Medical Student Curriculum Guide
Knowledge—Common Pediatric Illnesses & Problems

Rationale

A patient's illness comes to the physician's attention as a clinical problem. The problem may be a complaint (e.g. headache) or a complex of symptoms and signs (e.g. fever, rash and sore throat) that prompts the visit to the physician; or the problem may be identified as a finding on physical examination or from the results of laboratory tests or imaging studies. The physician must solve the problems posed by the patient using information obtained from the history, the physical examination and, when appropriate, laboratory tests and/or imaging studies. In the problem-solving process the physician typically develops a problem list that includes differential diagnoses for each of the problems identified. The diagnostic process demands knowledge of disease etiology, pathophysiology and epidemiology and of the patient's gender, ethnicity, environment and prior health status. When the patient is an infant, child or adolescent, the physician must also consider the effects of age, physical growth, developmental stage and family environment. Commonly occurring illnesses will be the first considered, but other, less common disorders may need to be included in the evaluation of various clinical problems.

The format of this section differs from that of the other sections of the curriculum because the Objectives and Competencies refer to all of the clinical problems listed in the tables rather than a listing of specific knowledge, skills or attitudes. Common clinical problems are presented with key conditions, physical and laboratory findings for the students to learn about. These have been adapted from the actual data from ambulatory pediatric practices.

Learning Objectives

Using the table of clinical presentations for each clinical problem (left hand column) develop a differential diagnosis and rationale assisted by conditions listed (middle and right hand columns).
Identify, in addition, for each of the Core Level Conditions on table (middle column):
- Etiology and/or pathophysiology
- Natural history of the disease
- Presenting signs and symptoms
- Initial laboratory test and/or imaging studies indicated for diagnosis
- Plan for initial management
To enhance your learning you may also identify for each of the Mastery Level Conditions on the table (right hand column):
- Etiology and/or pathophysiology
- Presenting signs and symptoms
- Initial laboratory test and/or imaging studies indicated for diagnosis

Competencies

Develop a diagnostic approach to any of the clinical problems listed in the table below.
Explain how the physical manifestations and the evaluation and management of many pediatric illnesses vary with the age of the patient. Give specific examples.
Discuss the characteristics of the patient and of the illness that must be considered when making the decision to manage the patient in the outpatient setting or to admit to hospital.

Common pediatric illnesses are categorized as presenting symptoms, findings, or laboratory values in the table below. Core pediatric level indicates more common diagnoses that would be expected from a junior medical student. Mastery level diagnoses would exceed expectations of junior medical students, but would be expected for a senior medical student planning a career in pediatrics. , Although rare conditions occasionally must be considered they are not usually included in these core lists. A student will need to expand the diff erential diagnosis beyond the core diagnoses when indicated with individual patients.

Presenting symptom, finding, or laboratory value	Core pediatric level	Mastery level
Cough and/or wheeze	Asthma	Allergic rhinitis
	Bronchiolitis	Chlamydia pneumonia
	Community acquired pneumonia	Cystic fibrosis
	Croup	Gastroesophageal reflux (GERD)
	Viral upper respiratory tract infection	Laryngomalacia and tracheomalacia
		Pertussis
		Tuberculosis

Fever without a focus	Bacteremia/sepsis	JRA
	Meningitis	malignancy
	Occult bacteremia
	Urinary tract infection
	Viral illnesses

Sore Throat	Group a streptococcal pharyngitis	Peritonsillar abscess
	Mononucleosis	Retropharyngeal abscess
	Postnasal drip
	Viral upper respiratory tract infection

Otalgia	Otitis media, Acute and Recurrent	Dental caries
	Otitis media with effusion	Foreign body of the canal
	Otitis externa	Mastoiditis
		Pharyngitis
		TMJ syndrome

Rhinorrhea	Allergic rhinitis	Nasal foreign body
	Sinusitis
	Viral URI.

