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  • 1. MEDEX Northwest MEDEX 462: Maternal-Child Health Spring Quarter 2003 Course Syllabus Course Chair: Linda Dale, PA-C--Yakima Coordinators Grace Landel, PA-C--Seattle Sharon Moses, ARNP--Spokane MEDEX Northwest Physician Assistant Program School of Medicine University of Washington
  • 2. COURSE OBJECTIVES This course is a continuation of Maternal Child Health, MEDEX 456. Spring quarter, the topics are focused more on the adolescent patient. As in winter quarter, interspersed among the health-promotion, disease- prevention, will be lectures on common illnesses or disease processes, which will be linked as closely as possible to lectures in other courses. The student will be able to identify and treat common childhood illnesses, as well as identify serious problems, which require additional evaluation and/or referral. The student will understand his/her role as advocate for the child or adolescent. Frequently, the primary care provider is the person who identifies problems, and coordinates care for children who may receive services from a multi-disciplinary team. Each lecture will have objectives, which contain more specific information and questions pertaining to the above subjects. The student will be expected to know this information, which will be tested by the mid term and final exams. Answers to objectives may be found in the texts, in the lecture material, and in supplemental readings/workshops. Workshop There will be one MCH workshop during Spring quarter. The workshop is an observation experience at a preschool specific for each site. Students will have the opportunity to visit and interact with mixed classes of typically developing and developmentally challenged children. The write-up from the workshop is due the Monday following the workshop. It will be graded Pass/Fail. Written Assignments
  • 3. There will be two take home problem solving assignments. Details will be discussed in class. Also, many students will be completing the written Patient/Parent Education assignment which was started during winter quarter. Please refer to the winter quarter syllabus and handout for more information regarding this assignment. Testing There will be a midterm and a final exam. The tests will consist of multiple choice, matching and short answer questions. Professionalism In addition to content knowledge, professional behaviors and attitudes will be considered when final grades are awarded. Attendance, tardiness, participation in class discussions, courtesy to and consideration for speakers and fellow students are markers of professional behavior and attitudes. This will account for 10% of your grade. Grading The course grade will be calculated as follows: Professional behavior and attitudes: 10% Written assignments 20% Midterm 35% Final 35% 100% Required Texts Current Pediatric Diagnosis & Treatment, 16th ed. Hay,W, et al, 2003 Emergency Medicine: a comprehensive study guide, 5th ed, Tintinalli,J, et al, 2002
  • 4. Physician Assistant A Guide to Clinical Practice, 2nd ed, Ballweg,R.,et al, 1999 Textbook of Physical Diagnosis: history and examination, 4th ed. Swartz,M, 2002 Recommended Texts Guidelines for Health Supervision III, 3rd ed, American Academy of Pediatrics, 1997
  • 5. MCH 462 - 2003 Reading Assignments TOPIC READINGS Respiratory Problems in Children Current (CR): ch. 18; pgs 1051-1064; LINK pgs 1099-1111 Tintinalli (TN): ch 119, 120, 129, Growth and Development LINK CR: ch. 64 Life Long Oral Health LINK CR: ch. 16; TN: ch. 234 Congenital Anomalies, Children CR: ch. 19, pgs.80-82, 90-98, 791, 852- with Disabilities, Cardiac Disease 855, 946-949, 967-972, 986-996, LINK 1011-1024, 1031-1050 TN: ch. 134 Swartz (SW): ch. 23 Adolescent Issues LINK CR: ch. 3, 4, 5, 40; pgs. 176-177; TN: pg 757, ch. 289, 290, 303; SW: pg 680-681 Adolescent and Sports PE LINK CR: ch. 3, 19, 25: SW: ch 23, ps 711-732 Child Physical and Sexual Abuse, CR: ch. 7; TN: ch. 289, 290 Neglect LINK Pediatric Dermatology LINK CR: ch. 14, pgs. 1110-1133 TN: ch. 131 Pediatric Orthopedics LINK CR: ch. 24, 25 TN: pgs 910, 1821-1824 SW: pgs 714, 726
  • 6. Respiratory Problems in Children 1. Discuss the following upper respiratory problems, including pathophysiology, clinical presentation, differential diagnosis, work- up and treatment: common cold allergic rhinitis viral croup (laryngotracheobronchitis) epighottitis sinusitis bronchitis pneumonia asthma 2. Discuss foreign body aspiration, including both upper and lower respiratory tract, clinical presentation, differential diagnosis, work- up (including radiographic findings) and patient education. 3. Given a case scenario provide a differential diagnosis and identify the most likely diagnosis for a child presenting with upper respiratory symptoms such as cough, congestion, or wheezing. 4. Discuss bronchiolitis in regard to the following: definition peak season for outbreaks age most likely organism involved common presentation treatments 5. Identify possible causes of stridor in children over 6 months old.
