AQUIFER PEDIATRICS LEARNING OBJECTIVES

Case 1
 List elements of the maternal prenatal history that are relevant to the care of the newborn.
 Discuss the potential effect on the fetus of maternal use of tobacco, alcohol, marijuana, and other
drugs
 Discuss the epidemiology and approach to prevention of neonatal Group B Streptococcal sepsis
 Summarize clinical findings in the infant that are associated with intrauterine (TORCH) infections
 Outline steps in neonatal resuscitation
 Describe the components of the APGAR score and explain its significance.
 Describe and perform components of a complete physical examination of a newborn infant,
including primitive reflexes and red reflex.
 Discuss the use of the Ballard Gestational Age Assessment Tool in the evaluation of the newborn
infant
 Define the terms small for gestational age (SGA) and intrauterine growth restriction (IUGR).
Differentiate symmetric and asymmetric IUGR.
 Outline a differential diagnosis for an infant noted to be small for gestational age
 List potential complications in infants who are born small for gestational age
 List medications and immunizations routinely given in the immediate newborn period and explain
the rationale for their use
 Summarize elements of routine discharge teaching for parents of newborns
 Discuss the potential role of social work in facilitating the transition from newborn nursery to
home

Case 2
 Recognize appropriate growth patterns in infants up to 9 months of age using standard growth
charts.
 Summarize nutritional requirements for appropriate growth for infants at ages 2, 6, and 9 months,
including caloric requirements, differences between formula and breast milk, and how and when to
add solid foods to the diet.
 Explain the difference between developmental surveillance and developmental screening
 List normal developmental milestones at 2, 4, 6, months
 Discuss the importance of prevention and anticipatory guidance during the well visits, including
behavior, development, safety and immunizations.
 Develop a differential diagnosis for an asymptomatic abdominal mass in an infant; formulate a
plan for evaluation.

Case 3
 Discuss the importance of identifying parent concerns in order to set priorities for a well child visit
 Describe the components of a preschool health supervision visit, including common concerns, key
elements of health promotion, recommended screening, and immunizations.
 Demonstrate ability to measure and assess growth including height/length, weight, and body mass
index using standard growth charts.
 List normal developmental milestones at 3, 4, and 5 years of age
 Identify eczema and discuss principles of management.
 Describe key elements of the physical exam for a well child visit in early childhood, including tests
 to identify strabismus
 Discuss strategies for modifying the elements of the well child visit to match the child's level of
comfort and cooperation
 List common causes of injury in early childhood
 Discuss age-appropriate anticipatory guidance about safety in preschoolers, including
recommendations for addressing firearms in the home
 Summarize risk factors and screening for TB, lead poisoning, anemia
 List potential causes of anemia in a preschool aged child
 Describe an initial approach to the management of suspected iron deficiency anemia
 List common dietary issues in early childhood.
 Discuss strategies for counseling parents on making dietary changes in preschoolers

Case 4
 Discuss conditions that may contribute to a child's failure in school.
 Summarize the signs, symptoms, and management of ADHD
 Demonstrate ability to measure and assess growth including height/length, weight, and body mass
index using standard growth charts.
 Discuss the epidemiology, risk factors, management, and complications of childhood obesity
 Discuss diagnosis, causes and management of hypertension in children.

Case 5
 Discuss principles of adolescent confidentiality; outline a practical approach to ensuring
confidentiality during adolescent health visits
 Summarize components of the adolescent psychosocial interview (HEADSSS)
 List features of each Tanner stage in males and females
 Perform an age-appropriate history and physical examination for an adolescent with fatigue
 Generate an age-appropriate differential diagnosis for fatigue in an adolescent
 Describe clinical findings associated with important causes of fatigue
 Discuss features of depression in adolescents
 Summarize clinical findings and complications of eating disorders
 Summarize the epidemiology, clinical features, diagnosis, and treatment of VonWillebrand disease

Case 6
 List key elements of the sports pre-participation evaluation in adolescents
 Outline a differential diagnosis for chest pain in a healthy adolescent
 Identify clinical features that distinguish cardiac from non-cardiac chest pain
 Discuss principles of adolescent confidentiality; outline a practical approach to ensuring
confidentiality during adolescent health visits
 Summarize components of the adolescent psychosocial interview (HEEADSSS)
 Summarize components of screening for substance use, using the CRAFFT mnemonic
 List essential components of the cardiovascular exam, including findings that should prompt
further evaluation
 List findings of importance in the male GU exam
 List features of each Tanner stage in males
 Describe components of the two-minute orthopedic exam
 List recommended immunizations in adolescence