Fever and rash	Group A streptococcal infection	drug reaction
	Kawasaki disease	JRA
	meningococcemia	Lyme disease
	viral exanthem	Rickettsial disease
		Toxic shock syndrome

Abdominal pain	Appendicitis	Bowel obstruction
	Constipation/encopresis	Cholecystitis
	Gastroenteritis	Dysmenorrhea
	HSP	Gastritis
	intussusception	Incarcerated hernia
	Pelvic inflammatory disease	Inflammatory bowel disease
	Urinary tract infection/pyelonephritis	Malignancy
		Malrotation and volvulus
		Ovarian or testicular torsion
		Pancreatitis
		Peptic ulcer disease
		pregnancy

Diarrhea	Gastroenteritis	Celiac Disease
		Clostridium difficile infection
		Encopresis
		Inflammatory Bowel Disease
		Malabsorption
		Toddlers diarrhea

Vomiting	Gastroenteritis	Bowel obstruction
	Gastroesophageal reflux	Congenital adrenal hyperplasia
	Pyloric stenosis	Diabetic Ketoacidosis
	UTI/pyelonephritis	Eating disorder
		Hepatitis
		Inborn errors of metabolism
		Inborn errors of metabolism
		Intracranial process (increased intracranial pressure)
		Meningitis
		poisoning
		Pregnancy
		Volvulus/malrotation

Rash	Atopic dermatitis	drug reaction
	Contact dermatitis	erythema toxicum
	cellulitis	molluscum contagiosum
	impetigo	warts
	lice
	monilial infections
	scabies
	seborrhea
	urticaria
	viral enanthem
	viral exanthem

Limp or extremity pain	developmental dysplasia of the hip	Acute rheumatic fever
	fracture	Henoch Schönlein purpura
	Legg-Calve-Perthes disease	JRA
	Nursemaid elbow	Lyme disease
	Osgood Schlatter disease	malignancy
	Osteomyelitis	reactive arthritis
	Septic arthritis	sickle cell crisis
	Slipped capital femoral epiphysis
	transient synovitis

Headache	meningitis	Brain tumor
	tension headache	concussion
		hydrocephalus
		increased intracranial pressure
		metabolic disorders

Seizures	febrile seizures	idiopathic seizures
		meningitis
		post traumatic seizure
		toxic ingestions

Bruising	trauma	coagulopathy
		leukemia

Petechiae/purpura	ITP	leukemia
	sepsis	coagulopathy
	trauma	rickettsial infection
	vasculitis
	viral infections

Heart murmur	innocent murmur	anemia
		CHF
		myocarditis
		PDA
		valvular defects

Lymphadenopathy	Bacterial adenitis	Cat scratch disease
	Streptococcal pharyngitis	HIV
	Viral illnesses (general or specific such as EBV)	Kawasaki disease
		Malignancy
		Mycobacterial adenitis

Splenomegaly	Malignancy (e.g. leukemia)	Hemolytic anemia
	Mononucleosis	Sickle cell anemia (infancy)
		Systemic infectious diseases

Hepatomegaly	hepatitis	congestive heart failure
		inborn errors of metabolism
		systemic infectious diseases

Abdominal mass	hydronephrosis
	malignancy
	pregnancy
	stool

White pupillary reflex	cataracts
	retinoblastoma

Red or wandering eye	conjunctivitis	allergy
	strabismus	esotropia
		exotropia
		foreign body
		trauma

Anemia	iron deficiency anemia	anemia of chronic disease
	sickle cell anemia	bone marrow failure
	thalassemia	hemolytic anemia
		hemolytic uremic syndrome
		malignancy

Hematuria	glomerulonephritis	benign familial hematuria
	trauma	hemolytic uremic syndrome
	UTI	hypercalciuria

Proteinuria	nephrotic syndrome	transient proteinuria
	orthostatic proteinuria	glomerulonephritis

Positive Mantoux skin test	latent tuberculosis	non-tuberculosis mycobacterial infection
	active tuberculosis


Copyright 2003 Medical College of Georgia All rights reserved.	School of Medicine \| Medical College of Georgia Please email comments, suggestions or questions to: Kenda Rindt, krindt@mail.mcg.edu. June 29, 2006

Medical Student Curriculum Guide Knowledge—Common Pediatric Illnesses & Problems

Medical Student Curriculum Guide
Knowledge—Common Pediatric Illnesses & Problems