Copyrighted e UPEC Manual 2013

Philippine Pediatric Society, Inc.
A Curriculum for Undergraduate Pediatric Education

for Philippine Medical Schools
(e-
(e-UPEC Manual 2013)
A joint publication of the PPS Undergraduate Pediatric Education Committee and the
PPS Council on Subspecialties and Sections
Editors:
Carmelo A. Alfiler, MD
Melflor A. Atienza, MD
Melinda M. Atienza, MD
Milagros S. Bautista, MD
A Curriculum for Undergraduate Pediatric Education

for Philippine Medical Schools
(e-
A joint publication of the PPS Undergraduate Pediatric Education Committee and the
PPS Council on Subspecialties and Sections
Editors:
CARMELO A. ALFILER, MD
MELFLOR A. ATIENZA, MD
MELINDA M. ATIENZA, MD
MILAGROS S. BAUTISTA, MD
The Philippine
Any part of
A CURRICULUM FOR UNDERGRADUATE PEDIATRIC EDUCATION
for PHILIPPINE MEDICAL SCHOOLS
(e-
may be freely reproduced
with proper acknowledgment
Copyright Reg. No. O2014-174
The Philippine Pediatric Society, Inc. (PPS)

PPS Building
52 Kalayaan Avenue, Diliman, Quezon City 1101
Tels. (02) 926-6758, (02) 926-6759
Fax (02) 926-2381
Webpage: www.pps.org.ph
Email address: ppsinc@pps.org.ph
ii
Dedicated
to
This Generation’s
Teachers
and
Learners
of
Pediatrics
and
to
The Filipino Children

of
Today
and
Tomorrow
iii
About the Editors
CARMELO A. ALFILER, MD, MD, FPPS, FPSN, FPNSP

Professor of Pediatrics, College of Medicine-Philippine General Hospital, UP Manila
Chairman, Department of Pediatrics, UPCM-PGH, 1998-2003
Director, Philippine General Hospital, UP Manila, 2004-2009
President, Philippine Pediatric Society,2000-2002
President, Philippine Society of Nephrology, 1990-1992
Founding President, Pediatric Nephrology Society of the Philippines, 1994-1997
Secretary-General, Asian Pediatric Nephrology Association, 2001-2007
MELFLOR A. ATIENZA, MD, MHPEd, FPCP, FPSG, FSDE

Associate Professor of Medicine, College of Medicine-Philippine General Hospital, UP Manila
Chair, Office of Extension and Continuing Education, NTTC-HP, UP Manila
College Secretary, NTTC-HP, UP Manila, 2010-2013
MELINDA M. ATIENZA, MD, MHPEd, FPPS, FPSPME

Associate Professor and Chair, Department of Pediatrics Faculty of Medicine and Surgery,
University of Santo Tomas
President, Philippine Pediatric Society, 2012-2014
President, Philippine Society of Pediatric Metabolism and Endocrinology, 2008-2010
MILAGROS S. BAUTISTA, MD, FPPS, FPAPP, FPCCP

Professor of Pediatrics, UE Ramon Magsaysay Memorial Medical Center, Inc.
Chair, Department of Pediatrics, UERMMMCI
President, Philippine Academy of Pediatric Pulmonologists, 1998-2000
iv
NOTICE
The authors and editors of this manual emphasized pediatric disorders and concerns being encountered during the time of
publication. Due to epidemiologic changes and dramatic advances in medical diagnosis, evaluation and management, information may be
different at a future time.
The Physician is therefore urged to continuously update himself with current trends and developments in Pediatrics. The Teacher is
also encouraged to update his syllabus accordingly in consonance with the prevailing epidemiologic picture and emerging health issues.
THE EDITORS
v
FOREWORD
In furtherance of the sole but far-ranging function of the Undergraduate Pediatric Education Curriculum Committee (UPECC) of the Philippine Pediatric Society (PPS), ie., to develop innovative and sustainable
programs that will enhance the teaching and practice of Pediatrics in the undergraduate years ensuring a strong foundation in knowledge and clinical skills for the future general practitioner and pediatric
specialist/subspecialist, this 2013 edition of the PPS-UPEC Manual saw electronic print twelve (12) years after the first hard copy and four (4) years after the latter’s expanded electronic version came out.
The aforementioned outputs spawned a series of innovative teaching and learning modules disseminated to Philippine medical schools and PPS-accredited training programs via seminar-workshops or printed
copies --- among them modern curricular concepts, breastfeeding, pediatric neurologic examination, growth and development --- which have contributed greatly to these schools’ and hospitals’ instructional
materials these past years.
This e-UPEC Manual 2013 differs from the past two editions in that (1) two subsections --- Growth and Development and Nutrition/Nutritional Disorders --- are added to the Core Section which previously
contained Data Gathering, Recording and Presentation and Pediatric Procedures (now titled under one subsection as Pediatric Diagnosis and Procedures); (2) component members of the PPS Council on
Subspecialty Societies and Sections, various PPS-UPEC workshop groups and individual experts/resource persons shared their time and knowledge exhaustively in revisiting and updating instructional designs on
Organ System Disorders; (3) Emergency Pediatrics joins the section of Selected Topics for the first time,(4) the topic on Integrated Management of Childhood Illnesses (IMCI) integrates educational vignettes
from the World Health Organization and our Department of Health in a major way; (5) outcome-based education as espoused by the Commission on Higher Education (CHED) is adhered to, and; (6) it is a joint
publication of PPS-UPEC and the PPS Council on Subspecialties and Sections.
This edition would not have been possible were it not for the unwavering support of the PPS Board of Trustees, now led by Dr. Melinda M. Atienza, the Association of Philippine Medical Colleges Foundation
(APMCF) under Dr. Fernando S. Sanchez, Jr., the Professional Regulation Commission Board of Medicine now chaired by Hon. Edgardo T. Fernando, the countless innovative workshop groups since October 2010,
the Task Forces and Writing Committees of the subspecialties under the PPS Council on Subspecialty Societies and Sections, and invited contributors.
Most of all, I reserve my heartfelt thanks to the members of PPS-UPEC Committee from 2002 to the present for their commitment to our objectives and action plans, to Prof. Melflor A. Atienza for taking over
the teacher-of-teachers/facilitator’s/co-editor’s role since 2010, to the PPS Secretariat’s Regine R. Mendoza and Norberto N. Puñegal, Jr., and to Pharex HealthCorp under President & CEO Tomas Marcelo G.
Agana III whose logistical assistance has been unburdening the committee for so many years running.
On everybody’s behalf, I hope that the guidelines in e-UPEC Manual 2013 will help promote a better and more rational Philippine child health care in our generation.
CARMELO A. ALFILER, MD
Chair, PPS-UPEC Committee
vi
MESSAGE
The internationalization and globalization of medical education has heralded novel approaches to improve the delivery of learning to medical learners. The advent of
“inverted curricula or flipped instructional materials” has allowed self-motivated and self-directed learning to future medical professionals. The impact of medical
informatics as an instructional tool provided medical educators with an almost limitless resource to innovate strategies of teaching and learning. These dynamics will
inevitably redound to better medical schools and hopefully to more competitive future medical professionals.
The Philippine Pediatric Society through its Undergraduate Pediatric Education Curriculum Committee (UPECC) is pleased and proud to offer the “e-UPEC Manual” as an
insightful contribution to modern day pediatric education in the undergraduate level combining “theoretical foundations with informatics innovation”. This unique
teplate will hopefully constructively align the fundamental concepts of pediatric mediicne to the practice of pediatrcis beyond the formative years of formal medical
education. This will ensure that what the medical learner learns in theory is what he will apply in practice using web-assisted designs and formats. This attempt towards
constructive alignment will undoubtedly strengthen the competencies of medical learners and later medical professionals in the art and science of pediatric practice.
Allow me to express the PPS’ sincerest appreciation to the “forces” that facilitated the realization of this document. Professor Carmelo A. Alfiler, former President of the
PPS who serves as Chair of the UPECC for the tenacity of spirit and resilience of mind to pursue this endeavour up to its fruition. Professor Melflor A. Atienza of the
National Teachers’ Training College for serving as the sturdy foundation of the frameworks that led to the completion of this teaching aid. Likewise, gratitude is in
order, to the working committees of the different subspecialties PPS Secretariat and our invaluable partners in the professionalization and regulation of pediatric
education and practice in the country, namely the Association of Philippine Medical Colleges (APMC) and the Professional Regulation Commission (PRC).
And of course last but not the least, our sincerest thanks go to Pharex Helath Corporation represented by its president CEO Mr. Tomas Marcelo G. Agana III for sharing
with the PPS the vision to enlighten, enable, equip and empower the future medical professionals of our country.
MELINDA M. ATIENZA, MD, MHPEd

President, Philippine Pediatric Society, Inc., 2012-2014
vii
Association of Philippine Medical Colleges Foundation, Inc
MESSAGE
The first curricula in the various medical subjects were developed in January to March 1969 during the preconference seminars of the First
National Conference on Medical Education in the Philippines under the auspices of the Association of Philippine Medical Colleges Foundation, Inc.
We, in APMCFI are gratified that in Pediatrics the pediatric faculty of the different schools have been updating the curriculum through the
Philippine Pediatric Society E – Undergraduate Curriculum, first in 2001 and now in 2013-2014. This assures that the teaching of Pediatrics in the
Philippine schools is abreast with the rest of the world.
Congratulations to the Pediatric faculty who labored to keep Pediatric teaching and practice in the Philippines up-to-date. You are doing a great
service to Philippine Medicine and to our society.
Continue the good work.
FERNANDO S. SANCHEZ, JR., M.D., MPH

Executive Director, APMCFI
viii
Republic of the Philippines
Professional Regulation Commission
Manila
MESSAGE
The PPS Undergraduate Pediatric Education Curriculum (PPS-UPEC) Manual 2001 inaugural edition has been an indispensable reference for
medical schools in introducing innovations in the pediatric curriculum. It has likewise been used as a guide by the Professional Regulatory Board of
Medicine in constructing its table of specifications.
Now, after years of hard work and dedication, another landmark in the history of PPS has been meticulously crafted. I am very impressed with
the high quality and standard of pediatric curriculum for medical education that has been presented by this updated edition.
My heartfelt congratulations, especially to the PPS-UPEC Committee for this remarkable work which will go a long way in improving the pediatric
education, training and practice of the specialty in our country
MABUHAY!
HON. EDGARDO T. FERNANDO, MD
Chairman
Professional Regulatory Board of Medicine
Professional Regulation Commission
ix
COUNCIL ON TRAINING AND CONTINUING PEDIATRIC EDUCATION
Committee on Undergraduate Pediatric Education Curriculum
Chair: CARMELO A. ALFILER, MD

Co-Chairs: ESPERANZA F. RIVERA, MD
RAMON L. ARCADIO, MD
Members: Department Chairs 2010 – 2012 2012-2014
FEU-NRMF JOSELITO C. MATHEUS, MD ANITA G. MARASIGAN, MD
MCU-FDTMF ELIZABETH R. TELADO, MD JOCELYN Y. FRANCO, MD
UERMMMC MILAGROS S. BAUTISTA, MD MILAGROS S. BAUTISTA, MD
UP-PGH CARMENCITA D. PADILLA, MD JULIET S. AGUILAR, MD
UST MELINDA M. ATIENZA, MD MELINDA M. ATIENZA, MD
Adviser: PERLA D. SANTOS OCAMPO
Resource Person: MELFLOR A. ATIENZA, MHPEd, UP-NTTC for Health Professionals
Function: To develop innovative and sustainable programs that will enhance the teaching and practice of Pediatrics in the undergraduate years
ensuring a strong foundation in knowledge and clinical skills for the future general practitioner and pediatric specialist/subspecialist
Action Plans: (1) To produce a core syllabus in undergraduate Pediatrics

(2) To introduce guidelines in the teaching and practice of Pediatrics in medical schools relevant to the Philippine setting
(3) To study other strategies/mechanisms by which Philippine Pediatrics can be promoted in a proactive manner as early as in the
undergraduate years
(4) To monitor and evaluate periodically the effectiveness and relevance of the above activities
Outputs: (1) A Curriculum for Undergraduate Pediatric Education for Philippine Medical Schools 2001
(2) Expanded e-copy of the above 2001 UPEC Manual, 2009
(3) Workshops on Innovative Teaching Strategies in Undergraduate Pediatrics, 2010-2012
(4) Teaching-Learning Modules on Breastfeeding, Pediatric NeuroExam, Growth & Development, Nutrition/Nutritional Disorders
(hard and e-copies), 2010-2012
(5) Feedbacks on utilization of PPS-UPEC materials, 2010-2012
(6) Workshop on Revisiting 2001 PPS-Undergraduate Pediatric Education Curriculum, 2013
(7) Revised and Updated ePPS-UPEC Manual, 2013
(8) Teaching-Learning Modules on Developmental & Behavioral Pediatrics and Pediatric Infectious Disease (in progress)
x
COUNCIL ON SUBSPECIALTIES AND SECTIONS
Chair : Melinda M. Atienza, MD Advisers: Wilberto L. Lopez, MD, Xerxes R. Navarro, MD, Joel S. Elises, MD
Child Neurology Society of the Philippines (CNSP) Rosalina Q. De Sagun, MD

Philippine Society of Pediatric Cardiology (PSPC) Magdalena J. Lagamayo, MD
Pediatric Nephrology Society of the Philippines, Inc (PNSP) Ofelia R. De Leon, MD
Pediatric Infectious Disease Society of the Philippines (PIDSP) Beatriz P. Quiambao, MD
Philippine Society of Pediatric Gastroenterology, Hepatology and Nutrition (PSPGHAN) Mary Jean V. Guno, MD
Philippine Society of Pediatric Metabolism and Endocrinology (PSPME) Sylvia C. Estrada, MD
Philippine Academy of Pediatric Pulmonologists (PAPP) Clara R. Rivera, MD
Philippine Society of Pediatric Oncology (PSPO) Cynthia Melicor, MD
Society of Pediatric Critical Care Medicine (SPCCM) Ronald V. Limchiu, MD
Philippine Society of Pediatric Surgeons (PSPS) Ma. Louisa Aquino, MD
Philippine Society of Newborn Medicine (PSNbM) Carina C. Quimbo, MD
Philippine Society for Developmental and Behavioral Pediatrics (PSDBP) Ma. Theresa A. Lim, MD
Philippine Society of Pediatric Hematology (PSPH) Rosalina P. Anastacio, MD
Philippine Society of Adolescent Medicine Specialists (PSAMS) Rosa Maria H. Nancho, MD
Section of Allergy & Immunology Ma. Stella G. Paspe, MD
Section of Adolescent Medicine Ma. Emma A. Llanto, MD
Section of Ambulatory Pediatrics Ma. Eva I. Jopson, MD
Section of Genetics Eva Marie C. Dela Paz, MD
INVITED SUBSPECIALTY GROUPS AND EXPERTS
Pediatric Rheumatology Leonila F. Dans, MD, Cherica A. Tee, MD

Pediatric Dermatology Carlos E. Paguio, MD
Child Protection Bernadette J. Madrid, MD
Community Pediatrics Community Pediatrics Society of the Philippines (CPSP)
Emergency Pediatrics Jonathan S. Cu, MD
Environmental Pediatrics and Poisoning Genesis C. Rivera, MD
Ethical Issues in Pediatrics Esperanza F. Rivera, MD
Pediatric Pharmacology and Therapeutics PPS Committee on Pharmacology and Therapeutics
Preventive Pediatrics Philippine Ambulatory Pediatrics Association (PAPA)
xi
MODULE PARTICIPANTS
PEDIATRIC DIAGNOSIS AND PROCEDURES ORGAN SYSTEM DISORDERS
DATA GATHERING, RECORDING AND PRESENTATION ALLERGY
Joselito Matheus (Chair) Agnes Gonzalez-Andaya

Edna Sarah Morada (Resource Person) Madeleine Sumpaico
Rhoderick Asuncion Florecita Padua .
Naomi Nocheseda Ma. Stella Paspe
Rosette Nancho Marysia Stella Recto
Grace Padilla (PSAAI)
Irwina Lazo
Elizabeth Gallardo BONES AND JOINTS
PEDIATRIC PROCEDURES Leonila Dans