Case 7
 Develop a differential diagnosis for tachypnea in the immediate newborn period
 Compare and contrast features of common causes of respiratory distress in immediate newborn
period – including risk factors, clinical presentation, exam CXR findings)
 Determine appropriate investigations to evaluate neonatal respiratory distress.
 Discuss the normal transition from intrauterine to extrauterine life
 Discuss effects of maternal diabetes on the neonate.
 Define LGA, SGA and list potential problems associated with each
 Recognize signs and symptoms of respiratory distress in the newborn
 Summarize the identification, management of neonatal hypoglycemia
 Discuss risk factors, exam findings, national screening guidelines for developmental dyplasia of
the hip
 List factors that determine the neonate's readiness for discharge from the hospital.

Case 8
 Describe newborn bilirubin physiology
 Outline features of and risk factors for acute and chronic bilirubin toxicity (kernicterus)
 Identify features of the maternal and newborn history that are relevant to the evaluation of newborn
jaundice
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for a
newborn with jaundice
 Describe the epidemiology, clinical and laboratory findings of important causes of newborn
jaundice
 Describe the advantages of breastfeeding and describe common difficulties experienced by
breastfeeding mothers.
 Assess the adequacy of breastfeeding, based on patient history and infant growth
 Summarize current guidelines for management of newborn hyperbilirubinemia

Case 9
 List key elements of the patient history for the first outpatient newborn visit
 Discuss expected weight changes in the first 2 weeks of life
 Assess the adequacy of breastfeeding, based on patient history and infant growth
 List of elements of routine care of the newborn in the hospital setting
 Generate a differential diagnosis and initial diagnostic plan for a newborn with poor feeding and
decreased activity
 Summarize key features of conditions that may present with poor feeding and decreased activity in
the newborn period
 List elements of a complete physical examination of the newborn infant.
 Assess fontanel size; list conditions associated with abnormalities in the size or appearance of the
fontanels
 Summarize the etiology, epidemiology, clinical presentation, and management of congenital
hypthyroidism
 Discuss the goals and practical implementation of newborn screening

Case 10
 Perform an age-appropriate history and physical examination for an infant presenting with fever
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for an
infant with fever
 Describe the epidemiology, clinical, laboratory, and radiographic findings, of important causes of
fever in infants
 Define fever without a source
 Discuss guidelines for the evaluation and management of fever without a source and how they have
changed with the advent of new vaccines.
 Discuss signs of meningitis in children and how these may vary with age
 Interpret results of CBC, Urinalysis, and CSF examination in a child with fever
 Outline factors that determine whether a patient with UTI should be treated in the inpatient vs.
outpatient setting.
 Select appropriate antibiotic treatment for an infant with UTI
 Calculate a drug dose based on body weight
 Discuss recommendations for imaging after a first febrile UTI

Case 11
 Perform an age-appropriate history and physical examination for a child with fever and rash
 Generate an age-appropriate differential diagnosis for fever and rash in a child
 Describe clinical findings associated with important causes of fever and rash
 Generate an age-appropriate differential diagnosis for fever and irritability
 Summarize the diagnosis and treatment of Group A streptococcal pharyngitis
 List causes of unilateral cervical adenopathy
 List and define terms commonly used to describe rashes
 Summarize diagnostic criteria, clinical features, pathophysiology, natural history, complications,
treatment, and follow-up care of Kawasaki disease

