperplasia (21 –
hydroxylose deficiency)4. Discuss diagnostic test.5. Describe the clinical presentation and
treatment of adrenal crisis.6. Recognize the prenatal diagnosis and
treatment.7. Describe clinical presentation of adrenal
hypoplasia.Describe the replacement therapy
Content of the lecture
Thyroid1. Diagrammatic illustration of the role of thyroid
hormones2. Causes of primary and secondary
hypothyroidism.
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3. Clinical presentation of congenital hypothyroid.4. Clinical presentation of autoimmune thyroiditis5. Causes hyperthyroidism6. Investigation of thyroid disorder7. Thyroid stimulation and suppression test8. Treatment
Adrenal
1. Anatomy and physiology of adrenal glands.2. Epidemiology.3. Classification.4. Table shows the different types of CAH and
their symptoms and signs.5. Laboratory tests and their interpretation.6. Adrenal crisis (clinical presentation,
investigation and treatment )7. Prenatal diagnosis and treatment.8. Clinical presentation and investigation of
adrenal hypoplasia.9. Table shows the replacement therapy.10.Indicators of adequate replacement therapy.11.List of differential diagnosis.
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Independent learning from Nelsons text book of paediatrics.
Independent learning from
the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
Self-assessment:Describe the clinical feature of congenital hypothyroidism
Outline the management of adrenal crises.
Student Notes: .
Lecture 27: RHEUMATOLOGY
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Learning objectives:
By the end of this lecture, the student should be able to:
Idiopathic Juvenile Arthritis
1. Define incidence and aetiology.2. Discuss the pathophysiology.3. Discuss the epidemiology.4. Discuss the classification.5. Discuss clinical manifestation.6. Discuss the complication7. Discuss differential diagnosis.8. Discuss the investigation.9. Discuss the management.
SLE1. Define SLE.2. Identify the criteria for diagnosis3. Discuss the clinical presentation.4. Discuss the management5. Discuss the complication.
Kawasaki1. Define Kawasaki.2. Discuss the risk factor.3. Discuss the clinical manifestation.4. List the criteria for diagnosis.5. Discuss the clinical feature.6. List the investigation.7. List the differential diagnosis.8. Discuss the treatment.9. Discuss the complications and prognosis.
Content of the lecture:
Idiopathic Juvenile Arthritis1. Incidence and aetiology.
Student Notes: .
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2. Pathophysiology.3. Classification4. Clinical manifestations5. Complications6. Differential diagnosis7. Investigations8. Management
SLE1. Definition of SLE.2. Criteria for diagnosis3. Clinical presentation.4. Management5. Complication.
Kawasaki1. Definition of Kawasaki.2. Risk factor.3. Clinical manifestation.4. Criteria for diagnosis.5. Clinical feature.6. Investigation.7. Differential diagnosis.8. Treatment.9. Complications and prognosis.
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Independent learning from
textbook
Textbook of pediatric rheumatologyName of the book-pages
Independent learning from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Review articles from:EmedicinePubMedOvidlook at the following web sites:
Self-assessment
Briefly answer the following short question:
What are types of IJA?Discuss the criteria of diagnosing SLE.What are the complications of Kawasaki disease?
Student Notes: .
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Lecture 28: Skin Disorders in Children
Learning objectives:
By the end of this lecture, the student should be able to:
1. Recognize the anatomy of the skin.
Student Notes: .
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2. Define the function of the skin.3. Describe different skin conditions.4. Discuss common skin disorders in children.5. Identify common diagnostic tests used in
paediatric dermatology.6. List skin lesion associated with systemic
disorders.
Content of the lecture: 1. Diagrammatic illustration of skin anatomy and
explanation of the role of each layer.2. Enumeration of skin role in maintaining good
health.3. Photographs illustrating different skin
condition.4. Discussion of common skin infection
i. Bacterial : Cellulitis, impetigo.ii. Viral : skin rash.
5. Enumeration of some fungal & parasitic skin infection.
6. Discussion of common non infectious skin condition.
i. Contact dermatitis.ii. Diaper rashiii. Atopic dermatitis
7. Enumeration of some non infectious skin condition
i. Seborrhiec dermatitisii. Acne.iii. Drug rash
8. Enumeration of some pigmentation disorders.9. Enumeration of some benign skin lesion
i. Birth marks
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Independent learning
from: Nelsons text book of paediatrics
Independent learning from the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
Self-assessment:
List the D.D of Maculopapular rash in 2yrs old child with fever.