Cherica Tee
Jocelyn Yambao-Franco (Chair) Karen Kimseng
Ma. Cecilia Alinea (Resource Person) (Invited Experts in Pediatric Rheumatology)
Jindra Tetangco
Joseph Vincent Alba BURNS AND INJURIES
Lynette Alcala
Rosalina Anastacio Ma. Luisa Aquino
Maria Teresa Cacas Jose Modesto Abellera, III
Carina Quimbo (PSPS)
Emmalyn Reveldez
Anita Marasigan CARDIOVASCULAR DISORDERS
Sonia Rosario
Aida Salonga Eden Latosa
Juliet Balderas
Ma. Rhodora De Leon
Marivic Esguerra-Motilla
Aurora Gamponia
Ma. Rhodora De Leon
(PSPC)
xii
CRITICAL CARE GASTROENTEROLOGY
Ronald LImchiu Rebecca Castro

(SPCCM) Portia Menelia Monreal
(PSPGHN)
DERMATOLOGY
HEMATOLOGY
Carlos Paguio
Rosalina Anastacio
DEVELOPMENTAL AND BEHAVIORAL DISORDERS Renee Maguinsay
Allan Robert Rancho
Ria De Guzman Joseph Vincent Alba
(PSDBP) Minerva Ramos
Jose Antonio Quitevis
ENDOCRINOLOGY AND METABOLISM Fernando Douglas Go
Ma. Lita Fe Paclibar
Melinda Atienza (Chair & Resource Person) Flerida Hernandez
Ofelia De Leon (PSPH)
Maria Theresa Lim
Eva Marie Dela Paz IMMUNOLOGY
Cynthia Lucman
Aimee Bretana Agnes Gonzalez-Andaya
Cynthia Feliciano Florecita Padua
Lourdes Tanchanco Ma. Stella Paspe
Susana Campos Marysia Stella Recto
Isabel Vilvar Madeleine Sumpaico
Alma Bie (PSAAI)
(PSPME)
INFECTIOUS DISEASE
NEONATOLOGY
Lester Deniega
Sheila Ann Masangkay Anna Lisa Ong-Lim
Carina Quimbo (PIDSP)
(PSNbM)
xiii
NEPHROLOGY ONCOLOGY
Ofelia De Leon Joseph Vincent Alba

Lorna Simangan Michelle Rodruguez
Joselito Matheus (PSPO)
Isabel M. Vilbar
Lynette Alcala RESPIRATORY DISORDERS
(PNSP)
Milagros Bautista(Chair)
NEUROLOGY Cesar Ong (Resource Person)
Ronald Limchiu
Aida Salonga Marieta Diaz
Lilian Lee Myrna San Pedro
Rhandy PeBenito Eden Latosa
Benilda Sanchez Jose Salazar
Teresita Rabanal Yolanda Johan
Rosalina De Sagun Manuel Valdez Jr.
Marissa Lukban Rodolfo. Ng
Madeleine Sosa (PAPP)
(CNSP)
NUTRITIONAL DISORDERS
Jossie Rogacion (Chair)

Fortunato Cristobal
Juliet Sio-Aguilar
Victor Doctor
(PSPGHN)
xiv
SELECTED TOPICS GENETICS
ADOLESCENCE Melanie Alcausin

Mary Anne Chiong
Rosa Maria Nancho Carmencita Padilla
Rosalia Buzon Eva Cutiongco-de la Paz
Emma Llanto (Section of Clinical Genetics)
Deborrah Red
(SAMPI, PSAMS) INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESSES
CHILD PROTECTION
Juliet Sio-Aguilar(Chair)
Bernadette Madrid Maria Emmalita Manalac(Resource Person)
Lester Deniega
COMMUNITY PEDIATRICS Agnes Dimaano
Lorna Simangan
Manuel Po Geraldine Anne S. Ramirez
Elizabeth Porras Agnes Mendoza
Leoncia Firmalo Marimel Pagcatipunan
Leticia Sarte Angeline Alabastro
(CPSP) Ma. Victoria Ribaya
Ma. Eva Jopson
EMERGENCY PEDIATRICS Rebecca Abiog-Castro
Jonathan Cu PEDIATRIC PHARMACOLOGY AND

THERAPEUTICS
ENVIRONMENTAL PEDIATRICS AND POISONING
Genesis Rivera (Chair)
Genesis Rivera Benjamin Co
Cleotilde How
ETHICAL ISSUES IN PEDIATRICS
PREVENTIVE PEDIATRICS
Esperanza F. Rivera
Ma. Eva Jopson
(PAPA)
xv
Participants in Various PPS-UPEC Workshops (Growth and Development, December 1, 2010; Nutrition and Nutritional Disorders, March
10, 2011; April 3, 2011)
APMC-AFFILIATED MEDICAL SCHOOLS
NATIONAL CAPITAL REGION
1. Ateneo de Manila University

School of Medicine & Public Health 7. Pamantasan ng Lungsod ng Manila
Don Eugenio Lopez Sr. Medical Complex Intramuros, Manila
Ortigas Avenue, Pasig City
8. San Beda College of Medicine
2. Emilio Aguinaldo College Mendiola, Manila
San Marcelino St., Ermita, Manila
9. St. Luke's College of Medicine William H. Quasha Memorial
3. Far Eastern University - Sta. Ignacia St., Quezon City
Dr. Nicanor Reyes Medical Foundation
Regalado St. Fairview, Q. C. 10. University of the East Ramon Magsaysay
Memorial Medical Center
4. University of Perpetual Help Rizal Jonelta Foundation Aurora Blvd., Quezon City
School of Medicine
Alabang-Zapote Road, Las Piñas City 11. University of Santo Tomas
Faculty of Medicine & Surgery
5. Manila Central University- Dean Maria Graciela G. Gonzaga, M.D.
Filemon D. Tanchoco Sr. Medical Foundation España, Manila
EDSA, Caloocan City
12. University of the Philippines Manila
6. Our Lady of Fatima University Pedro Gil, Manila
120 MacArthur Highway, Valenzuela City
xvi
NON-NCR REGIONS
CORDILLERA ADMINISTRATIVE REGION
13. Baguio Central University

18 Lower P. Burgos St., Baguio City REGION 4-A
20. De La Salle Health Sciences Institute
14. Saint Louis University Dasmariñas, Cavite
A. Bonifacio St., Baguio City
21. University of Perpetual Help - Dr. Jose G. Tamayo Medical
REGION 1 University
Sto. Niño, Biñan, Laguna
15. Lyceum-Northwestern University
Dr. Francisco Q. Duque Medical Foundation REGION 5
Tapuac District, Dagupan City, Pangasinan
22. Bicol Christian College of Medicine
16. University of Northern Philippines Rizal St., Legazpi City
Vigan, Ilocos Sur
REGION 6
17. Virgen Milagrosa University Foundation
San Carlos City, Pangasinan 23. Central Philippines University
Jaro, Iloilo City
REGION 2
24. Iloilo Doctors College of Medicine
18. Cagayan State University West Ave., Molo, Iloilo City
Tuguegarao City, Cagayan
25. University of Saint La Salle
REGION 3 La Salle Avenue, Bacolod City
19. Angeles University Foundation School of Medicine 26. West Visayas State University
MacArthur Highway, Angeles City, Pampanga La Paz, Iloilo City
xviii
REGION 7 27. Cebu Doctors University
Osmeña Blvd., Cebu City
28. Cebu Institute of Medicine 33. University of the Philippines School of Health Sciences
F. Ramos St., Cebu City Palo, Leyte
29. Silliman University Medical School REGION 9

SUMS Bldg., Aldecoa Road, Dumaguete City
34. Ateneo de Zamboanga University School of Medicine
30. Southwestern University La Purisima St., Zamboanga City
Matias H. Aznar Memorial College of Medicine, Inc.
Villa Aznar, Urgello St., Cebu City REGION 10
31. Gullas College of Medicine 35. Mindanao State University

University of the Visayas 1st Doña Juana Subdivision, Pala-o, Iligan City
Banilad, Mandaue City, Cebu
36. Xavier University-
REGION 8 Dr. Jose P. Rizal School of Medicine Ateneo de Cagayan
Corrales Ave., Cagayan De Oro City
32. Remedios Trinidad Romualdez Medical School Foundation
Calanipawan Road, Calanipawan, Tacloban City REGION 11
37. Davao Medical School of Medicine

Bajada, Davao City
FACILITATOR SUBSPECIALTY SOCIETIES AND SECTIONS
Philippine Society of Newborn Medicine (PSNbM)

Philippine Society for Developmental and Behavioral Pediatrics (PSDBP)
Philippine Society of Pediatric Metabolism and Endocrinology (PSPME)
Philippine Society of Pediatric Gastroenterology, Hepatology and Nutrition (PSPGHN)
Pediatric Nephrology Society of the Philippines (PNSP)
Society for Adolescent Medicine of the Philippines (SAMPI)
Section of Clinical Genetics
xix
TABLE OF CONTENTS
Title Page……………………………………………………………………………………………………………………………………………………………………….………………………………… i
Copyright Page………………………………………………………………………………………………………………………………….…………………………………………………………….. ii
Dedication Page………………………………………………………………………………………………………………….…………………………………………………………………………… iii
About the Editors………………………………………………………………………………………………………………………………….…………………………………………………………. iv
Notice from the Editors……………………………………………………………………………………………………….…………………………………………………………………………… v
Foreword by Dr. Carmelo A. Alfiler, Chair, PPS-UPEC Committee………………………….…………………………………………………………………………………………. vi
Message from Dr. Melinda M. Atienza PPS President 2012-2014………………………….……………………………………………………………………………………….… vii
Message from Dr. Fernando S. Sanchez, Jr., Executive Director, APMC Foundation……………………….………………………………………………………………… viii
Message from Hon. Edgardo T. Fernando, Chair, PRC Board of Medicine…………………………….………………………………………………………………………….. ix
Committee on Undergraduate Pediatric Education……………………………………………………….……………………………………………………………………………….… x
Council on Subspecialty Societies and Sections; Selected Subspecialty Groups and Individual Experts……………….………………………………………….… xi
Module Participants/Writing Committees/Task Forces/Invited Contributors…………………………….…………………………………………………………………….. xii
Participants in Various PPS-UPEC Workshops: APMC-affiliated Medical Schools and
Facilitator Subspecialty Societies and Sections…………………………………………….……………………………………………………………………………………………... xix
Introduction …………………………………………………………….……………………………………………………………………………………………………………………………………… 1
Glossary……………………………………………………………………………………………………………….………………………………………………………………………………………..… 2
INSTRUCTIONAL DESIGNS
Section I: CORE PEDIATRIC MODULES …………….…………………………………….……………………………………………………………………………………………………….. 3
Data Gathering, Recording and Presentation……………………………………………………………..…………….……………………………………………. 5

Pediatric Procedures……………………………………………………………………………….……………………………………………………………………………… 7
Growth and Development………………………………………………………………….………………………………………………………………………………….. 9
Nutrition and Nutritional Disorders………………………………………………………...................……………………………………………………………… 17
Section II: ORGAN SYSTEM DISORDERS……………………………………………………………………………………………………………………………………………………………. 28
Allergy……………………………………………………………………………………………………………………………………………………………………………………. 30
Bones and Joints…………………………………………………………………………………………………………………………………………………………………….. 34
Burns and Injuries………………………………………………………………………………………………………………….……………………………………………….. 38
Cardiovascular Disorders……………………………………………………………………………………………………….……………………………………………….. 43
Critical Care…………………………………………………………………………………………………………………………..……………………………………………….. 50
Dermatology………………………………………………………………………………………………………………………….……………………………………………….. 53
Developmental and Behavioral Disorders……………………………………………………………………………..………………………………………………… 57
Endocrinology and Metabolism……………………………………………………………………………………………..……………………………………………….. 60
Gastroenterology and Hepatology………………………………………………………………………………………………………………………………………….. 65
Hematology…………………………………………………………………………………………………………………………..………………………………………………… 68
Immunology………………………………………………………………………………………………………………………….………………………………………………… 72
Infectious Diseases……………………………………………………………………………………………………………….…………………………………………………. 76
Neonatology………………………………………………………………………………………………………………………….………………………………………………… 80
Nephrology……………………………………………………………………………………………………………………………………………………………………………… 89
Neurology……………………………………………………………………………………………………………………………..………………………………………………… 93
Oncology……………………………………………………………………………………………………………………………….………………………………………………… 99
Respiratory Disorders………………………………………………………………………………………………………………………………………………………………. 104
Section III: SELECTED TOPICS…………………………………………………………………………………………………………………………………………………………………………….. 110
Adolescent Risk-Taking Behaviors………………………………………………………………………………………..………………………………………………….. 112

Child Protection……………………………………………………………………………………………………………………………………………………………………….. 113
Community Pediatrics………………………………………………………………………………………………………….…………………………………………………… 115
Emergency Pediatrics…………………………………………………………………………………………………………..………………………………………………..... 119
Environmental Pediatrics and Poisoning…………………………………………………………………………………………………………………………………… 123
Ethical Issues in Pediatrics………………………………………………………………………………………………………………………………………………………… 126
Genetics……………………………………………………………………………………………………………………………….………………………………………………….. 128
Integrated Management of Childhood Illnesses……………………………………………………………………………………………………………………….. 132
Pharmacology and Therapeutics…………………………………………………………………………………………..………………………………………………….. 134
Preventive Pediatrics…………………………………………………………………………………………………………...………………………………………………….. 136
Board of Trustees, 2013-2014……………………………………………………………………………………………………………………………………………………………………………. 138

INTRODUCTION
Undergraduate Pediatric Education Curriculum
The word “curriculum” comes from the Latin word, curare, which means “race course.” Zais (1976) defined curriculum as the standardized ground covered by the students in their race toward the finish line. The
term “standardized” refers to the planning and decision making involved in curriculum design and implementation, the “ground” pertains to the content and teaching and learning activities, and the “finish line”
is the desired outcome (Sana, 2013)
Medical schools adopt the curricular track that best fit their respective mission, vision and goals. Whether these schools follow subject-centered or innovative curriculum, they are expected to produce
physicians that are knowledgeable, skilled, dutiful and altruistic (Medical School Objectives Writing Group, 1999).
In line with this, attention has turned to outcome-based education (OBE), an approach to education that focuses on learning outcomes that the students should display at the end of the instruction. These
outcomes are the “culminating demonstration of learning” (Spady, 1993).
OBE emphasizes exit learning outcomes and products more than the process, the results rather than the procedures. Such learning outcomes can be expressed in various ways. Smith and Dollase (1999)
identified nine abilities expected of medical graduates at the Brown University in Rhode Island. These are:
1. Effective communication
2. Basic clinical sciences
3. Using basic sciences in the practice of medicine
4. Diagnosis, management, and prevention
5. Lifelong learning
6. Self-awareness, self-care, and personal growth
7. The social and community contexts of healthcare
8. Moral reasoning and clinical ethics
9. Problem solving
These learning outcomes are reflected in the instructional designs presented in this e-manual. The components of an instructional design consists of learning objectives, content, suggested teaching and learning
activities and suggested evaluation methods (Sana, 2013). The assessment system in OBE is based on the demonstration of achievement of the learning outcomes by the individual student. Hence, there is
emphasis on workplace-based assessment (e.g., blinded patient encounter, clinical encounter cards, mini clinical evaluation exercise and multisource feedback).
References:
Medical School Objectives Writing Group. (1999). “Learning Objectives for Medical Student Education – Guidelines for Medical Schools: Report I of the Medical Schools Objectives Project.” Academic Medicine.
Vol. 74, pp. 13 – 18.
Sana EA, editor. (2013). Teaching and Learning in the Health Sciences. Quezon City: University of the Philippines Press (reprint).
Smith SR, Dollase R. (1999). Planning, implementing and evaluating a competency-based curriculum. Medical Teacher. 21(1):23–25.
Spady WG. (1993). Outcome-Based Education. ACSA report no 5. Belconnen: pii Australian Curriculum Studies Association.
Zais R. (1976). Curriculum, Principles, and Foundations. New York: Harper and Row Publishers.
1
GLOSSARY
Bedside Clinical teaching method that occurs with the actual patient as the focus
teaching
Blinded Assessment of a student based on direct observation of an encounter with a patient unknown to the student, to assess data
patient gathering, hypothesis generation, problem solving abilities
encounter
CbD Case-based discussion; a method of clinical evaluation wherein two case records of recently seen patients selected and discussed
to assess the student’s clinical assessment, investigation, treatment choice and medical record keeping abilities
CEC Clinical encounter cards; a method of assessment of students based on the clinical teacher’s direct observation of eight patient encounters,
with comments written on a 4” X 6” score cards
DOPS Directly Observation of Procedural Skills; a series of 15-25-minute, structured evaluation of students’ procedural skills using a
9-point rating scale
Mini-CEX Mini Clinical Evaluation Exercise, a series of 15-25-minute structured evaluation of students clinical competence using a 9-point rating scale,
to assess medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counselling skills,
organization/efficiency and overall clinical competence
MSF Multisource Feedback or 360 degree evaluation; a way of measuring and recording essential attributes, namely professionalism, patient management,
self-management, diligence, communication skill, and teamwork skills, of a student using a 9-point rating scale assessed by
peers, co-health workers, patients, and self
OSCE Objective Structured Clinical Examination; an organizational framework for evaluating students, consisting of various stations testing
different aspects of clinical competence, including history taking, focused physical examination, technical skills, interpretative skills, and patient
education
PBL Problem-based learning; a small group learning method where students work in groups on a given a problem from which they will identify
what they already know, what they need to know, and access new information to help them understand and solve the problem
SGD Small group discussion
2
Instructional Designs
Section I: CORE PEDIATRIC MODULES
DATA GATHERING, RECORDING AND PRESENTATION
OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

