INTRODUCTION

How to use this guide:

This guide is designed to help you get maximum benefit of your recommended
reference book in pediatrics " illustrated Textbook of Paediatrics". The sections in this
guide correspond to the titles of chapters in the book in same sequence. If a chapter in
the book doesn't have a corresponding section in your guide, this means that this
chapter is NOT part of your curriculum. The lists that come after each section in your
guide are the topics in each chapter of the book that you need to study. Sometimes
you'll notice that some topics within a chapter are skipped, this means that it's not part
of your curriculum. On the other hand, some specific topics have been added to this
guide to stress its importance and uniqueness in our society, you need to study these
topics from your guide.
Please note that at the end of each chapter, there are learning aids. These aids have
been mentioned to facilitate your study. The main learning aid is your reference book.
The other aids include: lectures, websites and links. Be keen to go through these aids to
strengthen your learning base which will help you both in your future clinical practice as
well as in your exams.

What do you have to master during your clinical training:

As an undergraduate student you will have straightforward and simple targets:

1. To be able to elicit and interpret findings from history and physical

examination.
2. To be able to construct a reasonable differential diagnosis and problem list.
3. To be able to prepare plans for appropriate investigation and management.
4. To be able to communicate adequately with children and with their parents.
History and examination
 Identify features of history taking and examination in pediatric practice.
 Describe the common clinical scenarios in pediatrics.
 List the aims and objectives of all clinical encounters.
 Demonstrate how to take history and do full clinical examination in an age-dependent
manner in clinical rounds.
 List the key problems and justify a management plan.
Other learning aids (resources):
 Paediatric Clinical Examination Made Easy. 6th edition.
 Macleod's Physical Examination Pediatric Head to Toe Assessment OSCE Guide 2016
https://www.youtube.com/watch?v=q4ZOkF9yTV8
https://batesvisualguide.com/multimedia.aspx?categoryID=21787#21770

Normal child development

 Identify the features of normal child development and the influence of heredity and
environment.
 List the four fields of development.
 Define the “median and limit ages”.
 Analyze the variation in the pattern of development and adjust for prematurity.
 Describe the pattern of child development and list the key developmental milestones
and their limit ages.
 Demonstrate how to perform a clinical assessment of development.
 Summarize cognitive development in children
 Describe hearing screening of newborn infants.

Developmental Problems and the child with special needs

 Identify features and definitions of developmental problems and the child with special
needs.
 Recognize the approach to a child with developmental problems and special needs
including developmental assessment, physical examination, presenting features and
causes of abnormal development and learning disability.
 Describe the presentations and causes of abnormal motor development.
 Recognize causes, clinical presentations and management of cerebral palsy.
 List the causes of speech and language delay.
 Describe “learning disability”.
  Summarize the problems of autism spectrum disorders and attention deficit
hyperactivity disorder (ADHD} in children.
Selected Topics:
Autism Spectrum Disorders (Abnormal Development of Social / Communication Skills)
Children who fail to acquire normal social and communication skills may have an autism
spectrum disorder. The prevalence of autism spectrum disorder is 3–6 per 1000 live births. It is
more common in boys. Presentation is usually between 2–4 years of age when language and
social skills normally rapidly expand.
The child presents with a triad of difficulties:
1. Impaired social interaction (e.g. prefers own company, no interest or ability to play with
peers)
2. Speech and language disorder (e.g. delayed language development and limited use of
gestures and facial expression)
3. Imposition of routines with ritualistic and repetitive behavior (e.g. violent temper if
disrupted, unusual stereotypical movements like hand flapping and spinning objects)
Also, the child might have associated comorbidities:
• General learning and attention difficulties
• Seizures
• Affective disorders – anxiety, sleep disturbance
• Mental health disorders – attention deficit hyperactivity disorder.

There is probably multiple etiology with a gene –environment interaction in most cases. The
condition is not the result of emotional trauma or deviant parenting. There is no evidence for a
suggested link with the MMR vaccine.