Student Notes: .
Lecture 29: ONCOLOGY
Le Student Notes:
.
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Learning objectives:
By the end of this lecture, the student should be able to:
1. Recognize the risk factors to develop cancer in general.
2. Identify the most encountered types in children.
3. List the types of leukaemia and lymphoma.4. Recognize the clinical presentation of
leukaemia &lymphoma.5. Discuss the investigation of leukaemia and
lymphoma.6. Recognize the common type of brain tumour in
children.7. Discuss Wilm's tumour.8. Discuss Neuroblastoma.9. Identify the general principles of treatments.
Content of the lecture
1. Cancer Epidemiology.2. Table for the common childhood cancer.3. Classification of leukaemia.4. Clinical presentation of ALL. Including the
prognostic factors5. Clinical presentation of lymphoma.6. Differential diagnosis of generalized
lymphadenopathy.7. Differential diagnosis of hepatosplenomegaly.8. Stepwise approach in investigation.9. Tabulated differences between Wim's and
neuroblastoma (clinical presentation, investigation)
10.Tabulated differences of Supra v.s. infra tentorial brain tumour.
11.List of cancer treatment modalities.12.Complication of chemotherapy.13. Complication of radiotherapy
Independent learning
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from Nelsons text book of paediatrics.
Independent learning from the CD-ROM.
Look at the following web sites:American Academy of Paediatrics
4.Transferable skills:
Childhood cancer is not rare.Keep high index of suspension in child with unexplainable fever, wt loss, or generalized lymphadenopathy.
Self-assessment:List the good prognostic factors in ALL..
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TUTORIAL
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Tutorial 1: Approach to a child with Fever and Rash
Learning objectives:Learning objectives:
By the end of this lecture, the student should be able to:
1. Define the Exanthema.2. Describe types of rash.3. Discuss clinical features of common pediatric
exanthema.4. Discuss the investigation of common pediatric
exanthema.5. Discuss the investigation of common exanthema.6. Discuss the management.
Content of the lecture:1. Definition of Exanthema.2. Different morphology of Rash.3. Discuss the causes, I.P. clinical feature,
complications, investigation.-measles-Rubella- Rose -chicken pox-scarlet fever
Student Notes: .
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Independent learning from textbook
1. Nelson textbook of Pediatrics, W.B. Saunders Company; Robert M. Kliegman, MD 18th edition
2. The Harriet Lane Handbook, Johns Hopkins Hospital, 18th edition.
Independent learning from
the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Student Notes: .
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Tutorial 2: Pallor And Anemia
Learning objectives:
By the end of this lecture, the student should be able to:
1. To recognize the method for detection of pallor.2. To define the causes of pallor and the definition of
anemia.3. To know the definition of hemolysis and the
classification of hemolytic anemia.4. To discuss the general approach to hemolysis
including history, examination and investigation.5. To differentiate between the types of hemolytic
anemia and recognize the most common types.6. To identify the main line of treatment for the most
common types of hemolytic anemia.
Contents:
1. Discussing the definition and the classifications of hemolytic anemia and the recognizing the main points in the history .
2. Recognizing the clinical sign of hemolytic anemia and the signs that relate to the complications of the anemia.
3. Discussing the most important of the various tests that are used to diagnose anemia, and the
4. main line of management.
Reading:
Illustrated Textbook of Pediatrics (Tom
Student Notes: .
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Lissauer/Graham Clayden), chapter 22, page 363-375.Nelson: Pediatrics Textbook
Independent learning from cd-rom. The computer cluster on the 2nd floor of the medical library, building no 7.Independent learning from web: <emedicine.medscape.com/article/201066-overview>
Questions: 1. Which of the following is Not a feature of haemolytic
anaemia?
a. Reticulocytosis.b. Decreased haptoglobin.c. Raised conjugated bilirubin.d. Pigmented gall stone.e. Leg ulcers.
2. A child presented with anaemia, which was microcytic
hypochromic, and Hepatosplenomegaly with target cell. There was a history of similar illness in the family. The best investigation to establish the diagnosis would be:
a. G6PD assay.b. Electrophoresis.c. Bone Marrow examination.d. Coombs’ test.e. Osmotic fragility test.