LEARNING ACTIVITIES METHODS
1. Elicit an age- Pediatric history: Lecture-discussion OSCE
appropriate, General data, Chief complaint, History of Film showing Written exam
organized, and present illness, Review of systems, Demonstration- Oral exam
complete history Maternal and birth history, Developmental return demonstration Mini-CEX
history, Nutritional history, Immunization Actual and simulated Blinded patient encounter
history, Family history and pedigree, patient
Psychosocial history, Past medical history, Actual patient care
Menstrual history, Environmental history,
[For adolescents: HEADSSS (Home,
Education, Activities, Drugs, Sexuality,
Spirituality, Safety)]
2. Perform an age- Physical examination (PE): Vital signs, Lecture-discussion OSCE
appropriate, Anthropometrics, Body mass index (BMI), Film showing Mini-CEX
thorough and WHO standardized charts for weight and Demonstration- Blinded patient encounter
proper physical length, Head, Eye, Ear, Nose and Throat return demonstration
examination (HEENT), Chest and lungs, Heart, Abdomen, Actual and simulated
Extremities, Genitourinary tract (GUT), patient
Integument, Neurological examination, Actual patient care
Tanner staging for adolescents
Proper technique in the use of basic
instruments – BP apparatus, otoscope,
stethoscope, ophthalmoscope, weighing
and height scale, tape measure for
anthropometrics, thermometer
3. Construct a Complete standardized data forms Lecture-discussion Written case history
complete and Written communication skills Recording of documents CbD
organized written Motor and technical skills *To include composition skills
history and physical Integrity, honesty, professionalism,
5
examination. confidentiality, neatness, systematic
synthesis
4. Effectively Interview techniques Lecture OSCE
communicate with Communication skills Film showing Mini-CEX
the family and Interpersonal skills Demonstration- CEC
patient during return demonstration
history taking and Actual and simulated
physical patient
examination Actual patient care
5. Present complete Verbal communication skills Role modelling Case presentation
and pertinent data Interpersonal skills Demonstration- Rating scale
clearly Knowledge of pertinent data return demonstration
Oral presentation
Bedside teaching
Case presentation
6. Demonstrate the Compassion, empathy, rapport, sensitivity, Role modelling MSF
desired attitudes responsibility, professionalism, friendliness, Actual and simulated Patient feedback
during history taking respect for privacy, patience, gentleness, patient Attitude Rating Scale
and physical non-judgmental attitude Actual patient care (Global Clinical Performance
examination. Ratings)
6
PEDIATRIC PROCEDURES

1. Discuss the steps, A. MUST KNOW PROCEDURES: Lecture/handouts Written exam
indications, and 1. Essential Intrapartum and Newborn Care SGD
contraindications of (EINC)
basic pediatric 2. Complete blood count
procedures 3. NGT/OGT insertion
4. Suctioning
5. Gastric lavage
6. Collection of blood specimen
7. IV access (peripheral, intraosseous,
umbilical)
8. Lumbar puncture
9. Injections (ID, SQ, IM)
10. Basic life support
(ABCs, chest compression, endotracheal
tube intubation )
11. Urine collection (bag collection, clean
catch midstream collection, urethral
catheterization)
12. Tourniquet Test
B. Anatomy involved
C. Indications and contraindications for each
pediatric procedure
D. Different steps involved in the
performance of each pediatric procedure
E. Complications/hazards associated with
each procedure
F. Post -procedural care
7
2. Properly prepare Appropriate preparation for the procedure: Demonstration- DOPS
oneself, patient and return demonstration
patient’s 1. Explain the specific procedure to the Video
parent/guardian for parent/guardian/child Simulation
the procedure 2. Obtain a signed informed consent Preceptorials
3. Prepare the child psychologically for the Bedside teaching
procedure
4. Materials /equipment necessary for the
procedure
5. Medication for analgesia
6. Proper positioning and restraint for the
specific procedure
3. Perform the Specific steps for each procedure Simulation DOPS
essential pediatric Proper technique in performing procedures Actual patient encounters OSCE
procedures under
direct supervision
4. Demonstrate the Attitudes of non-maleficence, privacy,
desired beneficence, confidentiality, respect,
attitudes/values in compassion and empathy
the conduct of the Religious & cultural sensitivity
procedure
5. Display the proper Communication skills:
communication Probing
skills before, during Reflective questioning
and after the Facilitating
conduct of the Summarizing
procedure
8
GROWTH

1. Define growth Definition of growth Lecture-discussion Written exam
SGD Oral exam
SGD output
2. Recognize the Organogenesis – resulting malformations / Lecture Written exam
importance and abnormalities Video presentation Oral exam
significance of Organ-specific growth patterns Small group discussion
growth a. Lymphoid
b. Neural
c. Somatic
d. Genital
3. Interpret growth Measurements of the following: Lecture OSCE
measurements a. Weight Demonstration Written exam
b. Length / height Exercises/ drills Oral exam
c. Head circumference Bedside teaching
d. Chest circumference Patient encounters
e. Weight for length / height
f. Mid-parental height
Plotting of measurements and
interpretation of significance over time
4. Utilize other Other parameters: Lecture Written exam
parameters and a. Mid-arm circumference Demonstration-return Oral exam
predictors of growth b. Skin fold thickness demonstration OSCE
c. Body proportion Exercises / drills Return demonstration
i. US/LS ratio- for short stature Interpretation
ii. Waist/hip ratio- for obesity Bedside teaching
d. BMI Patient encounters
e. Mid parental target height
Interpretation of results
9
5. Interpret changing Procedure in obtaining the following: Lecture Written exam
values in measures of a. Blood pressure SGD Oral exam
function of different b. Cardiac rate Drills / exercises on OSCE
organ systems c. Respiratory rate interpretation of values
d. Dentition Demonstration and return
e. Growth rates demonstration
f. Hematologic (CBC, platelet ) Video
g. Immunologic (IgG, A, M, D, E)
h. Neurologic (CSF )
Reference values for age and sex

Computation of annualized growth velocity
10
DEVELOPMENT
OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED

LEARNING ACTIVITIES EVALUATION
METHODS
1. Define development A complex process of growing and acquiring Lecture Written exam
skills occurring in an orderly, predictable Case discussion Oral exam
pattern as a result of maturation and SGD OSCE
experience
Reflects the increase in skill and complexity
of function performed by an individual
2. Recognize the Statistics on developmental disorders Lecture Written exam
importance and Gov’t programs / budget supporting child
significance of development
development Laws supporting development
a. ECCD- RA 8980
b. DOH AO 2010-0015= Adopting WHO
growth charts
c. RA 6972- Barangay Level total
development and protection in children
3. Explain the principles Basic principles: Lecture Written exam
that govern - Continuous process SGD Oral exam
development - Intimately related to the CNS
- Follows a definite sequence but variable
rate
- Follows a cephalo-caudal pattern
- Proceeds from gross undifferentiated skills
to precise and refined individual responses
4. Identify the factors Modifying factors: Lecture Written exam
affecting - Biological endowment Group research : Oral exam
development - Environmental Influences presentation of accumulated Graded
a. Human relations scientific evidence presentation
b. Nutrition Case discussions /report
11
METHODS
c. Available learning experiences SGD
d. Socio-economic resources History writing/data collection
5. Explain behavioral Behavioral Theories and Models: Lecture Written exam
theories and models - Cognitive Theory ( Piaget ) SGD Oral exam
governing - Psychosexual Theory ( Freud )
development - Psychosocial Theory ( Erickson )
- Neurodevelopmental Theory ( Gesell )
- Moral Development ( Kohlberg )
6. Enumerate periods of Prenatal period: Lecture Written exam
development Ovular 0 – 14th day Videos of childhood Oral exam
Embryo 14th day – end of 8th wk characteristics in the
Fetal 9th wk – birth different stages
Postnatal period:
(Please see Infancy Birth – 1 yrs
Module on Toddler 1 – 3 yrs
Adolescent Childhood
Growth and Early 3 – 5 yrs
Development) Middle 6 – 8 yrs
Late 9 – 10 yrs
Adolescence
Early 10 – 13 yrs
Middle 14 – 16 yrs
Late 17 – 19 yrs
7. Describe the domains Discuss the different domains and milestones: Lecture Written exam
and milestones in the a. Motor (gross, fine) Video presentation of skills Oral exam
different age groups b. Language (receptive, expressive) Actual patient OSCE
c. Personal/social demonstration/observation
d. Cognitive SGD
According to age groups: Developmental history-
a. Newborn taking
12
METHODS
b. Infancy Drills / exercises on
c. Toddler interpretation of
e. Pre-school milestones
f. School age
8. Differentiate Differentiation between surveillance methods Lecture Written exam
methods of - Screening SGD OSCE
Developmental - Monitoring Demonstration
Surveillance - Assessment Video presentation
Indications for recent and commonly-used Ward work
tools for screening / monitoring development
- PEDS
- Denver II
- Gesell Scales
- Cattell – Clinical Linguistic and Auditory
Milestones
WHO Assessment CD
9. Recognize the Limit ages Lecture Written exam
indicators of Patterns of development SGD Graded case
developmental delay - Normal Case studies presentation
- Dissociated
- Deviant
- Delayed
10. Discuss the more Discuss the following disorders according to Lecture Written exam
common hallmarks, prominent symptoms/signs, Video presentation Oral exam
developmental patterns of development Case discussions/ Graded case
disorders A. Mental retardation (Down Syndrome) presentations presentation
(See Module on B. Cerebral palsy SGD
Developmental and C. Autism
Behavioral Disorders) D. AD/HD
E. Hearing Impairment
13
ADOLESCENT GROWTH AND DEVELOPMENT

1. Define “adolescence” Definitions of “adolescent”, “ young people”, Lecture Written exam
and related terms “youth“, “puberty”
Stages of adolescence: early, middle and late
2. Describe the normal Male and female pubertal changes (sequence of Interactive lecture with Written exam
physical and pubertal events) cases illustrating normal Group participation
changes - Difference between male and female variations
physical growth SGD
- Normal variations of pubertal growth Individual exercises
- Tanner staging Students decide if the
Physical manifestations in different phases of following are within
puberty, indicating differences between girls physiological limits :
and boys examples
1. Early phase: obvious breast budding and - A girl with pubic hair
acceleration of growth (girls) versus development began at 7.5
imperceptible increase in testicular yrs
volume (boys). - A girl with breast
2. Middle phase: menarche at a precise age development started at 8.5
(girls) versus mature spermatogenesis at yrs
a non-precise age and growth - A girl with menarche at 9.5
acceleration (boys). yrs
3. Late phase: body fat increase and change - A girl with primary
in distribution (girls) versus voice amenorrhea at 15.5 yrs
deepening, facial hair and increased - A boy with prepubertal
muscle mass (boys). penis at 14 yrs
Hormonal data of an adolescent
14
3. Identify the factors Factors that affect growth and development SGD with assigned cases Written exam
that affect growth • Genetics (e.g. delayed, precocious Report
and development • Hormones puberty; short stature, Group participation
• Environment overgrowth syndrome,
• Nutrition malnutrition)
• Illnesses Group report
Plenary
4. Identify the Developmental goals of adolescence Interactive lecture Written exam
psychosocial changes Cognitive, behavioral and social changes Exercises Report
in different phases: Cases
early, middle and late
adolescence
5. Obtain relevant Interviewing skills (listening skills, observing Lecture OSCE
information on for non-verbal cues etc) Demonstration Clinical histories
growth and Components of an adolescent-friendly Video Observation checklist
development during interview (privacy and confidentiality, Preceptorials Written exam
history-taking attitudes) Role playing
HEADSSS format (Home, Education, Activity, Highlight do’s and don’ts,
Drugs, Sexuality, Spirituality, Safety) points that can be
improved
Clinical rotation, bedside
teaching, actual patient
contact
6. Perform a thorough Weight, height, BMI, WHO Z-scores Lecture OSCE
physical examination PE highlights: Demo/ video Graded preceptorial
Tanner staging Plotting on WHO charts Written exam
Scoliosis screening Clinic preceptorship
Breast examination Clinical rotation, bedside
Respect for privacy; recognition of need teaching, actual patient
for chaperone contact
15
7. Interpret growth WHO charts: height, weight, BMI Student activity Written exam
measurements in Mid-parental height Actually plotting with OSCE
adolescence Tanner stage appropriate graphs
8. Promote healthy Health maintenance and anticipatory Group work: create content Group project
development of the guidelines of a program for health
adolescent Physical assessment, psychosocial promotion
assessment, laboratory, immunization, Lecture
health guidance Checklist for wellness
Adolescent interview – principles Preceptorials
Confidentiality/privacy Clinical rotation, bedside
teaching
9. Identify what Adolescent-friendly clinic/visit Use of metacards: Ask Written exam
constitutes an students to list as many Participation in group
adolescent- friendly characteristics they think activity and
clinic or visit an adolescent-friendly discussion
clinic health provider
should have
10. Identify legal and Laws governing confidentiality and consent Case reporting Written exam
ethical issues on Reporting of abuse Brainstorming Graded presentation
adolescent health Panel discussion, debate
care Plenary
11. Discuss the principles PPS preventive health guidelines to address: Advance organizer: PPS Written exam
and content of health - How often should an adolescent come for guidelines Group presentation
promotion and checkup? Lecture
maintenance for - What should a wellness check-up consist of? SGD: Give case scenario: Ask
adolescents - What health messages should we impart the students to make an
during each clinic visit? ideal schedule of
- What immunizations should an adolescent immunization update for
be given? (Use PPS-PIDSP updated an adolescent who comes
recommendations) for a wellness check-up
- Catch-up immunizations
16
NUTRITION AND NUTRITIONAL DISORDERS
NUTRITION