  • 7. Growth and Development 1. Discuss the Denver Developmental Screening test including purpose, sensitivity, specificity, and the four categories evaluated. Describe how it is performed, how results are recorded, and interpretation of results. 2. Given a scenario of a child in the following age groups, 0-6 months, 6-12 months, 1-2 years, 3-5 years and 6-11 years, be able to discuss the developmental milestones they should have reached. 3. Discuss the identification of language and motor delays, including possible causes. 4. Discuss why early intervention is important for children with developmental problems. 5. Compare and contrast expressive and receptive language disorders. 6. Discuss the following common developmental concerns in infants and young children; include management. - Feeding disorders - Sleep disorders - Temper tantrums - Breath-holding spells
  • 8. Life Long Oral Health: Pediatrics 1. Be able to identify basic tooth anatomy, including: - Enamel - Dentin - Pulp - Gingiva - Bone 2. Be able to explain the disease process of tooth decay from the simple destruction of the enamel, (caries), to facial abscess/cellulitis. 3. Be able to discuss, as anticipatory guidance, the American Academy of Pediatric Dentistry’s recommendations for a child’s oral health. Include: - First visit - Cause of caries - Prevention – brushing, flossing 4. Describe anklogossia, (tongue-tied), and its management. 5. Be able to discuss periodontal disease, including the structures involved, the signs and symptoms, as well as the management. 6. Identify, and describe the management of, these dental injuries as they pertain to primary and secondary teeth: - Coronal fracture - Root fracture - Luxation - Intrusion - Avulsion/evulsion
  • 9. OBJECTIVE: Congenital Anomalies: Kids with disabilities, Heart Work- up. 1. Discuss chromosome abnormalities. Distinguish Abnormalities of chromosome structure from Abnormalities of chromosome number. Classify the cause of Down syndrome and Cri-du-chat using this classification 2. Discuss autosomal dominant, autosomal recessive, and x-linked inheritance; include who might be affected and who might be “carriers.” Classify the cause of Marfan syndrome, Sickle Cell Disease, Cystic fibrosis, and Duchenne-Muscular Dystrophy using this classification. 3. Define “multifactorial” inheritance and give an example. 4. Describe the following prenatal screening tests and discuss why/when you would have them done: 6. Maternal serum alpha-fetoprotein (MSAFP) 7. Amniocentesis 8. Chorionic villas sampling(CVS) 9. Fetal Ultrasonography 5. Discuss the developmental disabilities you might see associated with these syndromes: 1. Fetal alcohol Syndrome 2. Fragile X 6. Outline the evaluation of a developmentally delayed child. 7. Discuss the health care issues that require close attention in a child with: • Neurofibromatosis
  • 10. • Turner’s Syndrome • Neural Tube Defects • Cystic Fibrosis 1. Duchenne-Type Muscular Dystrophy (DMD) 8. Discuss the Pathophysiology, clinical presentation, differential diagnosis, evaluation, and treatment strategies of cerebral palsy. 9. Discuss the Pathophysiology, clinical presentation, differential diagnosis, evaluation, and treatment strategies of Attention Deficit/Hyperactivity Disorder (ADHD). 10. Describe the medical conditions that are common in children with Down Syndrome. 11. Discuss why early intervention is important for children with developmental problems. 12. What physical signs/symptoms might indicate severe heart disease in a child? 13. Describe how you would do a cardiac work-up on a child with a heart murmur, including the history, physical and lab tests required. 14. What are the most common signs and symptoms of an infant with congestive heart failure? 15. Compare and contrast these cyanotic lesions with these common acyanotic cardiac lesions, distinguishing the different findings between them. Cyanotic: Tetralogy of Fallot, Hypoplastic Left Heart syndrome, and Transposition of the Great Arteries
  • 11. Acyanotic: Atrial/ventricular septal defects, Patent Ductus Arteriosus 16. Define Coarctation of the Aorta and identify the Pathophysiology and clinical manifestations. Explain the association to “coarctation syndrome”. Adolescence Issues: Drugs, ETOH, suicide, etc: 1. Discuss the following issues in adolescent medicine: - Confidentiality - The emancipated minor - Minor consent 2. History – approach to the adolescent patient - Discuss what is included in an adolescent history, including use of the HEADS mnemonic: H - Home E - Education A - Activity D - Drugs S – Sex - Discuss the important points to consider when obtaining the history of a rape victim; including any specific pieces of information that are important to elicit in this situation. 3. Concerns/Issues for the adolescent patient: Sexuality - Discuss adolescent sexuality and identification of the at-risk adolescent.