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Tutorial 3: Failure To Thrive (FTT)
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Define FTT2. Describe the normal growth pattern in full term
& pre-term infants3. Plot growth parameters on growth charts4. List the important points in the history (risk
factors)5. List the important physical signs on
examination.6. Know the difference between marasmus and
dehydration7. Know the classification of FTT8. Know non-organic FTT9. List the causes of organic FTT10.List the differential diagnosis11.List the lab tests.12.List the imaging studies13.Describe the dietary managements14.Describe the monitoring indices.
Student Notes: .
Tutorial 4: Acute and Chronic Abdominal Pain & Constipation
Learning Objectives:
By the end of this lecture, the student should be able to:
Student Notes: .
92
1. Approach Abdominal Pain by history, examination and proper investigation.
2. Differential diagnosis between: a. Acute Abdominal pain b. Chronic and Recurrent abdominal pain.
1. To identify organic abdominal pain.2. Define constipation & list its differential
diagnosis according to the age:
a. Neonatal b. Infancyc. Childhood
93
Tutorial 5: Approach to a child with Bleeding Disorder
Learning objectives:
By the end of this tutorial, the student should be able to:1. Describe the physiology of hemostasis.2. Recognize major causes of bleeding in children.3. Discuss non-thrombocytopenic purpura4. Discuss immune Thrombocytopenia purpura.5. Discuss Hemophilia A.6. Discuss Von-Willibrand disease.7. Identify the complication of plasma factors
Content of the Tutorial:
1. Diagramatic illustration of homeostasis2. Diagramatic illustration of Coagulation Cascades3. Description of platelet, Production, morphology,
function & abnormal condition)4. Pathophysiology, causes, presentation, diagnosis
and complication of hemophilia.5. Tabulated description of ITP (Causes, types S7S,
complication, of hemophilia. 6. Pathophysiology, inheritance, types,
presentation, diagnosis and complication and hemophilia.
7. Pahtophysiology, inheritance, presentation, diagnosis and complication of Von Willibrand Disease.
8. Wrapup approach to bleeding child as regard laboratory test and interpretation of each.
9. Case scenario.
Student Notes: .
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Independent learning from textbook
1. Nelson textbook of Pediatrics, W.B. Saunders Company; Robert M. Kliegman, MD 18th edition
2. The Harriet Lane Handbook, Johns Hopkins Hospital, 18th edition.
Independent learning from
the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Student Notes: .
95
Tutorial 6: Shock States in Children
Learning objectives:
By the end of this tutorial, the student should be able to:
1. Define Shock 2. Enumerate the different types of shock3. Outline the aetiology of shock in Children4. Identify the clinical manifestations of shock
in children.5. Explain the importance of early identification
and management of shock in children.6. Discuss the approach to management of
shock in Children
Content of the Tutorial:
1. Definitions for the following: Shock in “general” Five types of shock “individually” Multi organ dysfunction Syndrome “MODS” Early Goal Directed Therapy “EGDT”
2. Discussion of the aetiology of different types of shock states in children esp. : Gastroenteritis Trauma & Blood loss Congenital Heart Disease Sepsis
3. Outline the pathophysiology of the different types of shock.
4. Describe the clinical presentation of shock with emphasis on age related differences.
5. Outline the approaches to management of shock in general, stressing on Early Goal Directed Therapy “EGDT” in the Emergency room.
6. Describe the complications of persistence of shock states leading to MODS& MOFS.
Student Notes: .
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Independent learning from
textbook
1. Nelson textbook of Pediatrics, W.B. Saunders Company; Robert M. Kliegman, MD 18th edition
2. The Harriet Lane Handbook, Johns Hopkins Hospital, 18th edition.
Independent learning
from the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Student Notes: .
Tutorial 7: Poisoning and Environmental Hazards
Learning objectives: Student Notes: .
97
By the end of this tutorial, the student should be able to:1. Define poisoning, environmental exposure and
environmental hazards2. Identify different sources of environmental
hazards3. Perform the comparison of pharmacology and
toxicology4. Explain why children are more susceptible than
adults to environmental exposures.5. Discuss approaches to Injury prevention in
children
Content of the Tutorial1. Definitions for the following:
Poisoning Environmental exposures Environmental hazards Epigenetic Ergonomics
2. Discussion of the effects of the following on children’s health: Community Air Pollution Lead poisoning Sun exposure Second hand smoking Toxins such as Carbon monoxide, mercury
and asbestos. Pesticides. Environmental sanitation.
