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MEDEX 462: Maternal-Child Health
Spring Quarter 2003
Linda Dale, PA-C--Yakima
Grace Landel, PA-C--Seattle
Sharon Moses, ARNP--Spokane
MEDEX Northwest Physician Assistant Program
School of Medicine
University of Washington
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.
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.
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.
There will be a midterm and a final exam. The tests will consist of multiple
choice, matching and short answer questions.
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.
The course grade will be calculated as follows:
Professional behavior and attitudes: 10%
Written assignments 20%
Current Pediatric Diagnosis & Treatment, 16th ed. Hay,W, et al, 2003
Emergency Medicine: a comprehensive study guide, 5th ed,
Tintinalli,J, et al, 2002
Physician Assistant A Guide to Clinical Practice, 2nd ed,
Ballweg,R.,et al, 1999
Textbook of Physical Diagnosis: history and examination, 4th ed.
Guidelines for Health Supervision III, 3rd ed, American Academy of
MCH 462 - 2003 Reading Assignments
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
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
Respiratory Problems in Children
1. Discuss the following upper respiratory problems, including
pathophysiology, clinical presentation, differential diagnosis, work-
up and treatment:
viral croup (laryngotracheobronchitis)
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:
peak season for outbreaks
most likely organism involved
5. Identify possible causes of stridor in children over 6 months old.
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
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
5. Compare and contrast expressive and receptive language
6. Discuss the following common developmental concerns in
infants and young children; include management.
- Feeding disorders
- Sleep disorders
- Temper tantrums
- Breath-holding spells
Life Long Oral Health: Pediatrics
1. Be able to identify basic tooth anatomy, including:
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.
- 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
OBJECTIVE: Congenital Anomalies: Kids with disabilities, Heart Work-
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)
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
• 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
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
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
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
Acyanotic: Atrial/ventricular septal defects, Patent Ductus
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:
- 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:
- Discuss adolescent sexuality and identification of the at-risk
- 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
Substance abuse – drugs, alcohol, and tobacco
- Discuss the identification and treatment of an adolescent
- Discuss the identification and treatment of an adolescent
- Discuss how you would approach an adolescent when
discussing tobacco use.
- Discuss possible clinical presentations
- Discuss the management
- List the factors that are thought to contribute to teen violence
- Discuss primary care intervention strategies
-State the prevalence of eating disorders in adolescents as
discussed in Current
- Compare and contrast the clinical presentation of Anorexia
Nervosa and Bulimia Nervosa
- Discuss the “high risk” behaviors that increase when an
adolescent is homeless.
- Discuss the resources that are important to offer to an
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
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?
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
5. List the components of a sports PE and the reasons for including
6. Cardiovascular screening for sudden death in young athletes:
- Define sudden cardiac death
- State the most common causes of sudden cardiac death in
- 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:.
- Absence of one kidney
- Absence of one ovary/testicle
- Cystic Fibrosis
8. Concussion in sports:
- Define concussion; including features of frequently observed
- For concussions Grades 1-3 list features observed at each
level, symptoms, and recommendations for returning to
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
- 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
- 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.
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
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
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
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
8. Pediculosis - Discuss cause, clinical presentation, diagnosis, treatment,
and patient education.
9. Scabies - Discuss cause, clinical presentation, diagnosis, treatment, and
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
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)
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.
1. Be able to discuss with parents the normal sequence of
musculoskeletal development in regards to bowlegs” and “knock
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
9. Discuss the importance of evaluating hips in infants during the first
year of life.
10. Describe the positive physical examination findings which are
in DDH at various ages.
4. Describe the work-up and treatment of DDH and subluxation of the
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’