Diagnosis
Autism is diagnosed by observation of behavior, including the use of formal standardized tests.

Management
The condition has lifelong consequences of varying degrees for the child’s
social/communication and learning skills. Parents need a great deal of support. A wide range of
interventions have been promoted over the last 10 years to reduce ritualistic behavior, develop
language, social skills and play, and to generalize use of all these skills. Treatment approach
requires 25–30 hours of individual therapy each week. An appropriate educational placement
needs to be sought.

Other learning aids (resources):

 My Left Foot Movie on Cerebral Palsy: https://www.youtube.com/watch?
v=GMDUGElNilA
 Rain Man Movie on Autism: https://www.youtube.com/watch?v=x5xbGU7F6C4
Pediatric emergencies
 Revise the chapter of “Pediatric emergencies”. (except for the flow chart of pediatric
advanced life support).

Accidents and poisoning

 Identify features of accidents and poisoning in children.
 Outline the emergency management of the choking child.
 Identify “drowning”.
 Outline the management of a poisoned child or young person.

Genetics
 Discuss the features of genetic basis of diseases.
 Identify the mechanisms of developing genetically determined diseases.
 Discuss chromosomal abnormalities, Down syndrome and Turner syndrome.
 Draw a pedigree and identify the different types of Mendelian inheritance and the
influence of consanguinity.
 Identify mitochondrial or cytoplasmic inheritance, multifactorial and polygenic
inheritance, and epigenetic factors.

Perinatal medicine
 Identify the term perinatal medicine and its related definitions.
 List the causes of pregnancies at increased risk of fetal abnormalities.
 Discuss antenatal diagnosis and the techniques used for antenatal diagnosis.
 Explain fetal and neonatal problems associated with maternal diabetes (IDM).
 Identify the general clinical features of congenital rubella, cytomegalovirus and
toxoplasmosis.
 Discuss the perinatal changes leading to adaptation to extrauterine life.
 Demonstrate an overview of the steps used for neonatal resuscitation. B b
 Discuss meconium aspiration.
 Identify the causes, features and problems of infants with abnormal size at birth.
 Demonstrate newborn infant physical examination.
 Describe lesions in newborn infants that resolve spontaneously.
 Identify the importance of vitamin K therapy.
 Discuss newborn blood spot screening.
Neonatal Medicine
 Identify features of neonatal medicine.
 Discuss how to “stabilize the preterm or sick infant’.
 Describe the external appearance and enumerate the potential medical problems of
preterm infants and temperature control.
 Discuss: the preterm infant, respiratory distress syndrome, maturational changes in
appearance and development, the extremely preterm infant compared with the term
infant, oxygen therapy in preterm infants, patent ductus arteriosus, infection,
necrotizing enterocolitis, retinopathy of prematurity, and bronchopulmonary dysplasia.
 Identify jaundice and kernicterus in the newborn. (to convert serum/plasma bilirubin results
from umol/L to mg/dl divide umol/L by the number 17.1)
 Distinguish the signs and enumerate the causes of respiratory distress in term infants.
 List the causes and the clinical manifestations of birth injuries.
 Identify transient tachypnea of the newborn and meconium aspiration, and persistent
pulmonary hypertension of the newborn.
 Distinguish the early-onset, late-onset infection (sepsis), and Group B streptococcal
infection.
 Identify hypoglycemia in the newborn.
 Identify hypoxic-ischemic encephalopathy.
 Identify the different types of neonatal birth injuries.
 Distinguish neonatal seizures.