  • 12. - List the counseling issues regarding sexuality you would address and the information you would give the patient. - Discuss how you would approach contraceptive counseling with an adolescent. - Discuss how you would address STD’s and HIV with an adolescent Substance abuse – drugs, alcohol, and tobacco - Discuss the identification and treatment of an adolescent abusing drugs. - Discuss the identification and treatment of an adolescent abusing alcohol. - Discuss how you would approach an adolescent when discussing tobacco use. Suicide - Discuss possible clinical presentations - Discuss the management Violence - List the factors that are thought to contribute to teen violence - Discuss primary care intervention strategies Eating Disorders -State the prevalence of eating disorders in adolescents as discussed in Current - Compare and contrast the clinical presentation of Anorexia Nervosa and Bulimia Nervosa Homeless/runaways - Discuss the “high risk” behaviors that increase when an adolescent is homeless. - Discuss the resources that are important to offer to an
  • 13. adolescent. Adolescence and Sports Physicals 1. State the purpose of a sports PE. 2. State the timing and frequency of sports PE’s. 3. History – list the questions you need to ask during a sports history and how the information gathered will impact the decision to restrict or clear a student for participation in sports. 4. Another method of collecting the history is by using the mnemonic “P NOAH D,” identify the information that is collected using this technique: P - Perception of self, patient self-assessment How does the athlete see him/herself? N - Neurologic history Has athlete ever experienced light-headedness, dizziness, a loss of conscience, or seizures?
  • 14. O - Orthopedic history Has the athlete ever experienced fractures, dislocations, of repeated injuries such as sprains or strains? A – Allergies Does the athlete have a history of allergies, asthma, or use of medications for such related illnesses? H – Heart (Cardiac) history Does the athlete have a history of cardiac disease, cardiac studies, surgeries? D - Diets, Deaths, Developmental What is the current diet plan or program? Has there been a family member with an unexplained/ unexpected death under 50 y/o? What type of training program is the athlete currently participating in? 5. List the components of a sports PE and the reasons for including each.
  • 15. 6. Cardiovascular screening for sudden death in young athletes: - Define sudden cardiac death - State the most common causes of sudden cardiac death in young athletes - List the questions you need to ask during a sports history to screen for sudden cardiac death 7. Discuss the decision for clearance, limitation, or refusal for sports participation with the following conditions:. - Carditis - Diabetes - Fever - Absence of one kidney - Absence of one ovary/testicle - Cystic Fibrosis - Splenomegaly 8. Concussion in sports: - Define concussion; including features of frequently observed and symptoms - For concussions Grades 1-3 list features observed at each level, symptoms, and recommendations for returning to competition 9. Given a scenario of a student presenting for a sports PE, with a history or physical exam information, be able to state your recommendations for his/her participation in sports. 10. Physical Exam – issues for the adolescent physical
  • 16. - Describe the method for evaluating sexual development and discuss its role in the adolescent physical examination. - State the age ranges at which boys and girls begin puberty and the first physical changes noted. - Define precocious puberty, delayed puberty, and primary amenorrhea. - Discuss the timing of the first pelvic exam. Given a case scenario be able to decide if a pelvic exam is required as part of the patient evaluation. - Define gynocomastia and discuss evaluation and treatment. Given a case scenario be able to advise the patient and parents regarding gynocomastia.