3. Outlining the interaction between different environmental exposures and childhood disease.
4. Providing examples of pharmacology and poisoning.
5. Explain the relationship between childhood asthma and exposure to different environmental exposures.
6. Outline the approaches to injury prevention in childhood with examples from the daily
98
experiences.
Independent learning from textbook
1. Nelson textbook of Pediatrics, W.B. Saunders Company; Robert M. Kliegman, MD 18th edition
2. The Harriet Lane Handbook, Johns Hopkins Hospital, 18th edition.
Independent learning from
the CD-ROM.
The computer cluster is in the 2nd floor of the medical library, building No. 7.
Independent learning from the Internet
Look at the following web sites:http://www.ehponline.org/http://www.pubmedcentral.nih.govhttp://injuryprevention.bmj.com/
Student Notes: .
Tutorial 8: Approach to a child with Inborn Metabolism
Student Notes: .
99
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Recognize the importance of inborn errors of metabolism (IEM)
2. Recognize the clinical presentation of IEM3. Recognize some of physical abnormalities which
can be associated with IEM4. Discuss a diagnostic work up for a child
suspected to have IEM.5. Perform a diagnostic work up for a child having
(Metabolic acidosis, Hyperammonemia, Hypoglycemia, Acute liver disease, Unexplained neurological deterioration).
6. Discuss acute management of a child suspected to have IEM
Content of Lecture:
1. Introduction to IEM and the importance of early diagnosis.
2. Acute and chronic symptoms and signs IEM3. Indicators of possibility of IEM4. Physical anomalies associated with IEM5. Differential diagnosis of IEM6. Diagnostic work up and common laboratory
findings in IEM7. Problem Oriented Approach to metabolic
disorders with emphasis on metabolic acidosis, Hyperammonemia, Hypoglycemia, Acute liver disease, Unexplained neurological deterioration
8. Treatment of IEM
Independent learning from
100
Illustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden),chapter 16. pages 263-269
Nelson: Pediatrics textbook
Self Assessment:Give differential diagnosis of acidosis with hyperamonnia.
101
PSL PSL (Problem Solving
Learning)
The clinical scenario
Key information
Explore the problem
What you know
What you need to know
Identify learning issues
Self/group study
Share the knowledge
Solve the problem
Give feedback & reflect
102
PSL 1: Meningitis
Learning objectives:By the end of this PBL, the student should be able to:
1. Identify the types of meningitis2. List the causative agents of bacterial
meningitis3. Describe the clinical features of meningitis4. Identify the short and long term complications
of meningitis5. Describe the diagnostic tests used to diagnose
meningitis6. Differentiate the CSF parameters that are seen
in viral and bacterial meningitis7. Outline the management plan for treatment of
meningitis and its complications
Student Notes: .
103
PSL 2: Chronic Recurrent Cough
Learning Objectives:
By the end of this PSL, the student should be able to:
1. Know types of cough2. How to approach by History, Examination and
Proper Investigation. 3. Differential diagnosis of chronic cough and
know a bit about each cause.4. More details in:5. Bronchial Asthma6. Infectious Causes.
Student Notes: .
PSL 3 : Short Stature Student Notes:
.
104
Le Learning Objectives:
By the end of this lecture, the student should be able to:
1. Know the normal growth and how to predict for normal height
2. Interpret the growth centile and know its different types.
3. Identify causes of short stature and know a bit about each cause.
4. Know how to approach short stature via history examination and investigation.
PSL 4: Dehydration
Learning objectives
By the end of this lecture, the student should be able to:
Student Notes: .
105
At the end of the tutorial you should be able to: To know the causes of dehydration To recognise the clinical signs of
dehydration To know the assessment of the degree of
dehydration To know about different types of
dehydration To know fluid management in different
types of dehydration
Contents 1. Different causes of dehydration will be
discussed including acute gastroenteritis, diabetic ketoacidosis etc .
2. The students will be tought about the symptoms and signs of dehydration and how to look for them, photos and illustrations will also be used.
3. The student will learn how to assess the degree of dehydration into mild, moderate, and severe according to the clinical presentation.
4. The student will learn also about different types of dehydration (hyponatremia, isonatremiac and hypernatremic)
5. The student will be taught about the calculation of fluid requirement for different types of dehydration, including calculation of deficit, maintenance and ongoing losses.