Growth and puberty

 Identify features of growth and puberty.
 Discuss determinants of normal growth.
 Demonstrate techniques of growth measurement (weight, height, head circumference
and body mass index, growth charts, mid-parental centile, and correction for
gestational age).
 Identify the features of puberty in girls and boys.
 Identify short stature and investigations for short stature.
 Identify the causes and features of abnormal head growth (microcephaly,
macrocephaly, asymmetric heads, and craniosynostosis).
 Define Early and delayed puberty.
Selected Topics:
When growth charts are not available, a rough assessment of growth can be managed
as follows:
 Weight calculation: there is an initial weight loss of 5-10% of birth weight by the age of
3-4 days. This is usually regained by the 7th day followed by a rapid weight gain of an
average of ¾ kg/month during the first 4 months of age, ½ kg/month during the 2ed 4
months and ¼ kg/month during the last 4 months of the first year. During early
childhood (1-6 years), the body weight can roughly be calculated using a simple
equation:
Weight(kg) = (age in years x 2) + 8
Length/height calculation: the average birth length of the full term is about 50 cm.
Length increases rapidly to reach an average of 75cm by the age of one year (about 65
cm at 6 months). After the age of 2 years height can roughly be calculated by a simple
equation:
Height (cm) = (age in years x 5) + 80
Head circumference calculation: the average at birth is 35 cm, at 6 months is 42cm, at
one year is 45 cm, at 3 years 48 cm, at 5 years is 50 cm & at 15 years 55 cm.

In our country, short stature is defined as; height or length is more than 2 SD below the
mean or below the 3rd percentile for age and sex and microcephaly as; the
occipitofrontal circumference is more than 3 SD below the mean for age and sex.

Nutrition
 Identify features of nutrition in children.
 List the factors that contribute to the nutritional vulnerability of infants and children.
 Identify the changing reference values for energy and protein requirements according
to age.
 Recognize breast feeding (advantages, physiology, perceived barriers and potential
complications and promotion of breast feeding).
 Discuss formula feeding and the introduction of whole pasteurized cow’s milk.
 Discuss specialized infant formula and weaning.
 Identify faltering growth “failure to thrive” (diagnosis, clinical features, and causes).
 Identify vitamin D deficiency and other vitamin deficiencies in children.
 Discuss malnutrition (assessment, consequences, severe malnutrition and
management)
 Define the WHO recommendations to express the nutritional status.
 Classify severe protein-calorie malnutrition and identify their clinical manifestations
and consequences.
 Identify stunting.
 Define the body mass index (BMI).
 Discuss obesity: definition, complications, etiology, and prevention.
Selected Topics:
Criteria of good attachment: Infant’s chin is touching the breast, the mouth is widely
open and the lower lip is turned outward so that more areola is visible above than
below the mouth.
Criteria of adequate breast-feeding:
 Baby is calm and satisfied after feeds and in between.
 Baby sleeps well 2 - 4 hours after nursing.
 Good motions (stools of totally breast-fed baby are mustard yellow in color, soft to
semiliquid, having an acidic "fermentative" odor. Their frequency varies with age
from one motion after each feed to one motion every 2 - 3 days.
 Good amount of urine (6 or more full diapers per day).
 Good weight gain (20-30 grams/day). This can be assessed by weight charts or Test
Weighing (infant is weighed at 4 days interval, at a fixed time of the day and under
same circumstances, if weight gain is 100 grams or more, then the amount of breast
milk is adequate).
Criteria of insufficient breast feeding:
 Inadequate weight gain or weight loss.
 Inadequate urine and stools.
 Fretfulness, crying and sucking of fists between the feeds.
 Unsatisfied staying on each breast for a long period (more than 30 minutes).
 Sleeplessness or very short sleep.
 Air swallowing leading to colic.
Hypervitaminosis D is a state of vitamin D toxicity. An excess of vitamin D causes
hypercalcemia. Symptoms appear several months after excessive doses of vitamin D are
administered and include anorexia, irritability, vomiting, constipation, polyuria,
dehydration, hypotonia and nephrocalcinosis. In almost every case, a low-calcium diet
combined with a corticosteroid will allow for a full recovery within a month.
Obesity definition: BMI above the 85th percentile is considered overweight. BMI above
95th percentile is considered obese.
WHO Classification of Undernutrition
 wasting: weight-for-height < −2 to > −3 SD Moderate malnutrition
< −3 Severe malnutrition
(for age-group 6-59 mo) mid-upper arm circumference 115-125 mm Moderate maln.
<115 mm Severe maln.
 stunting: height-for-age < −2 to > −3 SD Moderate
<−3 Severe
Clinical Manifestations of severe malnutrition
Severe wasting (Marasmus)
 Wasting is most visible on the thighs, buttocks, and upper arms, as well as
over the ribs and scapulae, where loss of fat and skeletal muscle is greatest.
 Wasting is preceded by failure to gain weight and then by weight loss.
  The skin loses turgor and becomes loose as subcutaneous tissues are broken
down to provide energy. The face may retain a relatively normal appearance,
but eventually becomes wasted and wizened.
 The eyes may be sunken from loss of retroorbital fat, and lacrimal and
salivary glands may atrophy, leading to lack of tears and a dry mouth.
 Weakened abdominal muscles and gas from bacterial overgrowth of the
upper gut may lead to a distended abdomen.
 Severely wasted children are often fretful and irritable.