Case 12
 Perform an age-appropriate history and physical examination for an infant presenting with cough
and/or wheezing
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for an
infant with cough and/or wheezing
 Describe the epidemiology, pathophysiology, clinical, laboratory, radiographic findings, and
management of important infectious and noninfectious causes of cough and/or wheezing in infants
 Describe the optimal sequence of elements of the physical exam in an infant to maximize patient
comfort and cooperation.
 Describe key findings in a complete pulmonary examination, including abnormalities
 Describe signs of respiratory distress in an infant
 Outline essential elements of the diagnosis and management of a suspected foreign body
aspiration, including expected radiographic findings
 Provide anticipatory guidance for the prevention of choking, aspiration
Case 13
 Perform an age-appropriate history and physical examination for a child with chronic cough
 Generate an age appropriate differential diagnosis for a child with chronic cough
 Describe the epidemiology, pathophysiology, clinical findings, and management of important
causes of chronic cough
 Describe physical exam maneuvers included in a complete pulmonary examination and discuss the
significance of abnormal findings
 Summarize the epidemiology, risk factors, and diagnosis of tuberculosis in children
 Summarize current guidelines for the diagnosis, classification of severity, and management of
asthma
 Discuss clinical findings and management of allergic rhinitis
 Discuss the association between environmental allergies and asthma

Case 14
 Perform an age-appropriate history and physical examination for a toddler with congestion, cough,
fever
 Generate an age appropriate differential diagnosis for a toddler with congestion, cough, fever
 Describe the epidemiology, pathophysiology, clinical findings, and management of important
causes of congestion, cough, fever
 Describe the optimal sequence of elements of the physical exam in a toddler to maximize patient
comfort and cooperation
 Discuss key elements of the ear exam in a young child, including options for positioning and use of
pneumatic otoscopy
 List physical exam findings associated with a normal tympanic membrane, acute otitis media
(AOM), otitis media with effusion (OME), otitis externa
 List risk factors, common pathogens, and potential complications associated with acute otitis media
 Summarize current guidelines for diagnosis and management of acute otitis media
 Identify possible language delay in a toddler
 Discuss options for assessment of hearing in young children
 Summarize recommendations for management of otitis media with effusion

Case 15
 Generate an age-appropriate differential diagnosis for vomiting.
 Describe elements of the history and exam that differentiate causes of vomiting in infancy and
early childhood.
 List the symptoms and signs of dehydration, and estimate the severity of dehydration based on
clinical findings.
 Compare and contrast indications and methods for oral versus intravenous rehydration.
 Calculate maintenance and deficit replacement fluid requirements and identify appropriate fluids
for each.
 Discuss strategies for preventing transmission of viral gastroenteritis.
 Describe the electrolyte abnormalities typically seen in pyloric stenosis.
 Outline an immediate management plan for an infant with severe dehydration.

Case 16
 Discuss the role of professional interpreters in working with patients with Limited English
Proficiency.
 Outline a differential diagnosis for vomiting in a school-aged child.
 Discuss the epidemiology, pathophysiology, clinical features, laboratory findings,, and initial
management of diabetic ketoacidosis (DKA)
 Discuss the clinical signs and underlying causes of cerebral edema occurring as a complication of
DKA.
 Estimate a patient’s degree of dehydration based on clinical exam.
 Calculate a patient’s fluid deficit based on estimated degree of dehydration.
 Summarize basic principles of fluid management in pediatrics.
 Discuss the multidisciplinary nature of caring for patients with Type 1 diabetes mellitus.
 Summarize key elements of patient education for a patient newly diagnosis with Type 1 DM

Case 17
 Perform an age-appropriate history exam for a preschool child presenting with limp/extremity
pain/refusal to bear weight
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for
limp/extremity pain/refusal to bear weight
 Describe the epidemiology, clinical, laboratory, and radiographic findings, of important causes of
limp/extremity pain/refusal to bear weight
 Distinguish accidental from non-accidental bruising
 Discuss risk factors, screening, and complications of developmental dysplasia of the hip.
 Interpret standard growth charts
 Identify normal developmental milestones for a 4-year-old child
 Discuss the role of observation in assessing a child with a musculoskeletal complaint
 Outline elements of the musculoskeletal exam in children; identify abnormalities
 Provide dosing instructions for ibuprofen
 Discuss clinical features and complications of Lyme disease

Case 18
 Perform an age-appropriate history and physical examination for an infant with poor feeding
 Generate an age-appropriate differential diagnosis for feeding difficulty in an infant
 Discuss causes and characteristics of common heart murmurs in children
 List clinical features of structural heart defects
 Discuss the clinical presentation, causes, evalution and management of congestive heart failure in
children
 Explain the anatomy, pathophysiology, and clinical presentation of ventricular septal defect

