COMMON ACUTE PEDIATRIC ILLNESSES

Rationale
Prerequisites
Competencies
Processes

Rationale
Patients often come to medical attention because of a specific problem or complaint. 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 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 are first considered, but other, less common disorders may need to be included in the evaluation of various clinical problems.

Prerequisites

• Pathophysiology of common diseases.
• Fundamentals of epidemiology.
• Principles of pharmacology including pharmacokinetics and pharmacodynamics, and indications for drugs.
• Basic clinical data gathering skills.

Competencies

Knowledge

1. List the age appropriate differential diagnosis for pediatric patients presenting with each of the following symptoms. (CP) (See appendix for CP and M level differential diagnosis)
   
   
   • Abdominal pain
   • Cough and/or wheeze
   • Diarrhea
   • Fever and rash
   • Fever without a source
   • Headache
   • Lethargy or irritability
   • Limp or extremity pain
   • Otalgia
   • Rash
   • Rhinorrhea
   • Seizures
   • Sore throat
   • Vomiting
     
     
2. List the age appropriate differential diagnosis for pediatric patients presenting with each of the following physical findings. (CP) (See appendix for CP and M level differential diagnosis)
   
   
   • Abdominal mass
   • Bruising
   • Heart murmur
   • Hepatomegaly
   • Lymphadenopathy
   • Splenomegaly
   • Petechiae and/or purpura
   • Red or wandering eye
   • White pupillary reflex
     
     
3. List the age appropriate differential diagnosis for pediatric patients presenting with each of the following laboratory findings. (CP) (See appendix for CP and M level differential diagnosis)
   
   
   • Anemia
   • Hematuria
   • Proteinuria
   • Positive Mantoux skin test (PPD)
     
     
4. Describe the epidemiology, clinical, laboratory, and radiographic findings, of each of the core pediatric level conditions listed for each presenting complaint. (CP)
5. Explain how the physical manifestations of disease (CP) and the evaluation (CP) and management (M) may vary with the age of the patient. Be able to give specific examples.
6. Discuss the characteristics of the patient and the illness that must be considered when making the decision to manage the patient in the hospital or in the outpatient setting. (M)
7. Describe the epidemiology, clinical, laboratory, and radiographic finding for each of the mastery level conditions listed for each presenting complaint. (M)

Skills

1. Perform an age-appropriate history and physical examination pertinent to the presenting complaint of the child (see also Skills).
2. Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for each patient presenting with one of the following symptoms, physical examination findings, or laboratory findings (see also Clinical Reasoning). (CP)
   
   Symptoms
   
   
   • Abdominal pain
   • Cough and/or wheeze
   • Diarrhea
   • Fever and rash
   • Fever without a source
   • Headache
   • Lethargy or irritability
   • Limp or extremity pain
   • Otalgia
   • Rash
   • Rhinorrhea
   • Seizures
   • Sore throat
   • Vomiting
     
     

   Physical examination findings

   • Abdominal mass
   • Bruising
   • Heart murmur
   • Hepatomegaly
   • Lymphadenopathy
   • Petechiae and/or purpura
   • Splenomegaly
   • Red or wandering eye
   • White pupillary reflex
     
     
   Laboratory tests
   
   
   • Anemia
   • Hematuria
   • Proteinuria
   • Positive Mantoux skin test (PPD)

Processes
All students on the Pediatric Clerkship should see a patient or patients with the following system or symptom based complaints: (see appendix)

• Upper respiratory tract complaint e.g. sore throat, difficulty swallowing, otalgia
• Lower respiratory tract complaint e.g. cough, wheeze, shortness of breath
• Gastrointestinal tract complaint e.g. nausea, vomiting, diarrhea, abdominal pain
• Skin or mucous membrane complaint e.g. rash, pallor
• Central nervous system complaint e.g. headache, lethargy, irritability, fussiness
• Fever without localizing findings

Click here to link to the Clinical Case Scenarios.