In edematous malnutrition (Kwashiorkor)

 The edema is most likely to appear first in the feet and then in the lower legs.
 It can quickly develop into generalized edema affecting the hands, arms, and
face.
 Skin changes typically occur over the swollen limbs and include dark,
crackled peeling patches (“flaky paint”dermatosis) with pale skin underneath
that is easily infected.
 The hair is sparse and easily pulled out and may lose its curl. In dark-haired
children the hair may turn pale or reddish.
 The liver is often enlarged with fat.
 Children with edema are miserable and apathetic, and often refuse to eat.
 There may be diarrhea, hypothermia, bradycardia, and hypotension.
 low plasma albumin, potassium, glucose, and magnesium levels.

Gastroenterology
 Identify the features of gastrointestinal disorders in children.
 Discuss the differential diagnosis of acute abdominal pain.
 Distinguish the problems of recurrent abdominal pain in children.
 Interpret the clinical features of irritable bowel syndrome, abdominal migraine,
functional dyspepsia, peptic ulcer disease and Familial Mediterranean Fever.
 Distinguish the problems of vomiting in infants and children.
 Recall the important causes of vomiting and the “red flag” clinical features in the
vomiting child.
 Define the clinical features and management of gastroesophageal reflux and pyloric
stenosis.
 Define the causes, clinical features and management of gastroenteritis and post-
gastroenteritis syndrome.
 Discuss malabsorption, celiac disease, lactose intolerance and chronic non-specific
diarrhea.
 Discuss constipation and its management.
 Identify the clinical presentation and management of Hirschsprung disease.
 List the causes of hematemesis and rectal bleeding.
Selected Topics:
 THRUSH
Epidemiology
Oropharyngeal Candida albicans infection, or thrush, is common in healthy neonates.
The organism may be acquired in the birth canal or from the environment. Persistent
infection is common in breastfed infants as a result of colonization or infection of the
mother’s nipples. Thrush in healthy older patients can occur, but should suggest the
possibility of an immunodeficiency, broad-spectrum antibiotic use, or diabetes.
Clinical Manifestations
Thrush is easily visible as white plaques on oral mucous membranes. When scraped with
a tongue depressor, the plaques are difficult to remove, and the underlying mucosa is
inflamed and friable. Oropharyngeal candidiasis is sometimes painful and can interfere
with feeding.
Treatment
Thrush is treated with topical nystatin or an azole antifungal agent such as fluconazole.
When the mother’s breasts are infected and painful, consideration should be given to
treating her at the same time. Because thrush is commonly self-limited in newborns,
withholding therapy in asymptomatic infants and treating only persistent or severe
cases is a reasonable approach.