A. Discuss nutrition
and its role in the
growth and
development of
infants and children
1. Define nutrition and 1. Definition of nutrition and other related Lecture Written exam
related terms terms
2. Energy requirement and expenditure
and the factors that affect it
2. Discuss the digestion, Digestion, absorption, transport and Lecture Written exam
absorption, storage, function and dietary sources of: Game Evaluation of the presentation
transport, storage, 1. Carbohydrates Video presentation using a rating scale
functions and dietary 2. Lipids Role playing of the process
sources of essential 3. Proteins
nutrients. 4. Vitamins
5. Electrolytes: sodium, potassium,
calcium, phosphorus, magnesium,
chloride
6. Minerals: iron, copper, zinc,
chromium, selenium, manganese,
fluoride, iodine, molybdenum
7. Water
3. Discuss the function 1. Body composition and growth Lecture Written exam
of nutrition in child 2. Effects of nutrition on growth and SGD (tutorial or problem- SGD outputs
growth and development based learning) Participation in SGD
development 3. Relationship of nutrition, immunity and rating scale
infection
17
B. Discuss proper
nutrition for various
pediatric age groups
1. Discuss the 1. Recommended Energy and Nutrient Lecture Written exam
nutritional needs, Intakes (2001) Exercises, Seatwork
guidelines and eating 2. Nutritional guidelines (AAP, FNRI) e.g., Board work
patterns at various 3. Food Guide Pyramid (PSPGHAN) (computations of calories
pediatric age groups 4. Dietary Prescription (NCP) needed as well as % of
5. Eating patterns at various age groups carbohydrate, protein
• Infancy ( 0 – 23 months) and fat)
• Toddlers ( 2-3 years) Handouts (self-directed
• Preschool ( 4-5 years) learning)
• School age ( 6-10 years ) Games
• Adolescence (10 – 19 years)
2. Discuss the art and 1. Definition and four features of Lecture Written exam
science of complementary food SGD (tutorial) SGD output
introducing 2. Epidemiology of complementary food Role playing OSCE
complementary introduction Bedside teaching
foods 3. Guiding principles in the introduction of Actual patient contact
complementary foods among breastfed Q&A games
and non-breastfed infants (WHO and
PAHO)
4. Methods of introducing age- and
developmentally-appropriate food
3. Discuss the Appropriate physical activity at various Lecture Written exam

importance of pediatric age groups SGD (tutorial) SGD output
physical activity in
achieving a state of
well- being in
children
18
C. Discuss
breastfeeding in
terms of benefits,
techniques,
problems, legal
issues and
contraindications
1. Describe the 1. External structure of the breast Lecture Written exam
anatomy of the • Nipple Flipcharts with students OSCE
female breast • Areola reporting
• Montgomery’s tubercle Video clip
2. Internal structures of the breast SGD (tutorial, PBL)
• Lactiferous ducts
• Lactiferous sinuses
• Milk ducts
• Alveolus
2. Discuss the phases of 1. Endocrine control of lactation through 3 Lecture Written exam
lactation phases
• Mammogenesis or mammary
growth
• Lactogenesis or initiation of milk
secretion
• Lactogenesis or maintenance of milk
production
2. Autocrine control of lactation –
influence of local factors acting on the
breast
• Milk prolactin reflex – prolactin
hormone
3. Hormones in charge of supporting
continuous milk production
19
4. Variations of breast milk composition
• Colostrum vs transitional vs mature
breast milk
• Term vs preterm breast milk
• Foremilk vs hindmilk
• Fresh vs stored vs pasteurized
expressed breast milk
5. Biochemical composition of breast milk
6. Anti-infective properties of breast milk
• Immunoglobulin ( IgA, IgG, IgM)
• Bifidus factor
• Lactoferrin
• Macrophages and other cellular
components
• B-12 binding protein
• Antiviral factor
3. Discuss the benefits 1. Benefits to infant: SGD (PBL) Written exam
of breast milk and • Cognitive development Role-playing SGD output
breastfeeding • Anti-infective properties Rating scale
• Safety
• Enhanced immune response to
immunization
• Other benefits to the preterm infant
• Prevention of adult-onset diseases
2. Benefits to the mother
• Prevention of obesity
• Protection against cancers like
ovarian and breast
• Economical considerations
• Psychological benefits
20
3. Benefits to the maternal-infant dyad
• Skin-to-skin contact
• Maternal infant bonding
4. Discuss the harm of 1. Intrinsic contamination of powdered Lecture Written exam
using artificial milk milk substitutes : bacillus cereus , SGD (tutorial or PBL) SGD output
substitutes Enterobacter sakazakii Role-playing
2. Dangers of bottle feeding
3. Evidence for increased morbidity and
mortality among formula-fed infants
5. Discuss breastfeeding 1. Initiation of breastfeeding SGD (tutorial or PBL) Written exam
initiation, techniques, • Importance of early initiation of Bedside teaching SGD output
problems and breastfeeding Actual patient contact Direct observation during
solutions to these • Proper attachment of infant to Role-playing clinical / community
problems mother’s breast rotation
• Monitoring of adequacy of intake
• Different positions of breastfeeding
o cradle hold
o reverse cradle hold
o clutch hold
o side lying position
2. Common problems in breastfeeding
• Breast engorgement
• Sore nipples
• Mastitis
• Breast abscess
• Inverted/flat areola
21
6. Explain the proper 1. Different methods of breast milk Video presentation Written exam
collection and collection Demonstration – Return Checklist
storage of expressed • Manual expression demonstration Direct observation during
breast milk • Mechanical expression Case analysis of breast clinical / community
• Electric pumps problems rotation
2. Storage techniques of breast milk Bedside teaching
• Room temperature Actual patient contact
• Refrigerator
• Freezer
3. Thawing of stored breast milk
7. Identify the increased Dietary prescription for lactating mothers Lecture Written exam
need for macro- and Exercises (make dietary Seatwork
micronutrients of a prescription)
lactating mother
8. Recognize the need 1. Mother-Baby Friendly Hospital Initiative SGD Written exam
for active 2. Maternal and Newborn, Child Health EINC video Reporting
breastfeeding and Nutrition Policy of the DOH Preceptorials Direct observation during
promotion in the 3. Essential Intrapartum and Newborn Bedside teaching clinical / community
community/public Care Actual patient contact rotation
health administration 4. Breastfeeding and Rooming Act
5. EO 51 (Milk Code)
6. Ten Steps to Successful Breastfeeding
Policy
9. Discuss the Contraindications to breastfeeding / breast SGD Written exam
contraindications to milk Lecture SGD output
breastfeeding and 1. Maternal contraindications Role-playing Checklist
breast milk • Drug intake
• Medical conditions
2. Neonatal contraindication
a) Galactosemia
22
10. Discuss the 1. Acceptable medical indications for Advance organizers Written exam
acceptable medical breast milk supplementation and (handouts)
indications for the substitution (PPS Standards of Newborn Lecture
use of breast milk Care, 3rd ed. pp. 62-63) Brainstorming
substitutes for 2. Breast milk substitutes
infants. a) Standard infant formulas
b) Follow-on formulas
c) Whole cow’s milk formulas
d) Special formulas
• Soy-based formulas
• Protein hydrolysates
• Partially hydrolysed
• Extensively hydrolysed
23
NUTRITIONAL DISORDERS

A. Discuss the
nutritional disorders
of infants and
children
1. Identify the common 1. Undernutrition: protein-energy Lecture discussion Written exam
nutrition problems in malnutrition( Marasmus / Kwashiorkor) with video presentation SGD output
the Philippines 2. Overnutrition : Obesity SGD (tutorial or PBL) Direct observation during the
3. Other nutritional problems: Bedside teaching clinical rotation
e) Oral health problems Actual patient contact
f) Problems with vegetarian diet and
unusual diets
g) Feeding disorders: anorexia nervosa
and bulimia
2. Describe the Local epidemiology and magnitude of the Lecture Written exam
epidemiology of problem
malnutrition in the
Philippines
3. Discuss the Pathophysiology of malnutrition Lecture Written exam
pathophysiology of SGD (tutorial or PBL) SGD output
malnutrition
4. Describe the usual Clinical manifestation of the following: Lecture Written exam
clinical 1. Marasmus Audiovisual presentation SGD output
manifestations of 2. Kwashiorkor SGD (tutorial or PBL) Direct observation during the
malnutrition 3. Obesity Actual patient contact clinical rotation
4. Vitamin deficiencies/ excesses
5. Mineral deficiencies
24
B. Competently
assess the nutritional
status of given
patients
1. Given patients, 1. Parts of a comprehensive nutritional Lecture Written exam
obtain a complete history Video presentation Direct observation during clinical
medical history with 2. Rapport with patient and parents Demonstration- return / community rotation
emphasis on 3. Factors in the history predisposing and demonstration OSCE or practical exam
comprehensive contributing to present condition Role playing with video
nutritional history 4. Prognosis of patient Preceptorials
Bedside teaching
Actual patient contact
2. Perform a complete 1. Anthropometric measurements: weight, Lecture Written exam
physical examination height, head circumference, mid- upper Video presentation Direct observation during clinical
to include: arm circumference (MUAC), mid-arm Demonstration-return / community rotation
a. Anthropometric muscle circumference (MAMC), skinfolds demonstration OSCE or practical exam
measurements 2. Skin: dermatoses Preceptorials
b. Recognition of 3. Head: hair distribution Bedside teaching
signs of 4. Eye: xerophthalmia, conjunctival pallor Actual patient contact
malnutrition 5. Mouth: cheilosis, angular stomatitis,
referable to dental caries
macro- and 6. Abdomen: hepatomegaly, ascites
micronutrient 7. Extremities: edema
deficiency or
excess
3. Discuss appropriate 1. Diagnostic work ups for specific Lecture discussion Written exam
laboratory work-ups disorders SGD (tutorial or PBL) SGD output
for specific disorders 2. Interpretation of results Bedside teaching Direct observation during clinical
Direct patient contact rotation
Exercises OSCE or practical exam
25
C. Discuss the
appropriate plan of
management of
patients with
nutritional disorders
as well as the
nutritional
management of
patients with other
diseases
1. Outline the plan of 1. Treatment of the following nutritional SGD (PBL) Written exam
treatment of disorders: Preceptorials SGD output
common nutritional • Marasmus Bedside teaching Direct observation during clinical
disorders that • Kwashiorkor Actual patient contact rotation
include: • Obesity Lecture
a. Comprehensive • Vitamin A Deficiency- dose, route of
nutritional administration
assessment to • Iron Deficiency Anemia: dose, route
guide treatment of administration
b. Dietary • Iodine deficiency
prescription as 2. Need for antimicrobials
required by the 3. Micronutrient supplementation for
condition severe protein-calorie malnutrition
c. Recommendation 4. Fluid management of severely
for regular dehydrated malnourished children
monitoring of 5. Role of diet, exercise, and drugs in the
patients management of obesity
d. Specific treatment
26
2. Discuss nutritional Nutritional management of children with: Lecture discussion Written exam
management in 1. Renal disease SGD (tutorial or PBL) SGD output
children with specific • Hypertension Preceptorials Direct observation during clinical
diseases • Nephrotic syndrome Bedside teaching rotation
• Glomerulonephritis Direct patient contact OSCE
• Acute/chronic renal failure
• Children on dialysis
2. Hyperlipidemia and obesity
3. Cardiac diseases: CHF
4. Diabetes mellitus
5. Allergic disorders
6. Post-operative states
7. Burns
8. Other conditions
3. Provide health 1. Maintenance of nutritional status after SGD SGD output
education and proper nutritional rehabilitation Role-playing Participation in role play
disease concept to 2. Role of the family & community in the Preceptorials Direct observation during clinical
patients and families maintenance of nutritional status Bedside teaching rotation
3. Proper nutrition starting in infancy Direct patient contact OSCE or practical exam
4. Integration with other health programs Community rotation Research proposal output
5. Immunization, breastfeeding, control
of communicable diseases
27
Section II: ORGAN SYSTEM DISORDERS
ALLERGY

1. Discuss the principles Immune dysregulation Lecture-discussion Written exam
of allergic disorders (TH1, TH2, TH3 cells) SGD SGD or PBL output
Concept of allergen sensitization PBL
Types of hypersensitivity states
(Gell & Coombs Classification)
Type I (IgE-mediated reaction)
Type II (Antibody-dependent cell
cytotoxicity)
Type III (Complement-mediated)
Type IV (Delayed)
2. Discuss the common Common allergic triggers: Lecture-discussion Written exam
allergic triggers Housedust mites SGD SGD or PBL output
Pollens PBL
Moulds
Food
Animal dander
3. Discuss the allergic Mechanisms of the allergic march Lecture-discussion Written exam
march and the co- Co-morbid conditions: SGD SGD or PBL output
morbid allergic Bronchial asthma PBL
disorders Otitis media
Sinusitis
4. Recognize allergic Clinical presentation of allergic disorders: Lecture-discussion Written exam
disorders or adverse a. Pruritus SGD OSCE
drug/food reactions b. Skin rashes/eruptions PBL Direct observation
based on clinical c. Sneezing &/or runny nose Bedside teaching
presentation d. Wheeze
e. Recurrent/chronic cough
f. Persistent/recurrent diarrhea/vomiting
g. Hematochezia
30
Adverse drug reaction
Adverse food reaction
Allergic rhinitis/sinusitis
Atopic dermatitis
Bronchial asthma
Urticaria
5. Determine probable Role of history and physical examination Lecture Written exam
cause through Principle, rationale, and indications of each PBL OSCE
appropriate diagnostic ancillary test Discussion Direct observation
work-up CBC Independent study
Chest x-ray PA and lateral views Case discussion
Smear for eosinophilia in the nasal, Bedside discussion
bronchial and gastrointestinal
secretions
Peak expiratory flow rate
Blood gas analysis
Total serum IgE
In-vitro specific IgE test
Goldman’s criteria for the diagnosis of
food allergy (eg double-blind placebo-
controlled food challenge test
(DBPCFC)
Paranasal sinus Xray and/or CT scan
Indications and principles of allergy skin test
6. Outline the plan of Treatment for: Lecture Written exam
treatment for the PBL OSCE
common allergic a. Allergic contact dermatitis Discussion Direct observation
disorders b. Allergic rhinitis Independent study
c. Anaphylaxis Case discussion
d. Atopic dermatitis Bedside discussion
e. Bronchial asthma including cough
31
variant asthma
f. Drug allergy
g. Food allergy including cow’s milk
allergy
h. Urticaria
7. Explain the role of Epigenetics of allergic diseases Lecture Written exam
prevention in allergic (gene-environment interaction) PBL OSCE
diseases Risk factors for allergic diseases Discussion Direct observation
Identifying high risk atopic individuals Independent study
Principles of allergy prevention Case discussion
(primary, secondary and tertiary Bedside discussion
prevention)
8. Explain the basic Risk factors and triggers Lecture Written exam
principle of treatment Role of environment in disease exacerbation PBL OSCE
: How to avoid triggers through specific and Discussion Direct observation
a. Avoidance non-specific measures Independent study
Principle and rationale of the different Case discussion
b. Pharmacologic therapeutic modalities Bedside discussion
therapy Pharmacodynamics and pharmacokinetics of
the different first line pharmacologic agent
c. Aeroallergen Pharmacotherapeutics (method of
immunotherapy administration of these pharmacologic
agents
Adverse effects of the different
pharmacologic agents
Mechanism of immunotherapy
Indications for immunotherapy
Manner of administration, onset of action,
duration of treatment
Possible adverse effects,
prevention/treatment of complications
32
9. Identify the onset or Secondary infections: viral, bacterial, fungal Lecture Written exam
presence of Pneumothorax PBL OSCE
complications, their Cardiorespiratory failure Discussion Direct observation
treatment, prevention Anatomic, physiologic and pathophysiologic Independent study
and need for further basis of the above complications Case discussion
treatment and referral Bedside discussion
10. Clinically diagnose Anaphylaxis Lecture Written exam
common allergic Bronchial Asthma in severe PBL OSCE
emergencies exacerbation Discussion Direct observation
a. Anaphylaxis Causes, pathophysiology, clinical Independent study
b. Bronchial asthma presentation, management, indications for Case discussion
in severe admission and referral Bedside discussion
exacerbation
11. Provide proper health Basic concept in the development Lecture Written exam
education of allergic disease including role PBL OSCE
a. Pathophysiology of genetics and environment Discussion Direct observation
b. Treatment Role of clinical/immunologic Independent study
modalities methods in detecting Case discussion
(include compliance sensitization Bedside discussion
to treatment) Early warning signs to prevent
c. Prevention allergic diathesis and how to
(primary, prevent progression and
secondary, tertiary complications
prevention) Control measures to attain a Normal life
d. Control measures
e. Role of
immunotherapy
33
BONES AND JOINTS