  • 17. Child Physical Abuse, Sexual Abuse, and Neglect 3. List the clues that arouse suspicion in the history of an injured child including clues from observing the child’s behavior. 4. Describe physical finding associated with child abuse including bruises, bite marks, burns, fractures, visceral trauma, central nervous system trauma, and intentional poisoning. 5. Discuss child neglect including medical, emotional, physical, and failure to thrive. 6. Describe the evaluation and treatment of a child who has been abused or neglected including the clinician’s role as an advocate, the child protection and legal systems, and reporting requirements. 7. Given a case scenario be able to identify the history and physical exam findings that make you suspicious of abuse. Discuss the steps you would take including reporting and treatment 6. Define sexual abuse. Discuss its prevalence. 7. Discuss the most common identity of the perpetrator who is physically, sexually, and/or emotionally abusing a child. (ie., family member, friend, care giver, stranger) 8. Discuss the possible presentations of a child who has been sexually abused. 9. Discuss child reports of sexual abuse and how to obtain information without “leading” the patient. 10. Discuss the physical exam of a child who has been sexually abused or in whom sexual abuse is suspected. 11. Given a case scenario be able to: 10. identify the history and physical exam findings that make you suspicious of sexual abuse b. identify the labs you would obtain
  • 18. c. discuss treatment
  • 19. Dermatology 1. Seborrheic dermatitis - pathophysiology, clinical presentation, differential diagnosis, and treatment. 2. Diaper dermatitis - pathophysiology, clinical presentation, differential diagnosis, and treatment. 3. Contact dermatitis, (aka –allergic contact dermatitis) Discuss pathophysiology, clinical presentation. List common contact allergens in children. 4. Impetigo - Discuss cause, clinical presentation, and treatment 5. Superficial fungal infections - Define, by location, tinea capitis, tinea corporis, tinea cruis, tinea pedis and tinea versicolor. For each, discuss age of child in which most commonly seen, discuss pathophysiology, clinical presentation, differential diagnosis, work-up, and treatment. 6. Warts - List and describe the types of warts. Discuss clinical presentation and treatment. 7. Molluscum contagiosum - Discuss cause, clinical presentation, and treatment. 8. Pediculosis - Discuss cause, clinical presentation, diagnosis, treatment, and patient education. 9. Scabies - Discuss cause, clinical presentation, diagnosis, treatment, and patient education. 10. Acne - Discuss pathophysiology, clinical presentation including type of acne lesions, differential diagnosis, work-up, and treatment. 11. Alopecia - Discuss the causes of hair loss. Describe the assessment of a child with hair loss. 12. Given a case presentation of a child presenting with skin changes or hair loss, be able make a differential diagnosis, identify the most likely
  • 20. cause, and treatment. 13. Viral rashes - Describe the clinical presentation (including skin lesions or rash) and cause of the following viral exanthems: a. measles (rubeola) b. rubella (German measles) c. roseola infantum (exanthem subitum) d. Fifth disease (erythema infectiosum) e. Hand-foot-and-mouth disease f. infectious mononucleosis g. herpes simplex h. chickenpox (varicella)
  • 21. Pediatric Orthopedics Scoliosis 2. Discuss scoliosis including incidence, definition, etiology and natural history, clinical presentation, and management. 2. Discuss the importance of regular scoliosis screening for children. 3. Discuss appropriate indications for referral for scoliosis treatment. Lower Extremities 1. Be able to discuss with parents the normal sequence of musculoskeletal development in regards to bowlegs” and “knock knees.” 2. Describe the etiology, presentation, differential diagnosis, workup, and treatment of: • flat feet • metatarsus adductus • torsional deformities • bowlegs (genu varum) • knock knees (genu valgum) • talipes equinovarus • femoral anteversion 3. Given a case scenario of a child presenting with a lower extremity concern, provide a differential diagnosis and identify the most likely diagnosis and treatment. Developmental Dysplasia of the Hip 8. Define DDH including complete congenital dislocation of the hip and sublexation. 9. Discuss the importance of evaluating hips in infants during the first
  • 22. year of life. 10. Describe the positive physical examination findings which are present in DDH at various ages. 4. Describe the work-up and treatment of DDH and subluxation of the hip. 5. Given a case scenario of a child presenting with hip pain, limp, or an abnormal hip exam provide a differential diagnosis, identify most likely diagnosis, and treatment. Localized orthopedic problems 1. Discuss the following localized orthopedic problems, including presentation and treatment: • Septic arthritis (aka. Pyogenic arthritis) • Chondromalacia patellae • Osgood-Schlatter Disease • Slipped Capital Femoral Epiphysis • Avascular Necrosis of the Proximal Femur (Legg-Calve’ Perthes Disease)