Familial Mediterranean fever

Familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease
characterized by recurrent, sporadic, self-limited episodes of fever accompanied by
peritonitis, pleuritis, arthritis, and/or erysipelas-like erythema. The disease is prevalent
among populations surrounding the Mediterranean Sea.
The frequency of episodes varies from once every week to several times a year, and
unlike the term “periodic disease”, the attacks are at random and not cyclic. A typical
attack of FMF lasts 0.5–3 days, and between attacks patients are mostly asymptomatic.
One of the devastating outcomes of FMF is the development of AA amyloidosis, which
mostly affects the kidneys but may involve other organs. Since 1972, life-long
prophylactic colchicine has been the treatment of choice for FMF, which reduces the
number of acute attacks and prevents the development of amyloidosis. The disease is
caused by gain-of-function mutations in the MEFV gene, encoding pyrin associated with
the release of interleukin (IL)-1ß, resulting in inflammation.

Infection and immunity

 Identify features of infection and immunity in children.
 Discuss how to evaluate and manage a febrile child.
 Distinguish bacterial and viral meningitis.
 Distinguish viral meningitis and encephalitis/encephalopathy.
 Describe meningococcal, pneumococcal, H influenzae infections, staphylococcal and
group A streptococcal infections in children.
  Discuss antimicrobial resistance.
 Enumerate common viral infections associated with maculopapular and vesiculobullous
skin rash.
 Enumerate the human herpesviruses and the infections they cause in children.
 Identify chickenpox (primary varicella zoster infection), shingles (herpes zoster)
infectious mononucleosis, cytomegalovirus, and infections caused by human herpes
virus 6, human herpes virus 7 and human parvovirus B19.
 Identify infections caused by enteroviruses.
 Describe the seasonal viral infections; influenza and COVID-19 in children.
 Distinguish measles, mumps, and rubella in children.
 Identify prolonged fever and Kawasaki disease.
 Describe the clinical features, diagnosis, and prevention of primary infection with
tuberculosis in childhood.
 Identify typhoid fever in children.
 Recall the Egyptian compulsory schedule of vaccination. Suggested readings at
http://dahabclinic.com/vaccinations/
 Discuss vaccinations in children, the rational behind the current immunization
programme, and the contraindications to vaccination.
 Discuss the complications and contraindications to immunization.
 Classify immunodeficiency and identify the main presenting features of primary
immunodeficiency and investigations.

Allergy
 Identify the features and mechanisms of allergic diseases and allergy definitions.
 Discuss “the hygiene theory”.
 Distinguish the concept of “the allergic march”.
 Demonstrate the clinical evaluation of allergic disorders in children.
 Identify the age of onset and the prevention of allergic diseases.
 Discuss the clinical features, diagnosis and management of food allergy and food
intolerance in children.
 Discuss eczema.
 Identify the clinical features of urticaria and angioedema and drug allergy.
 Discuss anaphylaxis.
Selected Topics:
Papular urticaria is a delayed hypersensitivity reaction most
commonly seen on the legs, following a bite from a flea, bedbug,
animal or bird mite. Irritation, vesicles, papules and wheals appear and
secondary infection due to scratching is common. It may last for weeks
or months and may be recurrent.
Respiratory Disorders
 Identify the features and the presentations of respiratory disorders in children.
 Analyze the clinical features of upper respiratory tract infections including the common
cold (coryza), sore throat (pharyngitis and tonsillitis) and acute otitis media.
 Explain the physiology of stridor and wheeze.
 Identify the important causes and management of upper airway obstruction including
croup, acute epiglottitis, bacterial tracheitis and other causes of stridor.
 Identify lower respiratory tract infections including bronchiolitis, pneumonia and
whooping cough (pertussis).
 Recognize asthma and its management in childhood.
 Demonstrate how to choose and assess the correct inhaler technique in an age-
appropriate way.
 Discuss cough in children: chronic cough and protracted bacterial bronchitis.
 Identify bronchiectasis, cystic fibrosis and its main lines of treatment, primary ciliary
dyskinesia, and immunodeficiency.
 Demonstrate a case of foreign body aspiration.
Selected Topics:
Bronchopneumonia is a patchy consolidation involving one or more lobes. The neutrophilic
exudate is centered in bronchi and bronchioles, with centrifugal spread to the adjacent alveoli.
In interstitial pneumonia, patchy or diffuse inflammation involving the interstitium while the
alveoli do not contain a significant exudate, but hyaline membranes may line the alveolar
spaces. Bacterial superinfection of viral pneumonia can also produce a mixed pattern of
interstitial and alveolar airspace inflammation.
In management of pneumonia, the choice of antibiotic agent may vary based on local
resistance rates. In areas where resistance is very high (>25% of strains being non-susceptible),
a third-generation cephalosporin might be indicated. Older children, in addition, may receive a
macrolide to cover for atypical infections. Children who are toxic appearing should receive
antibiotic therapy that includes vancomycin (particularly in areas where penicillin-resistant
pneumococci and methicillin-resistant S aureus [MRSA] are prevalent) along with a second- or
third-generation cephalosporin.