Case 19
 List potential causes of altered mental status in a toddler.
 Categorize seizures (e.g. partial, generalized, simple, complex) according to typical clinical
features.
 List key features to include in the history and exam in determining the etiology of a new-onset
seizure.
 Outline normal developmental milestones for a 16-month-old child.
 Generate a differential diagnosis for a generalized seizure.
 Compare and contrast the clinical features of different causes of seizures.
 Distinguish simple from complex febrile seizures.
 Summarize national practice guidelines for the evaluation of simple febrile seizures.
 Discuss options for anticipatory guidance to families in the aftermath of a febrile seizure.
 Describe the typical history, presentation, and exam findings associated with roseola (exanthem
subitum).

Case 20
 Perform an age-appropriate history and exam for a school-aged child presenting with headaches
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for a
child with headache
 Describe the epidemiology, clinical, laboratory, and radiographic findings of important causes of
headaches
 List the elements of a thorough neurologic exam and interpret abnormalities.
 Identify signs and symptoms of increased intracranial pressure.
 Formulate a differential diagnosis for ataxia in children.
 Discuss communication strategies that may be helpful in delivering difficult news to a patient and
family
 Summarize features of common brain tumors in children

Case 21
 Perform an age-appropriate history exam for a school-aged child presenting with purpura/petechiae
 Generate an age appropriate differential diagnosis and initial diagnostic and therapeutic plan for
purpura/petechiae in a school-aged child
 Describe the epidemiology, clinical, laboratory, and radiographic findings of important causes of
purpura/petechiae
 List clinical findings that suggest that a patient requires urgent stabilization
 Describe an approach to eliciting the patient's perspective on illness
 List features that are important to consider in evaluating skin lesions
 Compare and contrast features of accidental vs. non-accidental bruising.
 Differentiate normal and abnormal findings on examination of the lymph nodes, liver, and spleen.
 Summarize clinical features, lab findings, natural history, and complications of Henoch-Schönlein
purpura.
 Outline typical clinical and laboratory features of idiopathic thrombocytopenic purpura (ITP),
acute lymphocytic leukemia (ALL), and intussusception.

Case 22
 Perform an age-appropriate history and physical examination for an adolescent with abdominal
pain
 Generate an age-appropriate differential diagnosis for abdominal pain in an adolescent
 Describe clinical findings associated with important causes of abdominal pain
 Describe the unique features of the physician-patient relationship during adolescence including
confidentiality and consent.
 Interview an adolescent patient, using the HEADSSS method, to ask sensitive questions about
lifestyle choices that affect health and safety
 Discuss the epidemiology, clinical features, and management of of pelvic inflammatory disease
 Discuss clinical features of testicular torsion
 Provide counseling regarding prevention and management of sexually transmitted infection

Case 23
 Outline a differential diagnosis for altered mental status in an adolescent
 List findings that indicate that a child is critically ill
 Explain steps in the initial assessment of a critically ill patient (CABs)
 Define the term shock; differentiate compensated and uncompensated shock in children.
 Compare and constrast different types of shock
 Summarize recommendations for initial fluid management for a patient in shock
 identify potentially life threatening causes of fever and rash
 Summarize clinical findings in bacterial meningitis
 Discuss the epidemiology, clinical features, complications of meningococcal disease
 Discuss prevention of meningococcal disease, including current recommendations for
immunization and post-exposure prophylaxis
 List measures for preventing medication errors when writing orders or prescriptions
 Calculate a weight-based medication dose for an adolescent patient
 Discuss strategies for giving bad news

Case 24
 Outline a differential diagnosis for altered mental status in a toddler
 Discuss steps in the immediate assessment of a child with altered mental status
 List elements of history-taking relevant to the evaluation of a suspected toxic ingestion
 List features of key toxidromes (cholinergic, anticholinergic, sedative-hypnotic, opioid,
sympathomimetic).
 Summarize decontamination strategies and indications/contraindications for their use
 Discuss the clinical features and management of toxic ingestion of iron and acetaminophen
 Describe clinical findings associated with toxic ingestion of tricyclic antidepressants
 Describe the role of the Poison Control Center (1-800-222-1222) in the management of an
accidental or intentional ingestion.
 Discuss approaches to communication about home safety in the wake of an accidental ingestion

Case 25
 Perform an age-appropriate history and physical examination for an infant with altered mental
status/apnea
 Generate an age-appropriate differential diagnosis for altered mental status/apnea in an infant
 Describe clinical findings associated with important causes of altered mental status/apnea in infants
 List initial steps in the management of a patient who is clinically unstable
 Discuss clinical and radiographic findings that raise suspicion for non-accidental trauma
 List key components in the evaluation of suspected child abuse
 Discuss the ethical and legal responsibility of health care workers to report suspected child abuse to
 the Department of Human Services.