1. Identify the role and Recognize situations where children benefit SGD Written exam
general scope of from skills of specialists trained in caring PBL
practice of for the pediatric age group Bedside teaching
rheumatology
2. Distinguish normal or Benign (growing pains) vs. pathologic limb Lecture-discussion Written exam
transient disorders pain SGD SGD output
from pathological Mechanical vs. inflammatory joint pain PBL CEC
rheumatologic Typical presentation of HSP, Kawasaki Preceptorials
conditions disease, post-infectious arthritis, chronic
rheumatologic condition
Signs and symptoms suggestive of
rheumatologic diseases:
• Arthralgia vs arthritis
• Common pediatric skin rashes vs.
suspicious inflammatory rashes
(vasculitis, malar rash, heliotrope
rash)
• Fever patterns suggestive of JIA,
rheumatic fever, other systemic
inflammatory processes
• Fatigue, tender points vs. chronic
painful, inflammatory condition
• Weight loss
• Back pain
3. Elicit a thorough History taking SGD Mini-CEX
history including red Red flags in general pediatrics requiring PBL Practical exam
flags requiring further further work up Demonstration-return OSCE
work up Interviewing skill demonstration Clinical performance rating
Preceptorials
34
Bedside teaching
4. Competently perform Technique of PE and musculoskeletal Instructional video Mini-CEX
a musculoskeletal examination (pediatric gait, arms, legs, Demonstration-return Practical exam
exam on patients spine or pGALS) demonstration OSCE
seen in rheumatology Respect for patient safety, comfort and Preceptorials Clinical performance rating
clinic or in inpatient privacy Bedside teaching
consultation
5. Interpret the Indications, limitations and interpretations Lecture-discussion Written exam
following tests of appropriate diagnostic examinations: SGD CbD
commonly employed Blood examinations: PBL CEC
in rheumatologic • CBC Bedside teaching: OSCE
disease • ESR Review of laboratory
• Complement findings in consult
• Urinalysis patients
• Rheumatoid factor Actual patient encounter
• ANA with laboratory
• Anti-DNA interpretation of
Synovial fluid analysis examination results
Imaging studies Self-directed learning
• Joint x-ray
• Joint MRI
• CT scan
• Ultrasound
• Bone scan (nuclear medicine study)
6. Provide prevention The role of physical therapy, occupational Role play MSF
counseling to parents therapy, and routine eye exams in various Preceptorials Clinical performance rating
and patients with types of juvenile arthritis Bedside teaching
rheumatologic Use of antibiotic prophylaxis in lupus Actual patient encounter
conditions patients undergoing dental cleaning or
other invasive procedures
The role of healthy eating behaviors, diet,
35
and calcium/vitamin D supplementation
in children on chronic glucocorticosteroid
treatment
The role of sun protection in children with
autoimmune diseases
The importance of monitoring growth
parameters in children with chronic
rheumatic diseases
The importance of anticipatory guidance
regarding risky behaviors and medical
noncompliance in adolescents with
chronic rheumatic diseases
Use of proper sports safety equipment to
prevent bone and joint injuries that may
lead to future disability
Use of antibiotics in streptococcal diseases
or with prior rheumatic fever to reduce
the risk of new or recurrent rheumatic
fever
7. Outline the
appropriate
management of
patients with
rheumatologic
disease
a. Discuss the Principles of treatment Lecture-discussion Written exam
appropriate Drugs used for patients SGD SGD output
treatment for given PBL CbD
patients Bedside teaching CEC
Clinical performance rating
36
b. Discuss the Determine safety of live virus vaccination in SGD Written exam
considerations a given patient PBL SGD output
involved in Determine need for influenza vaccination Bedside teaching CbD
administering CEC
various vaccinations Clinical performance rating
c. Discuss special Fever/ infectious disease management SGD Written exam
considerations in Routine monitoring of PPD status PBL SGD output
immunosuppressed Post-exposure prophylaxis Bedside teaching CbD
patients Actual patient encounter CEC
d. Identify problems at Screen for depression, anxiety or SGD Written exam
school for which adjustment disorders PBL SGD output
patients with Disrupted school attendance and Actual patient counter MSF
chronic disease are performance
at higher risk and Encourage physical education class and
well as ways to sports participation
modify the risk
37
BURNS AND INJURIES
BURNS

1. Explain the Epidemiology of burn injuries Self-instructional materials, Written exam
epidemiology of burn manuals and handouts SGD output
injuries Lecture-discussion
SGD
PBL
2. Describe types of Types of burn injuries: Self-instructional materials, Written exam
burn injuries • Scald manuals and handouts SGD output
• Flame Lecture-discussion
• Chemical SGD
• Electrical PBL
• Radiation
3. Assess the depth of Depth of burn injuries: Self-instructional materials, Written exam
the burn injury Partial thickness— first degree manuals and handouts SGD output
second degree Lecture-discussion Clinical performance
Full thickness or third degree SGD
PBL
Actual patient encounter
Bedside teaching
4. Estimate the extent Extent of burn injury: Self-instructional materials, Written exam
of the patient s burn Lund and Browder chart and other body manuals and handouts SGD output
injury as percentage surface charts Lecture-discussion Clinical performance
of total body surface Audiovisual presentations
area using body SGD
surface charts PBL
Bedside teaching
38
5. Describe the Pathophysiology of burn injuries: Self-instructional materials, Written exam
pathophysiologic Hemodynamic manuals and handouts SGD output
changes due to burn Autonomic Lecture-discussion
injuries Cardiopulmonary SGD
Renal and metabolic disturbances PBL
Bedside teaching
6. Formulate preventive Models of preventive strategies: Self-instructional materials, Written exam
strategies against Injury matrix manuals and handouts SGD output
burn injuries using Haddon s 10 generic strategies Lecture-discussion Clinical performance
various preventive Agent-host-environment interactive model SGD OSCE
models The “safety equation” PBL CEC
Model of risk factors and consequences Actual patient encounter CbD
The 4 E’s: Bedside teaching
Education
Enforcement
Engineering
Environment
7. Institute appropriate Emergency procedures in the management Self-instructional materials, Written exam
medical procedures of burn injuries manuals and handouts SGD output
in the emergency Fluid, electrolyte and colloid therapy Lecture-discussion OSCE
phase of burn SGD
injuries PBL
Bedside teaching
8. Recognize patients American Burn Association criteria for Self-instructional materials, Written exam
that should be referral to a burn center manuals and handouts SGD output
referred to a Burn Actual patient encounter Clinical performance
Center Bedside teaching
39
9. Discuss treatment of Complications following burn injuries: Self-instructional materials, Written exam
complications Cardiac dysfunction manuals and handouts SGD output
Respiratory problems SGD Clinical performance
Severe oliguria PBL CEC
Renal failure Actual patient encounter CbD
Endotoxemia Bedside teaching
Nutritional problems
10. Discuss the Rehabilitation measures for burn patients Self-instructional materials, Written exam
appropriate manuals and handouts
rehabilitation SGD
program of patients PBL
Bedside teaching
11. Express sympathy to Showing sympathy to children with burn Actual patient encounter Clinical performance
parents of children injuries Bedside teaching MSF
with burn injuries
12. Assist parents and Showing concern and sensitivity to parents SGD Written exam
family members in and family members PBL
coping with the Actual patient encounter
patient s situation Bedside teaching
40
INJURIES

1. Interpret the Epidemiologic features of common injuries Self-instructional materials, Written exam
epidemiologic on the road, school and home: manuals and handouts SGD output
features of common Traffic injuries Lecture-discussion
childhood injuries Submersion injuries SGD
(Please see Module Falls PBL
on Emergency Burns
Pediatrics) Poisoning
2. Explain the Epidemiologic framework: Self-instructional materials, Written exam
relationship among The agent-host-environment model manuals and handouts SGD output
the agent of injury, Child development and injuries Lecture-discussion
the host or injured SGD
child and the PBL
environment
3. Formulate preventive Models of preventive strategies: Self-instructional materials, Clinical performance
strategies against Injury Matrix manuals and handouts OSCE
common injuries Haddon’s 10 generic strategies Lecture-discussion CEC
using various Agent-host-environment interactive model SGD CbD
preventive models or The “safety equation” PBL
approaches Model of risk factors and consequences Actual patient encounter
The “4E’s”:Education Bedside teaching
Enforcement (of the law and regulations)
Engineering
Environment
4. Teach first aid and Management of the injured child: Self-instructional materials, Clinical performance
other preventive First aid manuals and handouts OSCE
measure to parents Primary care Actual patient encounter
and other members Secondary Bedside teaching
of the family and the Tertiary care
community
41
5. Assess the injured Pediatric Trauma Score Actual patient encounter Written exam
child using the Glasgow Coma Score Bedside teaching SGD output
Pediatric Trauma Clinical performance
Score and other OSCE
scoring systems and CEC
know when to refer CbD
to a Trauma Center
6. Apply first aid and Airway Demonstration-return Clinical performance
other appropriate Breathing demonstration OSCE
primary care Circulation Actual patient encounter CEC
measures to Disability Bedside teaching CbD
Exposure
Principles of application of first aid
7. Record accurate and Proper documentation Self-instructional materials, Written exam
complete Thoroughness manuals and handouts SGD output
information Accuracy SGD Clinical performance
surrounding the PBL OSCE
particular injury Actual patient encounter CEC
Bedside teaching CbD
8. Discuss with the Concern, empathy and sensitivity to the Actual patient encounter Clinical performance
parents/caregiver the parents and families of the injured child Bedside teaching OSCE
status of the injured CEC
child CbD
9. Report the injury injury surveillance Actual patient encounter Written exam
incident to the Proper reporting Bedside teaching CbC
proper medico-legal Concern for the welfare of the patient CEC
authorities
42
CARDIOVASCULAR DISORDERS

1. Explain the anatomic, Anatomy and physiology of the Lecture-discussion Written exam
physiologic and cardiovascular system: fetal and postnatal SGD Graded oral recitation
pathophysiologic Pathophysiology of Complaint/Problem PBL Written report
basis of the Practical exam
presenting Clinical performance rating
problem/complaint. Oral exam
OSCE
CEC
Mini-CEX
2. Identify clinical Murmur: physiologic and pathologic Lecture-discussion Written exam
presentation of Cyanosis: central and peripheral SGD Graded oral recitation
cardiovascular Difficulty of breathing PBL Written report
diseases Edema Bedside teaching Practical exam
Hypoxic spell Clinical performance rating
Irregular rhythm Oral exam
Chest pain OSCE
Systemic hypertension CEC
Cardiomegaly Mini-CEX
Syncope
Dysmorphic features
3. Elicit a complete Complete history of the patient, focus on Demonstration-return Written exam
history which focuses the C-V complaint/problem demonstration Written report
on the character and Include prenatal history and family history Preceptorials Practical exam
circumstances Communication skills Bedside teaching Clinical performance rating
surrounding the Interpersonal skills Oral exam
complaint. Respect for patient’s privacy confidentiality OSCE
Thoroughness CEC
Mini-CEX
43
4. Perform a complete Complete PE and cardiac evaluation Instructional video Written exam
PE including a including BP in all extremities, body weight Demonstration-return Graded oral recitation
systematic cardiac and height (length), cyanosis +/- clubbing demonstration Written report
examination using of nailbeds, edema, pulses upper and Preceptorials Practical exam
inspection, palpation, lower extremities, dysmorphic features Bedside teaching Clinical performance rating
and auscultation Cardiac examination: chest symmetry, point Actual patient encounters Oral exam
of maximal impulse and location, heave, OSCE
thrill, heart sounds and murmur, rhythm CEC
and rate Mini-CEX
Communication skills
Consideration for the patient’s safety,
comfort and privacy
5. Determine the most Correlation and findings on PE with Lecture-discussion Written exam
likely abnormality knowledge of the anatomy and physiology SGD Graded oral recitation
and severity based on of the cardiovascular system PBL Written report
information gathered Signs and symptoms presented and their Preceptorials Clinical performance rating
severity Bedside teaching Oral exam
Actual patient encounters OSCE
CEC
Mini-CEX
6. List the logical Differential diagnosis: Lecture-discussion Written exam
differential diagnoses A. Congenital heart disease PBL Graded oral recitation
based on gathered 1. Acyanotic: volume overloading SGD Written report
data lesions or pressure overloading Bedside teaching Practical exam
lesions. Clinical performance rating
2. Cyanotic: Increased pulmonary Oral exam
blood flow, decreased OSCE
pulmonary blood flow CEC
B. Acquired heart disease Mini-CEX
1. Rheumatic fever
Rheumatic heart disease
44
2. Infective endocarditis
3. Myocardial disease
4. Pericardial disease
5. Kawasaki disease
C. Arrhythmias
D. Heart failure
E. Metabolic syndrome
Approach to differential diagnoses
Primary diagnosis and bases
Functional classification of the disease
7. Choose the Indications, availability, reliability of Lecture-discussion Written exam
appropriate diagnostic examinations PBL Graded oral recitation
diagnostic Blood examinations: SGD Written report
examinations to Complete blood count Bedside teaching Clinical performance rating
establish the Arterial/venous blood gas Oral exam
diagnosis Serum electrolytes (Na, K, Ca, Mg) OSCE
Acute phase reactants: ESR, CRP CEC
ASO titer, Anti DNAseB test Mini-CEX
Blood culture (2x)
Cardiac enzymes
Imaging studies
Chest radiograph (PA and L views)
Magnetic resonance imaging/
Angiography
Cardiac catheterization/
Angiocardiography
Echocardiography: 2-D echo,
color Doppler studies, TEE
Electrocardiogram 15 leads, rhythm strip,
holter (ambulatory) , monitoring (24-
hour), treadmill
45
Exercise Test
Pericardiocentesis
Written informed consent containing:

a. Role in the diagnosis and treatment
b. Necessity of the procedures
c. Cost–risk-benefit evaluation
Psychological support to the patient and
family
Importance and principles of asepsis in the
collection of biological specimen
Interpretation of the results of laboratory
tests done
Correlation of laboratory test results with
the clinical data, differential diagnosis and
natural course of the illness
Adverse clinical outcome of diagnostic tests
8. Establish the Diagnostic criteria for common Lecture-discussion Written exam
diagnosis using cardiovascular diseases PBL Graded oral recitation
evidence SGD Written report
Bedside teaching Practical exam
Oral exam
OSCE
CEC
Mini-CEX
9. Outline a plan of Relevance, availability, socio-economic Lecture-discussion Written exam
treatment for factors, rehabilitative care and schedule of PBL Graded oral recitation
emergency care, follow-up in the common cardiovascular SGD Written report
definitive care, and disease Bedside teaching Practical exam
long- Indications for hospitalization and Clinical performance rating
46
term/rehabilitative emergency care of patients with Oral exam
care for various cardiovascular problem(s): OSCE
cardiovascular • Heart failure CEC
diseases • Arrhythmia Mini-CEX
• Hypercyanotic attacks
• Sudden death
Equipment, materials and medications for
resuscitation
Steps in emergency care
Basic Life Support (BLS)
Pediatric Advanced Life Support (PALS)
Cardiovascular resuscitation techniques and
stabilization measures including
cardioversion
Appropriate fluid management
Palliative procedures
Surgical procedures
Catheter device procedures
Therapeutic agents for symptomatic relief of
CHF, RF, RHD, pulmonary hypertension
Indications for limitation in physical
activities, sports and employment
List of C-V diseases with tendency to
chronicity and requiring long-term follow-
up: Grown–ups with CHD (operated and
unoperated),RHD, pulmonary
hypertension
Specific therapeutic agents for long-term
care of patients with C-V diseases
Specific definitive care of patients with C-V
diseases
47
Correct (appropriate) diet for the C-V
disease; appropriate physical activity/
sports for the C-V disease
Correct pharmacological agents for long-
term care
Antimicrobial prophylaxis against bacterial
endocarditis
Rehabilitative care for chronic C-V disease
Recognition of complications and need for
referral:
Pulmonary artery hypertension
Heart failure
Infective endocarditis
CNS: Complications: brain abscess, brain
embolism, infarct
Arrhythmias
Hypoxic spells
Cardiac tamponade
10. Perform proper Steps in performing ECG Demonstration-return Clinical performance rating
diagnostic procedure demonstration Practical exam
(EKG, 2D echo in Bedside teaching OSCE
hospitalized patients) Actual patient encounters
48
11. Provide health Effects of heart disease to patient, family, SGD Clinical performance rating
education to families and its implication to the community and Role play OSCE
to prevent national health Bedside teaching Mini-CEX
occurrence of Epidemiologic facts affecting the Actual patient encounters
acquired heart occurrence, spread and chronicity of C-V
disease and its disease
complications Ten leading causes of morbidity (DOH)
Ten leading causes of death (1-5years old)
(5-10,10-15 years old )
Institutional studies
Institutional data
Registry of diseases
Role of medical, paramedical and traditional
health providers in the management and
control of acquired C-V disease
Interaction and dynamics between the
family and C-V disease
Preventive measure including physical
activity and sports
49
CRITICAL CARE