Cardiac Disorders
 Identify recent developments in pediatric cardiac diseases.
 Classify the most common congenital heart diseases.
 Illustrate the circulatory changes at birth.

  Distinguish the clinical presentations of cardiac diseases: antenatal diagnosis, heart
murmurs, heart failure and cyanosis.
 Plan the diagnostic procedures for children with cardiac problems.
 Discuss the clinical features, investigations, and management of congenital heart
diseases with left to right shunt (atrial septal defect, ventricular septal defect and
patent ductus arteriosus).
 Distinguish the clinical features, investigations, and management of tetralogy of Fallot.
 Analyze the circulatory changes and clinical features in cases with TGA.
 Discuss Eisenmenger syndrome.
 Distinguish the clinical features, investigations and management of the outflow
obstruction lesions in a well child (aortic stenosis, pulmonary stenosis, and adult-type
coarctation of the aorta).
 Discuss the clinical features of coarctation of the aorta in the neonate.
 Identify sinus arrhythmias and supraventricular tachycardia.
 Interpret the pathogenesis, clinical features, and management of rheumatic fever.
 Discuss the clinical features, investigations, management, and prophylaxis of cases with
infective endocarditis.
 Discuss myocarditis and cardiomyopathy.
 Identify Kawaski disease.
 Define the pediatric inflammatory multisystem syndrome temporally associated with
COVID-19 (PIMS-TS).
Other learning aids (resources):

 Lectures on cardiac disorders “department of pediatrics”

 Heart sounds and murmurs https://www.youtube.com/watch?v=dBwr2GZCmQM
 Tetralogy of Fallot https://www.youtube.com/watch?
v=DrgUSGvL_4Q&index=2&list=PLi-7CrjHWbqjfR22cqX1skLCgpzDkUSUd
 AVSD https://www.youtube.com/watch?v=C0Gb-yScjSk&list=PLi-
7CrjHWbqjfR22cqX1skLCgpzDkUSUd&index=7
 TGA https://www.youtube.com/watch?v=lBGUtiBp8k8&index=5&list=PLi-
7CrjHWbqjfR22cqX1skLCgpzDkUSUd
 ASD transcatheter occlusion animation https://www.youtube.com/watch?
v=I5sRAcOVGiU
 PDA transcatheter
 Cardiac arrhythmias https://www.youtube.com/watch?v=6LrptveKYus&pbjreload=10
 What is SVT? https://www.youtube.com/watch?v=1vaNyXfuUjs