6. The students will also be tought about oral versus intravenous hydration and the indication for each.
106
Independent learning from
textbook
Illustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden),chapter 12. pages 177-180
Nelson: Pediatrics textbook
Self-assessment
Student Notes: .
107
PSL 5 : Recurrent Infections (Immunodeficiency of HIV ) Learning objectives:
By the end of this lecture, the student should be able to:
1. Describe the types of Immunodeficiency2. Identify the clinical features that characterize
primary immunodeficiency3. Identify the basic diagnostic tests that
identifies primary immunodeficiency4. Outline the strategies used to prevent and
treat infection in children with primary immunodeficiency
5. Describe the methods of transmission of HIV6. Identify the diagnostic tests to diagnose
neonatal and pediatric HIV7. Outline the treatment of pediatric HIV8. Discuss the issues related to the primary care
management of a child with HIV
Student Notes: .
108
PSL 6: Hypotomia
Learning Objectives:
By the end of this lecture, the student should be able to:
1. Approach to hypotomia by history, examination and investigation.
2. Difference between central and peripheral hypotomia,
3. Difference between acute and chronic hypotonia
4. List differential diagnosis according to age Neonatal Infant Childhood
Student Notes: .
109
PSL 7: Prolonged Jaundice in the Newborn
Learning Objectives:
By the end of this SDL, the student should be able to:
1. Bilirubin Physiology and metabolism.2. How to assess for jaundice3. Difference between direct & indirect hyper
bilirubinemia.4. Causes of Jaundice and know a bit about each
cause.5. Approach to jaundiced baby6. Management7. Know a bit about photo therapy and exchange
transfusion.8. Know the causes of prolonged jaundice.
Student Notes: .
110
SDLSELF DIRECTIVE LEARNING
SDL 1 : Selected febrile illness (malaria , leishmania, brucella)
Learning objectives:
Student Notes: .
111
By the end of this SDL, the student should be able to:
Malaria
1. Identify the types of malaria infection2. Describe the clinical features of malaria
infection3. Identify the diagnostic tests that are used to
diagnose malaria
Describe the management of malaria infection
Leishmania1. Identify the types of leishmania infection2. Describe the clinical features of leishmania
infection3. Identify the diagnostic tests that are used to
diagnose leishmania4. Describe the management of leishmania
infection.
Brucella1. Identify the types of brucella infection2. Describe the clinical features of brucella
infection3. Identify the diagnostic tests that are used to
diagnose brucella4. Describe the management of brucella infection.
112
SDL 2: Enuresis - Self directed Learning
Learning objectives:
By the end of this SDL, the student should be able to:
1. Define nocturnal enuresis2. Define Diurnal enuresis3. Differentiate between organic causes and non-
organic causes of nocturnal enuresis4. Recognize the steps of investigating nocturnal
enuresis5. Enumerate treatment modalities available for both
diurnal and nocturnal enuresis6. Investigate diurnal enuresis
Independent learning from:
Pediatrics Nelson textbook & llustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden).
Student Notes:
113
Clinical clerkship
114
Clinical clerkshipGENERAL OBJECTIVES
To train the students on acquiring the required communication and examination skills and observe their competencies in those areas
To train students to apply the gathered data in formulating a diagnosis or differential diagnosis
To train students on formulating a management plan and how to implement it
To train the students in solve clinical problem faced on the ward
To teach students to utilize available resources in management of cases.
To expect the proper attitude and professional conduct on behalf of the students
STRUCTURE1. The students are divided in 12 group A-L2. Each block will have 4 groups
4 groups Ward (Inpatient) 4 groups Ambulatory care (OPD) 4 groups Emergency (2)
Nursery (1)Elective (1)
3. The groups will switch every 4 weeks.
Master Schedule
Weeks WARD AMBULATORY ER * N § E§
1 to 4 A B C D E F G H 1 J K L
5 to 8 1 J K L A B C D E F G H
9 to 11 E F G H 1 J K L A B C D
12 Final Exam
Note :* Switch after 2 weeks
§ Switch after 1 week
4. The first week: [Clerkship Orientation]
115
Orientation lectureso Structure of the programo What is expected from the studento Log book orientationo Schedules
General topic lectureso Ethics and professionalismo How to presento Hoe to write progress noteso How to prescribe, etc
Clinical foundation sessionso Series of sessions on communication skills ando Examination sessions of systems
5. Clinical rotations:
Ward Rotation
Objectives Conducting an interview Perform physical exam Manage medical data Communicate information to family Interact with various resources Educate oneself
Ward Schedule: Students are divided among the 3 teams in the ward and stay
with each team for the duration of the 4 weeks acquiring skills through continuity of patient care and continuity of staff contact.