1. Clinically diagnose Clinical presentation of common Modules/slide Written exam
common emergency emergency problems: presentation
problems A. Shock PALS interviews
B. Respiratory failure Independent patient contact
C. Foreign body aspiration Bedside tutorial
D. Multiple organ failure SGD
Lecture
Module simulation
2. Determine the A. Shock Lecture Written/oral exam
probable cause 1. Hypovolemic shock SGD Case presentation
through appropriate 2. Septic shock PBL
work-ups 3. Distributive shock Ward rounds
4. Cardiogenic shock Tape/slide program on
B. Respiratory failure
problem-oriented
C. Systemic Inflammatory Response
record-keeping
Syndrome (SIRS)
Preceptorials
3. Outline plan of Drugs, IVF support, airway support Lecture Checklist
treatment for A. Shock SGD Simulation assessment of video
common disorders 1. Hypovolemic shock Patient management recordings
2. Septic shock problem
3. Distributive shock Preceptorials
4. Cardiogenic shock
5. Multiple organ failure
50
4. Institute treatment ABC's of resuscitation: Ward team participation Models, knowledge and rapport
for the most Airway Models of procedures Simulation test
common Breathing circulation Demonstration- return Video-audiotape assessment
emergency Drugs/fluids gauging demonstration
conditions Human mentation
Patient management
Intensive care problem Independent
Treatment for the following conditions: patient contact
A. Pneumothorax
SGD
B. Barotraumas/volutrauma
C. Disseminated intravascular
coagulation (DIC)
D. Acute respiratory distress
syndrome(ARDS)
E. Apnea
F. Asystole
G. SIRS/Multiple organ
dysfunction
syndrome (MODS)
H. Transport -
emergency medical
system (EMS)
Transport by EMS
5. Identify the onset and Clinical presentation and treatment of the Case presentation OSCE
presence of following complications: Lecture Mini-CEX
complications, need A. DIC Algorithms
for further treatment B. ARDS Bedside teaching
and referral (over-
C. SIRS Ward rounds
treatment vs.
undertreatment) D. MODS SGD
E. Apnea Model simulation
51
F. Asystole
6. Provide health Control of disease Independent patient MSF
education and Counseling Contact Simulation
proper disease Good intrapartal management SGD
concepts Immediate neonatal care Model simulation
Diagnosis and treatment of life- Patient management
threatening but reversible conditions problem
Timely referral Ward rounds and team
Teaching and counseling regarding basic participation
and advance life support to caregivers Preceptor sessions with
video recordings of
patient interviews
Parent educating classes
Home hospital visits
52
DERMATOLOGY

1. Discuss common Descriptive terminology for skin lesions Lecture Written exam
dermatological 1. Primary lesions: macules, papules, patch, SGD Graded SGD & preceptorials
problems seen in plaque, vesicles, bulla, pustule, nodule, PBL using evaluation forms
the pediatric age
tumor, wheal OSCE
group
2. Secondary lesions: crust, scales,
lichenification, erosion, ulcer, fissure,
2. Construct a excoriation, atrophy, scar, hyper- or
complete history hypopigmentation, ulcer
with emphasis on 3. Other conditions: atrophy, burrow,
describing the
comedone, erythema, petechia,
initial
dermatological poikiloderma, purpura, sclerosis,
complaint, and the exanthem, enanthem
development &
progression of the Transient skin lesions in the newborn:
cutaneous problem Cutaneous defects
Vascular disorders
3. Perform a Hyperpigmentation
complete PE with Hypopigmentation
emphasis on Eczematous disorders
dermatological Papulosquamous disorders
examination Vesicobullous disease
Xerosis
Cutaneous bacterial infections
Cutaneous viral infections
53
Cutaneous fungal infections

Cutaneous infestations
Acne
Hair disorders
Dermatological emergencies:
Steven Johnson Syndrome - toxic
epidermal necrolysis and necrotizing
fasciitis
Physical and environmental hazards
4. Select the Diagnostics for: Lecture Written exam
appropriate 1. Bacterial infections: gram stain & Case-based SGD Evaluation forms
diagnostic culture Demonstration for group discussions
examinations for 2. Viral diseases: light microscopy (Tzanck Bedside/out-patient clinic OSCE
cutaneous smear), PCR, ELISA, viral cultures
problems teaching
3. Mycotic diseases: light microscopy
(KOH smear), wood's light exam, fungal Reading assignment with
5. Interpret accurately culture follow up discussions
the results of the 4. Immune mediated skin diseases: direct
tests & procedures & indirect immunoflourescence
microscopy
5. Other common cutaneous problems:
skin biopsy, skin scrap pings for scabies,
light microscopy exam for hair shaft
abnormalities
6. Propose a logical
diagnosis and
differential
diagnoses based on
data gathered
54
7. Discuss the A. Skin care & therapy- general principles: Lecture Written exam
principles & bathing, skin cleansers, creams, Case-based SGD Evaluation forms for group
rationale of ointments, shampoos Bedside/out-patient clinic Discussions
management of
B. Xerosis: emollients, moisturizers, teaching OSCE
common pediatric
dermatological humectants Reading assignment with
problems C. Pruritus and inflammation: emollients, follow up discussion
topical steroids, topical calcineurin
inhibitors, antihistamine, menthol,
phenol, topical doxepin,
8. Discuss the immunosuppressive agents, TNF
indications, inhibitors
appropriate dose, D. Physical & environmental hazards:
duration of use, sunscreens, barrier creams & ointments,
adverse, & side insect repellents, clothing
effects of
E. Skin infections: topical and systemic
therapeutic
antibiotics, topical and systemic
agents/modalities
antifungal agents, antiviral agents,
cantharadin, topical salicylic acid,
9. Recognize pediculocides & scabicides, electro-
dermatological cautery, cryotherapy
emergencies F. Acne: cleansers, topical retinoic acid,
topical & systemic antimicrobials,
55
10. Determine the isotretinoin,

indications for G. Dermatologic emergencies: wound care,
hospitalization, proper use of antimicrobials, fluid
surgical
management
intervention, &
referral to
specialists
11. Develop an
appropriate plan
for preventive care,
patient follow-up
56
DEVELOPMENTAL AND BEHAVIORAL DISORDERS

1. Discuss the Definition Lecture-discussion Written exam
classification and DSM 5 criteria for diagnosis of Instructional video SGD output
prevalence of • Intellectual disability/ Global PBL
various developmental delay SGD
developmental • Cerebral palsy Preceptorials
disabilities and • Autism
behavioral • Attention Deficit Hyperactivity Disorder
disorders (ADHD)
Hearing/ vision impairment
Risk factors/ protective factors
Co-morbidities
2. Recognize Clinical presentation of common Lecture-discussion Written exam
presenting signs developmental and behavioral disorders Instructional video SGD output
and symptoms of PBL
common SGD
developmental and Preceptorials
behavioral
disorders
3. Elicit a complete History-taking technique Lecture-discussion Written exam
and accurate Developmental milestones Instructional video SGD output
history including Red flags: Demonstration-return CbD
developmental • Speech delay demonstration Mini-CEX
milestones and red • Difficult behavior PBL Practical exam
flag signs for each • Aggressive behavior SGD OSCE
condition • Excessive tantrums Preceptorials
Communication skill
Interpersonal skill
Confidentiality
57
4. Perform a PE technique Lecture-discussion Written exam
systematic and Respect for patient’s safety, comfort and Instructional video SGD output
thorough physical privacy Demonstration-return CbD
examination Thoroughness demonstration Mini-CEX
PBL Practical exam
SGD OSCE
Preceptorials
Bedside teaching
5. List logical Clinical presentation of developmental Lecture-discussion Written exam
diagnosis and disabilities and behavioral disorders PBL SGD output
differential SGD CbD
diagnoses Preceptorials Mini-CEX
Bedside teaching OSCE
6. Select appropriate Principles, rationale and proper Lecture-discussion Written exam
diagnostic interpretation of tests and procedures in SGD SGD output
examinations for the diagnosis of developmental and PBL CbD
the common behavioral disorders and comorbid Preceptorials Mini-CEX
developmental and conditions Bedside teaching OSCE
behavioral
disorders
depending on
presenting
manifestation
7. Establish the Criteria for diagnosis of developmental and Lecture-discussion Written exam
diagnosis based on behavioral disorders SGD SGD output
supporting PBL CbD
evidence Preceptorials Mini-CEX
8. Discuss the Drug treatment Lecture-discussion Written exam
principles of Physical therapy SGD SGD output
management of Occupational therapy PBL CbD
58
common Speech therapy Preceptorials
developmental and Behavioral therapy
behavioral Referral to specialists
disorders
59
ENDOCRINOLOGY AND METABOLISM

1. Recognize Clinical presentation of the following Lecture OSCE/OSPE
presenting signs endocrinopathies: SGD Written exam
and symptoms of A. Abnormal stature Preceptorials Clinical encounter Cards
common 1. Hypopituitarism Demonstration/practice Case-based discussion
endocrinopathies in 2. Pituitary tumors SGD evaluation form
the pediatric age 3. Rickets Mini-CEX
group 4. Hypothyroidism
5. Hyperthyroidism
2. Elicit a complete 6. Overgrowth syndromes
history including 7. Chromosomal Disorders
red flag signs for B. Polyuria/polydipsia
endocrinopathies 1. Diabetes mellitus
2. Diabetes insipidus
3. Perform a C. Excessive weight gain
complete physical 1. Exogenous obesity
examination 2. Cushing syndrome
D. Acute weight loss
1. Diabetes mellitus
2. Hyperthyroidism
3. Addison’s Disease
E. Goiter
1. Hypothyroidism
2. Hyperthyroidism
F. Seizures
1. Hypoglycemia
2. Hypocalcemia
G. Abnormal pigmentation
1. Addison’s Disease
2. Acanthosis nigricans
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H. Precocious or delayed puberty
1. Pituitary tumors
2. Constitutional growth delay
I. Ambiguous genitalia
1. Congenital adrenal hyperplasia
2. Hypopituitarism
J. Hypertension
1. Pheochromocytoma
4. Select appropriate Principles and rationale for the use of Lecture Written exam
laboratory work-up different diagnostic examinations SGD SGD evaluation form
for the common A. Growth disorders: Preceptorials Mini-CEX
endocrinopathies Bone aging, growth hormone levels OSCE
including provocative tests with
physiologic and pharmacologic
stimulation (exercise, insulin,
clonidine, 1-dopa and arginine),
insulin-like growth factor-1, insulin-
like growth factor binding protein
B. Polyuric syndromes:
FBS, RBS, blood gas studies,
glycosylated haemoglobin, OGTT,
plasma and urine ketones, islet cell
antibodies, GAD, insulin, C-peptide,
insulin antibodies, water deprivation
test, vasopressin test, FT3, FT4, TSH,
newborn screening, thyroid scan,
thyroid ultrasound, TRH stimulation,
thyroglobulin, thyroid antibodies,
urinary iodine
C. Adrenal disorders:
Blood sugar, serum and urinary
61
electrolytes, urinary steroids,
plasma cortisol , 17-OH
progesterone, aldosterone, plasma
rennin activity, dexamethasone
suppression test
D. Pubertal disorders:
LH, FSH, prolactin, estradiol,
testosterone, LHRH stimulation test,
pelvic ultrasound, karyotyping
E. Disorders of bone metabolism:
Serum/urinary calcium and
phosphorus, alkaline phosphatase,
parathyroid hormone, urinary pH,
skeletal survey
F. Endocrine tumors:
Urinary VMA, metanephrine, urinary
cortisol
imaging studies : CT scan, MRI,
MIBG scan
5. Establish the Pathophysiology of endocrinopathies SGD Written exam
diagnosis based on Clinical presentation of endocrinopathies PBL SGD output
supporting Interpretation of diagnostic tests Bedside teaching CbD
evidence OSCE
6. Discuss the Principles of management of common Lecture Written exam
principles of endocrine disorders, including indication, SGD SGD output
management of dosage, duration of use and side effects Preceptorials CbD
common endocrine of therapeutic agents, need for Bedside teaching Mini-CEX
disorders hospitalization and referral OSCE
A. Growth disorders:
Growth hormone
Thyroid hormone
62
B. Polyuric syndromes:
Insulin
Oral hypoglycemics
Vasopressin
C. Adrenal disorders:
Glucocorticoid
Mineralocorticoid
D. Pubertal disorders:
Estrogen
Progesterone
Testosterone
LHRH agonist
E. Disorders of bone metabolism:
Calcium
Vitamin D
7. Discuss endocrine A. Diabetic ketoacidosis SGD Written exam
emergencies and 1. Fluids PBL Mini-CEX
the principles of 2. Electrolytes Preceptorials CEC
management 3. Insulin Bedside teaching
B. Hypoglycemia
1. IV glucose
C. Adrenal crisis
1. Glucocorticoids
2. Mineralocorticoids
D. Thyroid storm
1. Glucocorticoids
2. Antithyroids
E. Hypocalcemia
1. IV Calcium
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8. Outline a program Lecture Written exam
for follow-up and SGD SGD evaluation form
rehabilitative care PBL Mini-CEX
Preceptorials
Bedside teaching
9. Identify the onset Lecture Written exam
or presence of SGD SGD output
complications, PBL CbD
need for further Preceptorials CEC
treatment Bedside teaching
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GASTROENTEROLOGY AND HEPATOLOGY

1. Correlate the Anatomy of the esophagus, stomach, small Lecture-discussion Written exam
structure with intestines, large intestines, liver, biliary Oral report Grading oral presentation
function of the tree, pancreas and spleen SGD SGD outputs
digestive system
Physiology of swallowing, digestion &
absorption, esophageal, gastric &
intestinal motility, bile formation &
pancreatic function
Functions, absorption and requirements

(RENI) of carbohydrates, protein, fats,
fat-soluble & water-soluble vitamins &
micronutrients
2. Elicit a complete a. Important details in history taking in
and accurate patients with the following
history problems:
- vomiting
- abdominal pain
- diarrhea
- bleeding
- jaundice
b. Malnutrition
- Clinical features of different
types of protein-energy
malnutrition (PEM); vitamin A
65
- deficiency, iron deficiency

anemia, goiter (VADAG);
micronutrient deficiency (zinc,
vitamin D, copper, calcium)
Interpretation of growth curves using Z
scores
3. Perform a Steps in PE -Video presentation Practical exam
systematic and Anthropometric measurements and proper -Bedside demonstration OSCE
thorough physical interpretation -Anthropometric Clinical performance
examination
Proper attitude, including respect, concern measurements & proper
for patient’s comfort and safety, interpretation of WHO
confidentiality growth curves
4. Select appropriate Diagnostic tests, rationale, interpretation:

diagnostic tests and Blood examination, stool examination,
procedures to hepatitis profile, special examinations for
establish the
metabolic disorders, radiographs,
cause of these
disorders ultrasound, endoscopy
5. Diagnose various Acute gastroenteritis with different types of Reporting Written exam
gastrointestinal and dehydration (isotonic, hypotonic, Case discussion Oral presentation
hepatic disorders hypertonic) Journal reporting Audit
based on the
Intestinal obstruction (partial, complete; Institution of appropriate &
clinical features,
manifestations and upper, lower) proper diagnostic tests &
symptoms Constipation (functional, organic causes) specific management of various
Cholestatic jaundice among young infants: diseases
66
neonatal hepatitis & biliary atresia

Cholestatic jaundice among older infants:
viral hepatitis (ABCDEF),
Metabolic causes: Wilson Disease, Alpha – 1
anti-trypsin
Malnutrition: marasmus, kwashiorkor &
marasmus-kwashiorkor
Vitamin A deficiency, iron deficiency anemia,
goiter (VADAG)
Gastroesophageal Reflux Disease (GERD)
Gastritis
Pancreatitis
6. Outline proper Proper management of common Report Written exam
management of gastrointestinal, hepatic and nutritional SGD Oral presentation
gastrointestinal, disorders PBL CbD
hepatic and
Journal report Clinical performance rating
nutritional
disorders Bedside teaching OSCE
(Please see Module
on Nutritional
Disorders)
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HEMATOLOGY