Kidney and urinary tract disorders

 Identify the features of kidney and urinary tract disorders in children.
  Analyze the methods used in the assessment of renal function.
 Interpret the radiological investigations of the kidneys and urinary tract.
 Discuss congenital anomalies.
 Distinguish the congenital anomalies leading to urinary tract obstruction.
 Distinguish the problems of vesicoureteric reflux and urinary tract infection in children.
 Enumerate the causes of daytime enuresis.
 Interpret the problem of secondary (onset) enuresis.
 Distinguish the different types and causes of proteinuria in children.
 Identify nephrotic syndrome in children.
 Analyze the problem of hematuria.
 Identify acute nephritis in childhood.
 Distinguish post-streptococcal and post-infectious nephritis.
 Identify Henoch–Schönlein purpura.
 Enumerate the renal causes of hypertension in childhood.
 Enumerate the causes of acute kidney injury in children.
 Identify hemolytic uremic syndrome in children.
Selected Topics:

Post-streptococcal glomerulonephritis
Poststreptococcal glomerulonephritis (PSGN) is caused by prior infection with specific
nephritogenic strains of group A beta-hemolytic streptococcus, usually three weeks after
infection. It occurs most frequently in children 2 to 12 years of age and is more common in
boys. It is an immune-complex-mediated mechanism, a type III hypersensitivity reaction.
Complement activation is very important.
The clinical presentation of PSGN varies from asymptomatic microscopic hematuria to the full-
blown acute nephritic syndrome characterized by red to brown urine, proteinuria (which can
reach the nephrotic range), edema, hypertension, and acute kidney injury. Special attention
must be paid to blood pressure because hypertension may be severe enough to lead to
complications such as heart failure, seizures, and encephalopathy.
Therapy for PSGN is supportive and involves dietary sodium restriction, diuretics, and
antihypertensive agents as needed. Although treating the streptococcal infection does not
prevent PSGN, antibiotic treatment is still warranted with active streptococcal infection.
PROGNOSIS AND PREVENTION: The prognosis is generally favorable, but in some cases, the
long-term prognosis is not benign.
In typical cases, the gross hematuria, proteinuria, and edema decline quickly (in 5 to 10 days).
Microscopic hematuria may persist for months or even years; over 95% of children recover
completely with no long term sequelae. It is unclear whether or not acute PSGN can be
prevented with early prophylactic antibiotic therapy.
Liver disorders
 Identify the clinical features of liver disorders in children.
 analyze the term “neonatal cholestasis”.
 Distinguish biliary atresia and neonatal hepatitis syndrome.
 Recall the differential diagnosis of prolonged jaundice in infancy.
 Discuss neonatal metabolic liver disease: alpha1-antitrypsin deficiency and
galactosemia.
 Identify the clinical and diagnostic features of viral hepatitis (Hepatitis A, Hepatitis B,
Hepatitis C, Hepatitis D, Hepatitis E & seronegative hepatitis).
 List the consequences (complications) of chronic liver disease in children.

Malignant disease
 Identify features of malignant diseases in children.
 Recall the clinical presentations of cancer in children.
 Distinguish leukemia in childhood.
 Identify brain tumors in children.

Hematological disorders
 Identify features of hematologic disorders in children.
 Recall hematological values at birth and the first few weeks of life.
 Define anemia in children according to age and identify classification and causes.
 Identify iron deficiency anemia in children.
 Recognize red cell aplasia in children.
 Recall the mechanisms, causes and diagnostic clues of hemolytic anemia.
 Identify the pathogenesis, clinical features, diagnosis, and management of hereditary
spherocytosis.
 Distinguish the pathogenesis, clinical manifestations, diagnosis, and management of
Glucose-6-phosphate dehydrogenase deficiency.
 Explain the term “hemoglobinopathies” and give examples.
 Differentiate between Sickle cell anemia and Sickle trait and identify the pathogenesis
and clinical features of Sickle cell disease.
 Identify the different forms, clinical features, diagnosis, and management of β-
Thalassemias and α-Thalassemias.
 Recall the causes and diagnostic approach of anemia in the newborn.
 Define the term “bone marrow failure/aplastic anemia) and identify the clinical
presentation.
  Distinguish the useful initial screening tests of bleeding disorders.
 Distinguish the clinical features and management of hemophilia and von Willebrand
disease in children.
 Identify the acquired disorders of coagulation.
 Distinguish thrombocytopenia & purpura in children.
 Identify Disseminated intravascular coagulation in children.

