Lecture 1: - kau STUDY... · Web view1. Which of the following is Not a feature of haemolytic anaemia? Reticulocytosis. Decreased haptoglobin. Raised conjugated bilirubin. Pigmented

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.......................................................................

2

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).........................

3

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.

5

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

6

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.

7

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.

8

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.

9

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

10

11

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

12

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.

13

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

14

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]

15

(Prof. Jameela Kari)

Pediatric Secretary Bldg.10 G-1081 18327 [email protected] / 20208 [email protected]

1. Prof. Tahir S. Toonisi Professor G-1031 18058

[email protected]

2. Prof. Jameela Kari Professor 1-1069 18371 [email protected]

3. Prof. Mohammed M.S. Jan Professor 1- 1051 21232

[email protected]

4. Prof. Nadia Fida Professor 2-1058 18363

[email protected]

5. Dr. Saad Al Saedi Assoc Prof. 1-1034 18202

[email protected]

6. Dr. Abed Al Hazmi Assoc Prof. 1-1036 18204 [email protected]

7. Dr. Soad Jaber Assoc.Prof. 2-1041 18384

[email protected]

8. Dr. Rima Bader Assoc.Prof. 1-1062 18368 [email protected]

9. Dr. Mohamed A/fattah Assoc. Prof. G-1060 1833

[email protected]

10.Dr. Hussein M. Al Saggaf Assist Prof. G-1093 18290 [email protected]

11.Dr. Mohd F. Farouq Assist Prof. G-1062 18340

[email protected]

12. Dr. Wafaa Abulaenin Assist.Prof 1-1062 18368

[email protected]

13.Dr. Dhuha Al Amawi Assist.Prof. - - [email protected]

14.Dr. Hayat Kamfar Assist.Prof. 1-1045 18379

16

mailto:[email protected]













[email protected]

15.Dr. Mohd Muzaffer Assist Prof. G-1049 18337 [email protected]

16.Dr. Jameel Al Ata Assist Prof. G-1042 18412

[email protected]

17.Dr. Fayza Al Siny Assist.Prof. 2-1067 18369 [email protected]

18.Dr. Fatma Al Zahrani Assist. Prof. 1-1667 18369

[email protected]

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 - -

[email protected]

22. Dr. Nawaf Al-Dajani Assist Prof. [email protected]

23.Dr. Ahmed Azhar Assist Prof.

[email protected]

24. Dr. Wasim Anshasi Consultant 1-1047 18205

[email protected]

25.Dr. Hussein Bamashmous Consultant 1-1049 18206

[email protected]

26.Dr. Amal Al Dabbagh Consultant 1-1047 1837

[email protected]

27.Dr. Maha Bamehrez Consultant

[email protected]

28.Dr.Zaher Faisal Zaher Consultant

[email protected]

17













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.

18

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)

19

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: .

22

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



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.


Student Notes: .

24


The computer cluster is in the 2nd floor of the medical library, building No. 7.


Outline the main developmental milestone in the first year of life.

Lecture 3: Child Abuse


Student Notes:

25


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



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.


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.

27

Suggested Reading Material.

Essential Nelson Ilustated Peadiatric




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: .

28

Lecture 5: Rickets

objectives:


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


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: .

29

Independent learning from

Nelsons text book of paediatrics.


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

30

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.


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:

31

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:

32

Lecture 7: Genetic Disorder in Children

Learning objectives:


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:

33

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

http://www.dnalc.org/

http://www.amazon.com/



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.


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

35

http://www.cdc.gov/

from the CD-ROM. The computer cluster is in the 2nd floor of the medical library, building No. 7.


Outline the general contraindication of live attenuated vaccine.

36

Lecture 9: NORMAL NEWBORN



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.


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: .

37

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



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

.

39

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


40

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.

41

Lecture 11: Respiratory Distress Syndrome



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: .

42


1. Introduction2. Illustration of pathophysiology3. Risk Factors4. Clinical Feautres5. Investigations6. Management7. Complications8. Preventive measures

Independent Reading


43

Self AssessmentMention the complication of HMD.

Lecture 12: Upper Respiratory Tract Infection



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: .

44


1. Introduction to URTIs.2. Acute viral rhinitis.3. Acute otitis media4. Acute pharyngitis.5. Acute stridor syndromes.





Self-assessment

1. Describe the clinical features of acute epiglotitis and its management.

45

46

Lecture 13: Lower Respiratory Tract



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.