Each student is match to a preceptor that teaches him the basic skills and preparation for bulletin summary before the round.
The student shares the patient load with the team and needs to have a first encounter with at least 1 patient a week.
Two case summaries are expected to present in the round per week and 1 long case per rotation.
A logbook keeps track of the expectation and encounters. The day starts by interaction with the house officer and
preparation for the rounds. The students attend half the number of rounds and spend the
time in between processing the patient’s records, progress notes, summaries, long case.
In the afternoon after the lectures, the student joins other teams activities and participate in patient evaluation and preparation for endorsement
116
o 08:00 – 08:30 am Morning reporto 08:30 – 10:00 am Work roundo 10:00 – 12:00 pm Consultant roundo 1:00 – 4:30 pm follow up of patientso 3:00- 4:00pm didactic teachingo 4:30 – 5:00 pm Handover round
Clinic Rotation
Students will be exposed to common primary care pediatric problems
Students will deal more with issues related to growth, development and family issues
Students will share in health maintenance in the WBC
4 weeks: Ambulatory pediatricsa. 2 week: community pediatric clinics/WBC:
i. Clinical activities/1 session, ½ day; Student activities may include
1. Doing a complete patient workup2. Hx/PE (OSCE style)3. Focused history:Taking an immunization/
nutritional history4. Talking to a mother, give advice5. Attending a session: nutritional assessment,
developmental assessmentii. Academic activities / 1 session, ½ day
1. Minipresentation/SLD style on a topic covered in the am session: LF infant formula, rota virus vaccine, oral thrush, home safety etc
2. Ambulatory weekly grand round3. Case presentation/ discussion (case bank)4. Tutorials on topics related to OPD; child with
rash, acute diarrhea etciii. Other activities:
1. In the future, additional activities may include rotation to primary care centers in collaboration with community medicine, one session in the community; rehab centers, etc to get familiar with community resources.
b. 2 week:
117
i. 1 week :consultants' general and subspecialty clinics
ii. 1 week : walk-in clinic
4 weeksER
Approach is cantered on focused problems of critical nature and its assessment at presentation.
It accommodate 2 groups separated by a.m. and p.m. rotations
o 8:00 am – 12:00 pm Morning shifto 4:00 pm – 8 pm pm Evening shift
Nursery Examination and case of newborn Common neonatal problems Accommodates 1 group
o 8:00 am – 12:00 pm Morning round and Postnatalo 1:00 pm – 5:00 pm Admission & discharge
Elective Provide option to experience complex problems of critical
care (NICU / PICU or Radiology) According to the attachment (ex. Radiology, ICU, PICU,
Nephrology, Endocrine, Gastroenterology, Cardiology........
118
ER/Nursery/Elective
LOG BOOK
(Draft in progress)
119
INTRODUCTION TO THE COURSE
The Paediatric rotation is a 12 weeks clerkship that aims to train the students to solve clinical problems and fulfil expectations of attitude and professional conduct, in addition to the required skills and cognitive knowledge.You will be part of the managing team for the patient and it is important for you to participate in major decisions of diagnosis and management, You are expected to act as the primary physician to the patient. So work hard, try to learn, and improve your performance.
STUDENT RESPONSIBILITIESAttendance:
The student's attendance is mandatory in the introductory week and throughout the clinical rotation. He should revue his patients prior to the morning rounds which start at 08:00 am. He should attend the handover rounds in the afternoon. In the ER rotation he should be available during the shift's hours
Absence:
In case of sickness, notify the supervisor and the the pediatric secretary Bld 10 (Ground floor room 1081) department office should be contacted. A signed sick leave should be presented within 24 hours. In the event of a prolonged absence (more than 3 days) the student may be required to make up the time at a later date. This is to ensure that the student has mastered all the required core competencies in Pediatrics. The clerkship director and secretary should be informed of any such absence. We will work with the student to find a time to make-up for such absence.