Case 26

 Identify abnormal infant growth patterns using standard growth charts.

 Define failure to thrive and discuss its potential causes
 Perform and age-appropriate history and physical examination for an infant with failure to thrive
 Discuss laboratory and radiographic studies that maybe useful in the evaluation of failure to thrive
 Discuss the pathophysiology, genetics, clinical features, and management of cystic fibrosis

Case 27
 Perform an age-appropriate history and physical examination for a child with chronic abdominal
pain
 Demonstrate ability to measure and assess growth including height/length, weight, and body mass
index using standard growth charts.
 Generate an age-appropriate differential diagnosis for chronic abdominal pain
 Discuss the differential diagnosis of intestinal blood loss.
 Recognize critical findings ("red flags") that differentiate functional from pathological abdominal
pain.
 Order and interpret appropriate laboratory studies as part of the evaluation of abdominal pain.
 Outline the role of radiological studies in the evaluation of abdominal pain.
 Discuss the pathophysiology of anemias.
 Discuss the basis of therapy for inflammatory bowel disease.

Case 28
 Discuss the use of corrected age to monitor growth and development in ex-premature infants and
toddlers
 List domains of development typically assessed by standardized developmental screening tools
 List elements of the pediatric history relevant to the evaluation of possible developmental delay
 Summarize guidelines for developmental surveillance and screening
 Interpret results of developmental screening
 Summarize clinical features of autism and guidelines for screening
 Discuss factors related to prematurity that impact growth and development in children.
 Outline a differential diagnosis for developmental delay
 List strategies for performing a neurologic exam in a toddler
 Summarize risk factors, clinical features, and recommendations for management of cerebral palsy.

Case 29
 List common physical findings in Down syndrome.
 Discuss the epidemiology of Down syndrome.
 Summarize complications of Down syndrome.
 Discuss laboratory tests used to confirm the diagnosis of Down syndrome.
 Provide appropriate "anticipatory guidance" in the management of children with Down syndrome.
Case 30

 Discuss the pathophysiology, diagnosis, natural history, and potential complications of sickle cell
disease
 Summarize key elements of preventive care, including immunization prioritities, in children with
sickle cell disease
 List symptoms that warrant urgent attention in a patient with sickle cell disease
 Outline a differential diagnosis for fever and/or cough and/or chest pain in a child with sickle cell
disease
 Describe the management of acute chest syndrome.

Case 31
 Describe methods to establish rapport with a school-aged pediatric patient
 Perform an age-appropriate history and physical examination for a child with periorbital swelling
 Generate an age appropriate differential diagnosis for child with periorbital swelling
 Describe the epidemiology, pathophysiology, and clinical findings of important causes of
periorbital swelling
 Use history and physical exam findings to formulate and refine a differential diagnosis for
generalized edema.
 Summarize the epidemiology, clinical features, management, and prognosis of nephrotic syndrome
in children
 Explain the pathphysiology and underlying lab abnormalities in nephrotic syndrome.
 Discuss common complications of nephrotic syndrome, both in terms of the disease itself and
management.

Case 32
 Describe both primary dermatological lesions and secondary changes commonly seen in pediatric
patients in a systematic manner using appropriate medical terminology.
 Outline the key history and physical findings associated with the following common pediatric
dermatologic conditions: Urticaria, seborrheic dermatitis, contact dermatitis, acne, superficial
fungal infections, and scabies.
 List a prioritized differential diagnosis for an urticarial rash.
 Discuss the diagnosis and management of acne.
 Discuss the general approach to choosing a topical steroid and the common side effects associated
with their use.
 Discuss treatment options for common warts.
 List at least three conditions in the differential diagnosis of diaper rash.