Selected Topics:
The clinical features of B-thalassemia major can be summarized as:
 manifestations of anemia
 manifestations of increased hemolysis: jaundice, dark urine, dark stools.
 manifestations of increased medullary erythropoiesis: expansion of medullary spaces
leads to characteristic thalassemic facies and “hair standing on end” appearance in skull
X-ray.
 manifestations of increased extramedullary erythropoiesis: hepatomegaly,
splenomegaly, lymphadenopathy.
 manifestations of complications: iron overload, complications of blood transfusion,
secondary hypersplenism, gall stones.
 CBC: hypochromic microcytic anemia, RBCs show anisocytosis (cells of different sizes),
poikilocytosis (cells of different shapes), target cells (hemoglobin is distributed only in
the center and periphery of the cell), reticulocytosis.

Child and adolescent mental health

 Interpret meal refusal in children.
 Distinguish nightmares, night terrors.

Diabetes and endocrinology

 Identify features of diabetes and endocrine disorders in children.
 Demonstrate the classification of diabetes mellitus according to etiology.
 Identify the etiology, clinical features, diagnosis, and initial management of type 1
diabetes. To convert blood glucose levels from mmol/L to mg/dl: multiply mmol/L by
the number 18.
 List the types of insulin and modes of injection as well as dietary recommendations for
diabetic children.
 Distinguish the acute complications of diabetes in children including hypoglycemia
(clinical features and management), and diabetic ketoacidosis (clinical features,
essential investigations, and main lines of treatment).
  Identify the clinical presentations and treatment of hypoglycemia in children.
 Identify the causes, clinical features, and treatment of congenital and acquired
hypothyroidism.
 Discuss congenital adrenal hyperplasia.

Neurological Disorders
 Identify features of neurological disorders in children.
 Classify headaches and distinguish the clinical characteristics of primary headache.
(tension-type headache and migraine without aura) and secondary headaches due to
raised intracranial pressure and space-occupying lesions.
 Define terms of epileptic seizures, convulsions, epilepsies, and acute symptomatic
epileptic seizures.
 Identify febrile seizures and their management.
 Distinguish paroxysmal disorders (funny turns).
 Distinguish epilepsies of childhood and their diagnostic approach.
 Identify principles governing treatment of epilepsies.
 Classify motor disorders and distinguish the clinical characteristics of central motor
disorders and peripheral motor disorders (neuromuscular junction).
 Identify Guillain-Barre syndrome.
 Define the term “hypotonic or floppy infant” and enumerate the common causes.
 Identify the etiology and clinical features of hydrocephalus.
Selected Topics:
FEBRILE SEIZURES (FS)
Febrile seizures are the most common seizure or convulsive disorder of childhood.

To define a febrile seizure, you need the following criteria all together:

1- it is a seizure associated with fever in infancy or early childhood (usually between 6 months and
5 years of age),
2- without evidence of intracranial infection and
3- not preceded by previous non-febrile
4- not preceded by neonatal seizures.
The problem almost always resolves without sequel. Only a small minority will develop non-febrile
seizures later. There is no risk of brain damage.

Types of FS:
Typical or Simple Attack Atypical or Complicated Attack

- Always generalized - Focal (unilateral) or generalized

- Last less than 15 minutes - Last 15 minutes or more
- Do not recur within 24 hours - May recur in 24 hours
- No post-ictal manifestations (weakness, - May be followed by post-ictal paralysis
disturbed consciousness) (Todd’s paralysis) or disturbed
consciousness