1. Obtain a complete A. Anemias Lecture Written exam

history (to emphasize red 1. Anemia due to blood loss SGD SGD output
flags for hematologic 2. Nutritional anemias PBL CEC
disorders) 3. Hemolytic anemias
Preceptorials OSCE
2. Construct a pedigree 4. Bone marrow failure
3. Perform a complete B. Bleeding Bedside teaching CbD
physical examination 1. Platelet disorders
4. List the differential 2. Coagulation disorders
diagnoses C. Hematologic cancers
5. Discuss the anatomic, 1. Acute leukemias
physiologic, and 2. Chronic myelogenous
pathophysiologic bases leukemia
of the differential
diagnoses
6. Come up with a working
diagnosis based on
supporting evidence
7. Choose the appropriate A. Anemias: CBC, red cell Lecture Written exam
work-up for the common morphology,RBC indices, SGD SGD evaluation forms
hematologic disorders peripheral blood smear, Preceptorials Mini-CEX
Coomb’s test, G6PD level,
Hemoglobin electrophoresis,
HPLC,serum iron, TIBC, serum
ferritin, serum folic acid, Vitamin
B12 assay, osmotic fragility test,
stool exam (to include occult
blood), bilirubin levels, bone
marrow examination
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B. Bleeding disorders: CBC, platelet

count, peripheral blood smear,
bleeding time, prothrombin
time, partial thromboplastin
time, thrombin time, CRT, clot
lysis, coagulation factor assay,
fibrin degradation products,
Von Willebrands Factor
C. Hematologic cancers: CBC,
platelet count, peripheral blood
smear, reticulocyte count, bone
marrow exam, lymph node
biopsy, uric acid, LDH,
immunophenotyping flow
cytometric
8. Establish the diagnosis Criteria for diagnosis of hematologic Lecture Written exam
based on supporting disorders SGD OSCE
evidences Bedside teaching Case-based discussions
Preceptorials
9. Discuss the principles in Indication, dosages, onset of action, Lecture
the management of duration of use, side effects of SGD
common hematologic therapeutic agents, blood component Bedside teaching
disorders products, therapeutic interventions, Preceptorials
procedures, and appropriate referral
to specialists:
69
A. Anemias
Proper diet/ proper hygiene
Hematinics
Steroids
Immunosuppressives
Blood component therapy
Surgery
Genetic counseling
B. Bleeding Disorders
Steroids
IV immunoglobin infusion
Rhogam infusion
Vitamin K
Surgery
C. Hematologic cancers
Chemotherapy
Antibiotics
Radiotherapy
Bone marrow transplant
Stem cell transplant
10. Identify hematologic A. High output failure/ low output SGD Mini-CEX
emergencies and their failure PBL CEC
management 1. pRBC transfusion Preceptorials
2. Diuresis
Bedside teachings
3. Inotropic agents
70
B. Bleeding (massive/ fatal)

1. IVF
2. Blood component therapy
3. IV immunoglobulin infusion
4. Rhogam infusion
5. Coagulation factor infusion
6. Steroids
7. Surgery
C. Tumor lysis syndrome
1. IVF
2. Diuresis
3. NAHCO3
4. Allopurinol
5. Kayexalate/ insulin
6. Calcium gluconate
11. Outline a program for Proper monitoring and follow up of Lecture Written exam
follow-up and patients with hematologic disorders SGD SGD outputs
rehabilitative care Rehabilitative care Preceptorials Mini-CEX
Bedside teachings OSCE
CEC
71
IMMUNOLOGY

1. Describe the normal Ontogeny of the immune response Lecture Written exam
immune response Innate immune system SGD Written report
Cellular: macrophage/monocyte, Preceptorials Checklist
natural killer cell, phagocyte Self-instructional manuals
Soluble factors: complement,
cytokines, acute phase
reactants
Adaptive immune system
T cell
B cell
Interaction between the different
arms of the immune system
2. Describe and discuss the Definition of primary and secondary Lecture Written exam
abnormal immune immunodeficiency SGD Written report
response Mechanisms for immunodeficiency, Preceptorials Checklist
autoimmunity and immune Self-instructional manuals
a. Immunodeficiency dysregulation
(primary vs secondary Specific defects of:
immunodeficiency) Phagocytic disorders
b. Autoimmunity T cell disorders
c. Immunodysregulatory B cell disorders
states (relationship of Combined T and B cell immune
allergy to immune deficiency
dysregulation) Complement disorders
Syndrome complexes
3. Elicit a complete Jeffrey Modell Foundation (10 SGD Written exam
Immunologic history and warning signs of immunodeficiency) Preceptorials Written report
perform a 4 or more new ear infections Bedside teaching Checklist
comprehensive physical within 1 year Self-instructional manuals
72
examination 2 or more serious sinus infections
within 1 year
2 or more months on antibiotics
with little effect
2 or more pneumonias within 1
year
Failure of an infant to gain weight
or grow normally
Recurrent, deep skin or organ
abscesses
Persistent thrush in mouth or
fungal infection on skin
Need for intravenous antibiotics
to clear infection
2 or more deep seated infections
Including septicemia
Family history of primary
Immunodeficiency
4. Perform a complete Growth parameters Demonstration-return Written exam
physical examination on Dysmorphic features demonstration Written report
patients with symptoms Skin and mucous membranes SGD Checklist
referable to the immune Ear, nose, and throat Preceptorials
system Pulmonary Bedside teaching
Cardiovascular Self-instructional manuals
Lymphoreticular system
Neurologic
Musculoskeletal
5. Integrate history and Phagocytic defects Required readings Written exam
physical examination to T cell defects Lecture Written report
make a diagnosis B cell defects SGD Checklist
Complement defects Preceptorials or supervised
73
Combined T and B cell defects Patient encounters
Self-instructional manuals
6. Discuss the differential Anatomic and structural defect Lecture Written exam
diagnosis of immune (eg., cleft palate and recurrent SGD Written report
deficiency ear Infections) Preceptorials Checklist
Biochemical and metabolic Bedside teaching
deficiencies Self-instructional manuals
Nutritional deficiencies (protein-
calorie malnutrition, specific
vitamin/mineral deficiencies)
Autoimmune diseases
Allergic diseases
Malignancies
Immunosuppressive therapy
Chronic debilitating illnesses (eg.,
DM, TB)
Genetic disorders
7. Discuss the multiple factors Environment Lecture Written exam
affecting the development Genetics SGD Written report
of immunologic disorders Nutrition Self-instructional manuals Checklist
8. Determine the etiology Initial immunologic screening tests: Lecture Written exam
through appropriate CBC SGD Written report
immunologic work-up: Serum Immunoglobulins (Igs) Preceptorials SGD output
Chest Xray Self-instructional manuals
Primary immune disorders Nitroblue tetrazolium test (NBT)
T cell defects CH50
B cell defects
Phagocytic defects
Complement defects
Combined T and B cell
defects
74
Secondary immune
disorders
Infections (HIV, TB)
Debilitating diseases
Malignancy
Autoimmune diseases
Nutritional deficiencies
9. Outline a plan of General principles in the Lecture Written exam
management for: management of immunologic SGD Written report
T cells defects disorders and include issues on Preceptorials Checklist
B cell defects vaccination Self-instructional manuals
Phagocytic defects
Complement defects
10. Provide health education to Genetic counseling Lecture Written exam
the patient and their Good hygiene and isolation when SGD Written report
families necessary Role play Checklist
Adequate management of diseases Preceptorials
Intravenous gamma globulin (IVIG) Bedside teaching
Proper antibiotics Self-instructional manuals
Bone marrow transplantation
Gene therapy
Awareness of early signs and
symptoms
Early recognition and correction of
anatomic or structural defects
Multidisciplinary team
75
INFECTIOUS DISEASES

1. Recognize common clinical Etiology Lecture Written exam
presentations of infectious Epidemiology SGD OSCE
diseases, and be familiar Pathogenesis / pathophysiology Slide / video presentation
with the usual infectious Clinical presentation Bedside teaching
causes of these conditions Differential diagnosis:
Fever
Fever without localizing signs
Fever of unknown origin (FUO)
Fever with localizing signs
A. Rash
B. Cutaneous lesions other than
rash
C. Lymphadenopathy
D. Headache and/or altered
sensorium
E. Seizure
F. Eye discharge
G. Sore throat
H. Ear pain
I. Cough
J. Cyanosis
K. Abdominal pain
L. Jaundice
M. Hepatosplenomegaly
N. Diarrhea
O. Dysuria
P. Genital discharge
Joint pain
76
2. Choose appropriate work-up CBC Lecture Written exam
to reach definitive diagnosis Urinalysis SGD
of common infections Stool examination PBL
conditions Analysis and culture of blood, Bedside teaching /
discharges and other body fluids ward rounds
Serological test
Immunological tests (eg, Mantoux
test)
Radiologic and other imaging
procedures
Other ancillary procedures
3. Establish the diagnosis of Diagnosis of the following infectious
patients diseases:
A. Bacterial infections
Cholera
Diphtheria
Escherichia coli and other
gram negative
enterobacterial infections
Gonorrhea
Hemophilus influenzae
infection
Leprosy
Leptospirosis
Meningococcal infections
Pertussis
Pneumococcal infections
Salmonella infection
(typhoid, non typhoid)
Shigellosis
Staphylococcal infections
77
Streptococcal infections
Syphilis
Tetanus
Tuberculosis
B. Viral infections
AIDS and HIV infections
Cytomegalovirus infections
Dengue fever/dengue
hemorrhagic fever
Encephalitides and aseptic
meningitis (vs. purulent,
TB, fungal)
Epstein-Barr virus
Enteroveral (poliomyelitis,
coxsackie A and B, echo
virus)
Hepatitis A-G
Herpes simplex virus, types 1
and 2
Influenza and influenza-like
infections
Mumps
Rabies
Rubella, rubeola and other
viral exanthems
Varicella zoster virus
C. Parasitic diseases
Amebiasis
Ascariasis
Balantidiasis
Capillariasis
78
Enterobiasis
Filariasis
Giardiasis
Hookworm infection
Malaria
Paragonimiasis
Pneumocystis carinii
infection
Scabies
Schistosomiasis
Strongyloidiasis
Trichuriasis
Toxoplasmosis
D. Fungal infections
Candidiasis
Cryptococcosis
Aspergillosis
4. Outline a plan of Specific treatment via judicious use Lecture Written exam
management of antimicrobials Bedside teaching /
Symptomatic treatment ward rounds
Supportive treatment SGD
5. Recognize complications and Common complications of infectious Lecture Written exam
determine the need for diseases as listed in Bedside teaching /
initial management and/or “Content” #3 ward rounds
referral
6. Institute appropriate Isolation Lecture Written exam
prevention and control Chemoprophylaxis Bedside teaching /
Immunization (passive / active) ward rounds
Preventive measures: good hygiene, SGD
environmental sanitation, proper
waste disposal
79
NEONATOLOGY

1. Clinically recognize the Absence of maternal and fetal risk Lecture-discussion Written exam
normal newborn factor SGD SGD output
Natural history of normal pregnancy PBL Clinical performance
Normal process of labor and delivery Role playing
Fetal circulation Actual patient encounter
Neonatal/adult circulation
2. Discuss Essential Core principles of Essential Lecture-discussion Written exam
Intrapartum and Newborn Intrapartum and Newborn Care SGD SGD output
Care (EINC) practices (EINC) Evidence-based Standard PBL
Practices: Mother’s class
Immediate & thorough drying
Skin-to-skin contact
Properly time cord clamping
Non-separation of mother and
baby
Early latching less than 1 hour
of life
3. Perform a complete physical Physical examination technique Lecture-discussion Written exam
examination, including Neurologic maneuvers SGD SGD output
APGAR score and neurologic Normal physical findings PBL Clinical performance
examination State of alertness Instructional video Mini-CEX
Vital signs Role playing
Components of APGAR score and Demonstration-return
interpretation demonstration
Anthropometric measurements Actual patient encounter
Gestational aging (Ballard’s exam)
Inspection, palpation, auscultation,
percussion
Normal physiologic variations in
80
newborn
Primitive reflexes
Levels of alertness (sensorium)
4. Provide comprehensive Risk assessment: maternal, fetal and Lecture-discussion Written exam
newborn care neonatal factors SGD SGD output
Application of EINC protocol to PBL Clinical performance
infants (34 weeks AOG or older) Instructional video Mini-CEX
Neonatal resuscitation Demonstration-return
Cord care demonstration
Thermoregulation
Bathing
Vitamin K prophylaxis
Eye prophylaxis
Immunizations (Hepatitis B, BCG)
Kangaroo care
Lactation promotion
5. Recommend newborn Concept, significance of newborn Lecture-discussion Written exam
screening after 24 hours of screening, procedures involved SGD SGD output
life and implications of results PBL Clinical performance
Demonstration-return Mini-CEX
demonstration OSCE
Bedside teaching
6. Provide proper newborn Involvement of both parents Lecture-discussion Written exam
care instructions to parents Kangaroo care SGD SGD output
and caregivers Lactation promotion PBL Clinical performance
Expression and storage of breast Demonstration-return Mini-CEX
milk demonstration OSCE
Cord care Bedside teaching
Signs of illness in the newborn Actual patient encounter
Well baby visits and immunizations
81
7. Discuss the anatomic, Deviation/aberration in intrauterine Lecture-discussion Written exam
physiologic and growth SGD SGD output
pathophysiologic basis of Predisposing maternal, placental, PBL Clinical performance
the manifestations of and fetal factors Demonstration-return Mini-CEX
problems in the newborn Classification of newborns according demonstration OSCE
to the Lubchenco chart Bedside teaching
Anatomic and physiologic Actual patient encounter
handicaps, potential
pathologies (risk assessment)
peculiar to each category
Feeding difficulties
Anatomic and physiologic
development of the digestive
system
Fluid, electrolyte, caloric, nutrient
requirements of the newborn
Normal variations in feeding
patterns
Signs and symptoms suggestive of a
feeding problem
Respiratory distress
Physiology of normal breathing in
the newborn
Signs and symptoms of
respiratory distress
Definition of apnea
Forms of cyanosis
Differences between pulmonary
and non-pulmonary causes of
respiratory distress
Classification of condition
82
according to severity
System/s involved based on
history and physical
examination
Vomiting, diarrhea, abdominal
distension
Normal stool patterns of the
newborn
Differences between organic and
non- organic causes of
abdominal distension
Manifestations of intestinal
obstruction and corresponding
level of obstruction
Abnormal secretions / discharges
Source/s of abnormal discharges
based on history and gathered
data
Pallor and bleeding
Normal hematologic values in
the newborn
Normal coagulation process
Causes of neonatal anemia
Differences between acute and
chronic blood loss
Different sources of bleeding
Jaundice
Neonatal bilirubin metabolism
Differences between physiologic
and pathologic jaundice
Various types of
83
hyperbilirubinemia
Jitteriness/ seizures
Differences between jitteriness
and seizure
Different types of neonatal
seizures
Correlation of seizure with
possible cause/s
Meconium-related disorders
Classification of meconium
staining
Prenatal/ perinatal factors
predisposing to the condition
Concomitant signs of fetal
distress on fetal monitoring
Potential problems relating to
meconium staining
Pathophysiology behind potential
problems
Temperature instability
Different methods of obtaining
body temperature and its
corresponding normal values
Signs and symptoms of
temperature abnormality
Acceptable alternative methods
of taking body temperature
Sensorial problems
Signs of irritability, alterations in
consciousness, changes in
muscle tone
84
Predisposing factors to above
condition/s
8. Elicit an accurate and Clinical presentation of problems in Lecture-discussion Written exam
thorough history with focus the newborn: SGD SGD output
on character and A. Deviations/ aberration in PBL Clinical performance
circumstances surrounding intrauterine growth Demonstration-return Mini-CEX
the manifestations B. Feeding difficulties demonstration OSCE
C. Cyanosis, respiratory Bedside teaching
distress and apnea Actual patient encounter
D. Vomiting, diarrhea,
abdominal distension/
constipation
E. Abnormal secretions/
discharges
F. Pallor and bleeding
G. Jaundice
H. Jitteriness/ seizures
I. Meconium- related
disorders
J. Temperature instability
K. Sensorial problem
9. Perform a complete physical Clinical findings Lecture-discussion Written exam
and neurologic examination SGD SGD output
PBL Clinical performance
Instructional video Mini-CEX
Role playing
Demonstration-return
demonstration
10. List differential diagnosis Lecture-discussion Written exam
based on evidence SGD SGD output
85
demonstration OSCE
Bedside teaching
11. Describe the natural course Lecture-discussion Written exam
of the illness SGD SGD output
demonstration OSCE
Bedside teaching
12. Determine the probable Asphyxia of the newborn Lecture-discussion Written exam
cause through appropriate ABG analysis SGD SGD output
work-up Urinalysis PBL Clinical performance
Occult blood in stools Demonstration-return Mini-CEX
Cranial CT scan demonstration OSCE
Renal function tests Bedside teaching
ECG Actual patient encounter
Chest x-ray
Coagulation studies
EEG
Intrauterine growth retardation
CBC
Microbiologic studies
Serologic studies
Chromosomal studies
Newborn screening
Respiratory distress syndrome
Chest x-ray
ABG analysis
86
Infections
CBC
Culture and sensitivity of body
fluids/secretions
Cranial ultrasound/CT scan
Hemolytic disease of the newborn
CBC
Coomb’s test
Blood typing of mother/ baby
Peripheral smear
Hematologic tests on other family
members
Bilirubin levels
Meconium aspiration syndrome
Chest x-ray
ABG analysis
Hemorrhagic disease of the
newborn
Coagulation studies, PT/ PTT,
coagulation factor
determination
Apt’s test
Birth trauma
Cranial ultrasound
Cranial CT scan
Radiographic examination of
body parts
Metabolic disorders
Hemoglucotest
Serum electrolytes
Serum calcium and magnesium
87
Urine metabolic screen
Renal function tests
Anatomic congenital anomalies
Imaging studies of organ involved
88
NEPHROLOGY