Dress Code:
All students are expected to conform to the dress code and dress in a professional manner. At all times students should wear their I.D CARD and WHITE COAT. For females the proper attire should be conformed to. It is against hospital rules to wear open-toed sandals.
Inpatient Ward Service:
120
The student will function as though he/she is the primary physician for the patient. This includes daily examinations of patients and writing progress notes. Students are encouraged to develop a friendly rapport with patients and their families .Each student will be assigned one or more patients on the first day of the rotation. This may be a new admission or a patient already on the ward. Each student should have a minimum of one to two new patients. In addition, the senior resident may ask a student to follow other patients on the service. The average patient load might be two to four patients per student. Students are expected to present the patients they admit at daily rounds with an initial presentation the morning following admission. You also may be asked occasionally to present your patients in other settings such as attending rounds, professor’s rounds or radiology rounds. Ideally, these presentations should be practiced beforehand with the senior resident or intern. You will interact with house staff and faculty. Please introduce yourself to your attending and attempt to discuss your patients with him or her when they are available.
Outpatient Service:
Depending upon the situation, the student should takea complete or focused history and physical examination on their patient. Each patient then must be presented to a senior resident or attending. The student needs to follow through on all plans for that patient. The number of patients a student sees each day will vary by the difficulty of the patient problem and the efficiency of the student. You are here to learn and need to take as much time as is necessary to be thorough. The resident or attending may structure your independent interaction with the patient in a busy clinic (i.e., student does the history or physical exam alone and the remaining components together). Students should have independent time with all of their patients.
Emergency Care:
Emergency settings, you will work with a variety of attending. Pace is often fast and focused. You will be expected to see patients while shadowing your staff as well as on your own depending on the acuity of illness. Objectives will include understanding acute care management, basis for hospital admission or consultation with a specialist. Clinical hours will be primarily morning and evenings.
121
PEDIATRIC MEMBERS CONTACT LIST
PEDIATRIC OFFICE Area Pager Extension
Chairwoman
Prof. Jameela Kari Bldg. 10 Rm 1083
2520 640-8327
Secretaries
Rizthy C. Ancla Bldg. 10 G/ Floor
0530439217
20208, 18353
Laila Abdulaziz Rm 1081
18327
WARD TEAMS Pager Extension
TEAM A
TEAM B
TEAM C
TEAM D
Dr. Soad JaberDr. Amal Al DabbaghDr. Wafaa AbuleininDr. Mohd FarouqProf. Jameela Kari
Prof. Tahir ToonisiProf. Nadia FidaDr. Abdulmoein Al AghaDr. Mohd Abdulfattah
Prof. Mohd S. Saed JanDr. Hussein Al SaggafDr. Fayza Al SinyDr. Hayat KamfarDr. Fatma Al Zahrani
Dr. Jameel Al AtaDr. Rima BaderDr. Ahmad AzharDr. Zaher F. Zaher
2511 183892517254325052520
2504251025252574
25242503252125092522
2523251322802534
16657166571834018371
18339183631830618339
1832818290183691837918369
1841218368
WARD Area Pager ExtensionPMW 1Ward Director
Dr. Shatha Al Bokhari
Hosp. Bldg. 2548 11614
Head Nurse
PMW2
Ms. Alyemma Josheph
1st Floor
Ward DirectorHead Nurse
Dr. Abeer Al NajjarMs. Irshad George
2nd Floor 2549 12605
122
PICU Area Pager Extension
Director Dr. Norah Al Khathlan
2nd Floor 2528 12814
Team
Head Nurse
Dr. Wasim AnshasiDr. Dhuha Al AmawiMs. Saadatu Abdullahi
HospitalBldg. PICUUnit
25162512
12815
NICU Area Pager Extension
Director Dr. Saad Al Saedi 1st Floor 2528 11822Team
Head Nurse Nursery H.N.