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: .

47

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.

48

Lecture 14: TUBERCULOSIS



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 .


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: .

49

Outline the Clinical feature of primary T.B

Lecture 15: Bronchial Asthma in ChildrenLearning Objectives:


1. Define Bronchial asthma.2. Describe the pathophysiology .3. Identify the risk factors (precipitating).4. Discuss the diagnostic tools of asthma.

Student Notes: .

50

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.


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

51

Self-assessment

Discuss the management of acute bronchial asthma.

52

Lecture 16: ANEMIA Learning Objectives:


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.


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: .

53

References:Nelsons textbook of pediatric.

Self-assessment

Describe the difference in presentation between sickle cell anemia and Thalasemia in first year of life.

54

Lecture 17: Congenital Heart Disease

Objectives:


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.


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: .

55

Pediatric Cardiology for the practitioners, by Myung K. Park

Self-assessment:

Discuss the X-Ray Findings of Tetralogy of Fallot.

56

Lecture 18: Rheumatic Heart Disease / Endocarditis/ Heart Failure



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.


Student Notes:

57

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

58

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: .

59

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.


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.

60

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.


the CD-ROM.


Self-assessment:

1. List the postnatal causes of CP.

Student Notes: .

Lecture 20: Seizure Disorder

61

Objectives:


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.


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: .

62




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

63

Urinary Tract Infection



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.


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).


Student Notes:

64

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:

65

Lecture 22: Hematuria / Renal Failure



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:

66

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

67

c) Prophylactic antibioticsd) In-activated vitamin D (Vit D2)

Prednisolone to reduce proteinuria

68

Lecture 23 : Chronic Diarrhea and Malabsorption

Objectives:


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.


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: .


Nelson: Pediatrics Textbook

Illustrated textbook of Pediatrics

Student Notes: .

69

(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

70

Lecture 24: Hepatobiliary diseases



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.


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:

71

Independent learning from textbook

Illustrated textbook of Pediatrics (Tom Lissauer/Graham Clayden),chapter 16. pages 277-284


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:

.

72

Objectives:


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.


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.

73




the CD-ROM.


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: .

74

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


Thyroid1. Diagrammatic illustration of the role of thyroid

hormones2. Causes of primary and secondary

hypothyroidism.

Student Notes: .

75

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.

76

Independent learning from Nelsons text book of paediatrics.


the CD-ROM.


Self-assessment:Describe the clinical feature of congenital hypothyroidism

Outline the management of adrenal crises.

Student Notes: .

Lecture 27: RHEUMATOLOGY

77



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.


Idiopathic Juvenile Arthritis1. Incidence and aetiology.

Student Notes: .

78

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.

79

80


textbook

Textbook of pediatric rheumatologyName of the book-pages




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: .

81

Lecture 28: Skin Disorders in Children



1. Recognize the anatomy of the skin.

Student Notes: .

82

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

83


from: Nelsons text book 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:

.

84



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.


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


85

from Nelsons text book 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..

86

TUTORIAL

87

Tutorial 1: Approach to a child with Fever and Rash

Learning objectives:Learning objectives:


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: .

88


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.


the CD-ROM.



Student Notes: .

89

Tutorial 2: Pallor And Anemia



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: .

90

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.

91

Tutorial 3: Failure To Thrive (FTT)



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



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


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: .

94





the CD-ROM.



Student Notes: .

95

Tutorial 6: Shock States in Children


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: .

96


textbook




from the CD-ROM.



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.





the CD-ROM.



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

http://injuryprevention.bmj.com/

http://www.pubmedcentral.nih.gov/

http://www.ehponline.org/



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


100



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


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:


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


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


textbook



Self-assessment

Student Notes: .

107

PSL 5 : Recurrent Infections (Immunodeficiency of HIV ) Learning objectives:


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



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


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)


Student Notes: .

111


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


diagnose leishmania4. Describe the management of leishmania

infection.

Brucella1. Identify the types of brucella infection2. Describe the clinical features of brucella


diagnose brucella4. Describe the management of brucella infection.

112

SDL 2: Enuresis - Self directed Learning



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


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

Documents

Lecture 1: - kau STUDY... · Web view1. Which of the following is Not a feature of haemolytic anaemia? Reticulocytosis. Decreased haptoglobin. Raised conjugated bilirubin. Pigmented