Dr. Abed Al HazmiDr. Hussein BamashmousDr. Nawaf Al DajaniDr. Maha BahamerizMs. Quiny QuilartoMs. Haleema Dabroom
HospitalBldg. NICUUnit
25162512
1820418206
11822/1184611767
EMERGENCY Area Pager Extension
Director Dr. Manal Halawani
Ground 2528 10415
Team
Head Nurse
Dr. Shafigah Al Sharif
Ms. Maria Ricana
Floor HospitalBldg. Pediatric ER Clinic
25162512
123
Clinical clerkship
GENERAL OBJECTIVESEach student should
acquire the required communication and examination skills apply the gathered data in formulating a diagnosis or
differential diagnosis formulating a management plan and show how to implement
it be able to solve clinical problems utilize available resources in management of cases. Behave in accordance wexpect the proper attitude and
professional conduct
STRUCTURE1. The students are divided in 12 group A-L2. Each block will have 4 groups
4 groups Ward (Inpatient) 4 groups Ambulatory care (OPD) 4 groups Emergency (2)
Nursery (1)Elective (1)
3. The groups will switch every 4 weeks.
Master ScheduleWeeks WARD AMBULATORY ER * N § E§
1 to 4 A B C D E F G H 1 J K L
5 to 8 1 J K L A B C D E F G H
9 to 11 E F G H 1 J K L A B C D
12 Final Exam* - Switch after 2 weeks § - Switch after 1 week
124
4. The first week: [Clerkship Orientation]
Orientation lectureso Structure of the programo What is expected from the studento Log book orientationo Schedules
General topic lectureso Ethics and professionalismo How to presento Hoe to write progress noteso How to prescribe, etc
Clinical foundation sessionso Series of sessions on communication skills ando Examination sessions of systems
6. Clinical rotations: Clinical rotations:
Ward Rotation
Objectives The student should be able to
Conduct an interview Perform a physical exam Manage medical data Communicate information to family Interact with various resources Educate oneself
Ward Schedule: Students are divided among the 3 teams in the ward and stay
with each team for the duration of the 4 weeks acquiring skills through continuity of patient care and continuity of staff contact.
Each student is match to a preceptor that teaches him the basic skills and preparation for bulletin summary before the round.
The student shares the patient load with the team and needs to have a first encounter with at least 1 patient a week.
Two case summaries are expected to present in the round per week and 1 long case per rotation.
A logbook keeps track of the expectation and encounters. The day starts by interaction with the house officer and
preparation for the rounds. The students attend half the number of rounds and spend the
time in between processing the patient’s records, progress notes, summaries, long case.
125
In the afternoon after the lectures, the student joins other teams activities and participate in patient evaluation and preparation for endorsement
o 08:00 – 08:30 am Morning reporto 08:30 – 10:00 am Work roundo 10:00 – 12:00 pm Consultant roundo 1:00 – 4:30 pm follow up of patientso 3:00- 4:00pm didactic teachingo 4:30 – 5:00 pm Handover round
Clinic Rotation
Students will be exposed to common primary care pediatric problems
Students will deal more with issues related to growth, development and family issues
Students will share in health maintenance in the WBC
4 weeks: Ambulatory pediatricsc. 2 week: community pediatric clinics/WBC:
i. Clinical activities/1 session, ½ day; Student activities may include
1. Doing a complete patient workup2. Hx/PE (OSCE style)3. Focused history:Taking an immunization/
nutritional history4. Talking to a mother, give advice5. Attending a session: nutritional assessment,
developmental assessmentii. Academic activities / 1 session, ½ day
1. Minipresentation/SLD style on a topic covered in the am session: LF infant formula, rota virus vaccine, oral thrush, home safety etc
2. Ambulatory weekly grand round3. Case presentation/ discussion (case bank)4. Tutorials on topics related to OPD; child with
rash, acute diarrhea etciii. Other activities:
1. In the future, additional activities may include rotation to primary care centers in collaboration with community medicine, one session in the community; rehab centers,
126
etc to get familiar with community resources.
d. 2 week: i. 1 week :consultants' general and subspecialty
clinicsii. 1 week : walk-in clinic
4 weeks
ER Approach is cantered on focused problems of critical nature
and its assessment at presentation. It accommodate 2 groups separated by a.m. and p.m.
rotationso 8:00 am – 12:00 pm Morning shifto 4:00 pm – 8 pm pm Evening shift
Nursery Examination and case of newborn Common neonatal problems Accommodates 1 group
o 8:00 am – 12:00 pm Morning round and Postnatalo 1:00 pm – 5:00 pm Admission & discharge
Elective Provide option to experience complex problems of critical
care (NICU / PICU or Radiology) According to the attachment (ex. Radiology, ICU, PICU,
Nephrology, Endocrine, Gastroenterology, Cardiology........
127
ER/Nursery/Elective