1. Recognize presenting signs Pathophysiology, epidemiology, Lecture OSCE
and symptoms of the ten clinical presentation, red flags of the SGD Written exam
(10) most common renal following renal syndromes: Preceptorials CEC
syndromes A. Glomerular diseases Demonstration/ practice CbD
1. Hematuria SGD output
2. Elicit a complete and 2. Proteinuria Mini-CEX
accurate history 3. Oliguria/anuria
4. Hypertension
3. Perform a complete physical 5. Post-infectious
examination glomerulonephritis
6. Nephrotic syndrome
4. List the differential B. Tubular disorders
diagnoses 1. Polyuria and polydipsia
2. Renal tubular acidosis
5. Discuss the epidemiologic 3. Tubulointerstitial nephritis
basis of the common renal C. Fluid and electrolytes
syndromes 1. Hyponatremia
2. Hypernatremia
3. Hypokalemia
4. Hyperkalemia
5. Hypocalcemia
6. Acid-base disorders
D. Systemic diseases
1. Systemic lupus
erythematosus
2. Henoch-Schoenlein
purpura
3. Infectious diseases of the
kidney
89
E. Hypertension
1. Primary
2. Secondary
F. Urinary tract disorders
1. Urinary tract infection
(UTI)
2. Urolithiasis
3. Obstructive uropathy
G. Congenital anomalies of the
kidneys and the urinary tract
(CAKUT)
H. Renal tumors
1. Wilms tumor
2. Renal cell carcinoma
I. Acute kidney injury
1. Pre-renal
2. Intrinsic
3. Post-renal
J. Chronic kidney ddisease
6. Select appropriate Principles, rationale, proper collection Lecture Written exam
laboratory work-up for the and correct interpretation of SGD OSCE
10 common renal diagnostic examinations for renal Preceptorials Mini-CEX
syndromes problems: SGD evaluation form
• Complete blood count
• Urinalysis
• Urine culture and sensitivity
• Blood chemistries: BUN,
creatinine, serum Na, K, Cl,
calcium, phosphorus,
magnesium, uric acid, TPAG,
lipid profile (include
90
cholesterol, triglycerides)
• Arterial blood gas
• Urine protein creatinine ratio
or 24 hour urinary protein
collection
• Creatinine clearance
• Imaging studies –
ultrasonography, Doppler
studies, x-rays, nuclear
imaging, CT scan
• Ultrasound guided renal
biopsy
7. Arrive at a working diagnosis
based on supporting
evidence
8. Discuss the principles of Indication, precaution, dosage, Lecture Case-based discussion
management of common duration of use, side effects of SGD SGD evaluation form
renal disorders therapeutic agents: Preceptorials OSCE
• Antimicrobials Mini-CEX
• Diuretics
• Anti-hypertensives
• Steroids and
immunosuppresants
• Renal supportive treatments –
erythropoietin, iron
supplement, sodium
bicarbonate, calcium
supplement, vitamin D
• Renal replacement therapy-
Dialysis [peritoneal dialysis
(PD) and hemodialysis (HD)]
91
and kidney transplantation
• Surgical procedures
9. Recognize • Pulmonary congestion Case-based learning Mini-CEX

emergencies • Hypertensive Clinical encounter Cards
emergencies/urgencies Written exam
• Uremic syndromes
• Severe electrolyte and acid
base disorders
10. Outline a program Lecture OSCE
for follow-up and SGD Mini-CEX
rehabilitative care Preceptorials SGD output
11. Identify the onset Lecture SGD

or presence of SGD CbD
complications, need Preceptorials CED
for further treatment
92
NEUROLOGY

1. Classify common neurologic Etiology of common neurologic Lecture-discussion Written exam

problems in terms of problems SGD SGD output
etiology and given Definition and classification of: PBL Group presentation
diagnostic criteria
• Seizures Oral exam
• Epilepsy syndromes (1989.
ILAE)
• Non-epileptic movement
disorders (based on ILAE
2010, 1989 & 1981)
• Primary headaches
• Secondary headaches
(Classification of headache
based on International
Headache Society)
• Criteria for the diagnosis of
headache and increased
intracranial pressure:
• Head trauma (Treatment
Guidelines and Pediatric
Glasgow Coma Scale)
• Congenital malformations
(cranial and spinal)
• CNS infections
• Movement disorders
Embryogenesis: Ontogenesis in the
development of the nervous
system (timelines in the
93
development of malformations
according to time of consult)
2. Describe the clinical Clinical presentation of common Lecture-discussion Written exam
presentation of common neurologic problems: SGD SGD output
neurologic problems • Seizure PBL Group presentation
• Headache Bedside teaching Oral exam
• Head trauma
• Congenital anomalies
• Developmental delay
• Weakness
Red flags in the developmental
milestones
Age limit for developmental
milestones
Algorithm in the diagnosis and
management of children with
developmental delay
Clinical characteristics of central vs.
peripheral cause of motor
weakness (UMN vs. LMN)
Algorithm in the diagnosis of
patients with common neurologic
symptoms/signs:
• Headache
• Seizures with fever
• Seizures without fever
94
• Developmental delay
(language, motor,
conduct/behavior problems)
• Congenital malformations
• Dysmorphisms
3. Elicit a complete and Components of neurological history Lecture-discussion Written exam
accurate history focusing on and pediatric history SGD SGD output
red flags for developmental Skill in history taking PBL Group presentation
delays and neurologic
Demonstration-return Oral exam
problems
demonstration Clinical performance
Instructional video Mini-CEX
Bedside teaching CEC
Actual patient encounters OSCE
4. Perform systematic and Knowledge of neuroanatomy and Lecture-discussion Written exam
thorough physical and neurophysiology SGD SGD output
neurologic examination in Steps and proper technique in doing PBL Oral exam
various pediatric age groups
PE and neurological examination Demonstration-return Clinical performance
Neurologic instruments demonstration Mini-CEX
Instructional video CEC
Actual patient encounters
5. Identify logical differential Localization based on signs and Lecture-discussion Written exam
diagnosis based on signs and symptoms SGD SGD output
symptoms Differential diagnosis considering PBL Oral exam
the patient’s age, sex, clinical Bedside teaching Clinical performance
course, findings and other Actual patient encounters Mini-CEX
associated conditions CEC
95
OSCE
6. Select appropriate Indications, contraindications of the Lecture-discussion Written exam
diagnostic examination to following examinations: SGD SGD output
establish the diagnosis • Skull series PBL Oral exam
• CSF examination (lumbar Bedside teaching Clinical performance
puncture) Actual patient encounters Mini-CEX
• CT scan (plain and with CEC
contrast)
OSCE
• MRI (head and spine)
• Cranial ultrasound
• EMG/NCV
• Muscle biopsy
• Nerve biopsy
• Spine x-rays
7. Outline the appropriate plan Short-term, long-term, Lecture-discussion Written exam
of management for patients pharmacologic, surgical SGD SGD output
with neurologic problems treatment and rehabilitation of PBL Oral exam
neurologic disorders: Bedside teaching Clinical performance
• CNS infection (viral, Actual patient encounters Mini-CEX
bacterial, TB) CEC
• Hydrocephalus OSCE
• Meningocoele/
encephalocoele
• Seizures and epilepsy
syndromes
• Epilepsy and epilepsy
syndromes
96
• Brain and spinal tumors

• Increased intracranial
pressure
• Acute flaccid paralysis
• Head and spine injury
• Headache and migraine
• Inborn errors of metabolism
• Congenital CNS infections.
• Neuromuscular disorders:
Myasthenia Gravis
• Congenital muscular
dystrophy
• Mental retardation
8. Discuss causes, clinical Normal intracranial pressure and Lecture-discussion Written exam
presentation, and physiology of CSF production and SGD SGD output
management of neurologic circulation PBL Oral exam
emergencies
Pathophysiology of increased Bedside teaching
intracranial pressure
Herniation syndromes, clinical signs
and anatomic correlates
Definition and algorithm in the
management of status epilepticus
Definition and causes of coma and
stages of altered consciousness
Pediatric Glasgow Coma Scale
97
9. Discuss with patient and Communication skill Lecture-discussion Written exam

family the neurologic Obtaining informed consent SGD SGD output
problem, course, prognosis Family counselling technique PBL Clinical performance
and management
Bedside teaching Mini-CEX
Actual patient encounters CEC
OSCE
98
ONCOLOGY
SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT
1. Identify presenting signs and Red flag signs Lecture-discussion Written exam
symptoms of common Clinical presentation of benign vs. SGD SGD output
malignancies in children malignant tumors PBL Clinical performance
Common pediatric tumors Preceptorials MiniCEX
Syndromes and systemic Bedside teaching OSCE
manifestations associated with
pediatric malignancies.
Feminization
Virilization
Bleeding
Others such as WAGR,
hypertension,
hemihypertrophy
2. Elicit complete and accurate Components of medical history Lecture-discussion Written exam
history Red flags SGD SGD output
Clinical presentation of common PBL Clinical performance
malignancies Demonstration-return MiniCEX
Communication skill demonstration OSCE
Interpersonal skill Preceptorials
Respect for confidentiality Bedside teaching
99
OBJECTIVES CONTENT
3. Perform thorough physical Steps in doing PE Lecture-discussion Written exam

examination Communication skill SGD SGD output
Compassion PBL Clinical performance
Respect for patient’s safety, comfort Demonstration-return MiniCEX
and privacy demonstration OSCE
Preceptorials
Bedside teaching
4. Select appropriate Blood examinations, including tumor Lecture-discussion Written exam

diagnostic examinations to markers SGD SGD output
establish the diagnosis Imaging studies: x-rays, ultrasound, PBL Clinical performance
CT scan, MRI Demonstration-return MiniCEX
Biopsy demonstration OSCE
Preceptorials
Bedside teaching
100
OBJECTIVES CONTENT
5. Arrive at a logical diagnosis Criteria for diagnosing and staging Lecture-discussion Written exam
and differential diagnosis common malignancies SGD SGD output
1. CNS tumors PBL Clinical performance
a. supratentorial (glioma, Demonstration-return MiniCEX
ependymoma) demonstration OSCE
b. infratentorial (cerebellar Preceptorials
medulloblastoma, brain Bedside teaching
stem glioma)
2. Retinoblastoma
3. Liver tumors (malignant
hepatoblastoma, benign
hemanioendothelioma)
4. Renal tumors (malignant Wilms
tumor, benign mesoblastic
nephroma)
5. Adrenal and endocrine tumors
(neuroblastoma,
pheochromocytoma)
6. Soft tissue tumors

(rhabdomyosarcoma,
fibrosarcoma)
7. Bone tumors (osteosarcoma,
Ewing sarcoma)
8. Germ cell tumors (germinoma)
9. Histiocytic (Langerhans cell
histiocytosis)
101
OBJECTIVES CONTENT
6. Recognize oncologic Clinical presentation and Lecture-discussion Written exam

emergencies pathophysiology of oncologic SGD SGD output
emergencies: PBL Clinical performance
Tumor lysis syndrome Demonstration-return MiniCEX
Superior vena cava syndrome demonstration OSCE
Intestinal and genitourinary Preceptorials
obstruction Bedside teaching
Neurologic symptoms
7. Discuss the general Management of oncologic Lecture-discussion Written exam

principles in the emergencies SGD SGD output
management of oncologic PBL Clinical performance
emergencies Demonstration-return MiniCEX
demonstration OSCE
Preceptorials
Bedside teaching
8. Discuss the principles of the Treatment options in the Lecture-discussion Written exam
different treatment options management of childhood SGD SGD output
in the management of malignancies: PBL Clinical performance
childhood malignancies Surgery Demonstration-return MiniCEX
Chemotherapy: adjuvant vs. demonstration OSCE
neoadjuvant Preceptorials
Radiotherapy Bedside teaching
Palliative care
102
OBJECTIVES CONTENT
9. Recognize the importance of Multidisciplinary approach Lecture-discussion Written exam

multidisciplinary care Team work SGD SGD output
Demonstration-return MiniCEX
demonstration OSCE
Preceptorials
Bedside teaching
10. Discuss with the Psychological, social, emotional SGD Written exam
patient/family the nature of aspects of illness PBL SGD output
the problem and Principles of disclosure Demonstration-return Clinical performance
management options Empathy demonstration MiniCEX
Communication skill Role play OSCE
Interpersonal skill Preceptorials
Honesty Bedside teaching
Confidentiality
11. Promote primary and Communication skills Lecture-discussion Written exam

secondary cancer prevention Risks associated with malignancies SGD SGD output
Primary and secondary cancer PBL Clinical performance
prevention Public health lecture MiniCEX
Preceptorials OSCE
Bedside teaching
12. Recognize the roles of Team work Lecture-discussion Written exam

family, primary physician, Involvement of the family and other SGD SGD output
government agencies and institutions in the care of the PBL Clinical performance
private organizations, in the patient Public health lecture MiniCEX
management of childhood Preceptorials OSCE
malignancy Bedside teaching
103
RESPIRATORY DISORDERS

1. Explain the anatomic, Anatomy and physiology of the Lecture-discussion Written exam
physiologic and respiratory system SGD Graded oral recitation
pathophysiologic basis of PBL Written report
the presenting Pathophysiology of common Practical exam
problem/complaint. respiratory complaints: Clinical performance rating
Nasal catarrh Oral exam
Sneezing OSCE
Hoarseness CEC
Cough MiniCEX
Stridor
Wheezing
Gurgly chest (halak)
Hemoptysis
Chest pain
Difficulty of breathing
Cyanosis
2. Elicit a complete history Complete history of the patient, Demonstration-return Written exam
which focuses on the focus on respiratory demonstration Written report
character and circumstances complaint/problem Preceptorials Practical exam
surrounding the complaint. Communication skill Bedside teaching Clinical performance rating
Interpersonal skill Oral exam
Respect for patient’s privacy OSCE
confidentiality CEC
Thoroughness MiniCEX
104
3. Perform a complete PE Complete PE including BP in all Instructional video Written exam
using inspection, palpation, extremities, body weight and Demonstration-return Graded oral recitation
percussion, and height (length), cyanosis +/- demonstration Written report
auscultation clubbing of nailbeds, edema , Preceptorials Practical exam
pulses upper and lower Bedside teaching Clinical performance rating
extremities, dysmorphic features Actual patient encounters Oral exam
Cardiac examination: chest OSCE
symmetry, point of maximal CEC
impulse and location, heave, MiniCEX
thrill, heart sounds and murmur,
rhythm and rate
Communication skill
Consideration for the patient’s
safety, comfort and privacy
4. Determine the most likely Correlation and findings on PE with Lecture-discussion Written exam
abnormality and severity knowledge of the anatomy and SGD Graded oral recitation
based on information physiology of the respiratory PBL Written report
gathered system Preceptorials Clinical performance rating
Signs and symptoms presented and Bedside teaching Oral exam
their severity Actual patient encounters OSCE
CEC
MiniCEX
5. List the logical differential Approach to differential diagnoses Lecture-discussion Written exam
diagnosis based on gathered Primary diagnosis and bases PBL Graded oral recitation
data. Upper respiratory tract: SGD Written report
A. Rhinitis Bedside teaching Practical exam
B. Pharyngitis Clinical performance rating
Oral exam
C. Sinusitis
OSCE
D. Otitis media CEC
E. Tonsillitis MiniCEX
105
F. Epiglottitis
G. Acute laryngotracheobronchitis
Lower respiratory tract:
A. Bronchitis
B. Bronchiolitis
C. Pneumonia
D. Asthma
E. Pulmonary tuberculosis
6. Choose the appropriate Indications, availability, reliability of Lecture-discussion Written exam
diagnostic examinations to diagnostic examinations PBL Graded oral recitation
establish the diagnosis Pulse oximetry SGD Written report
Complete blood count Bedside teaching Clinical performance rating
Microbiological studies Oral exam
Tuberculin skin tests OSCE
Blood gas analysis CEC
Chest radiograph MiniCEX
Special procedures, to include:
Spirometry
Peak flow measurement
Thoracentesis
Lung tap
Lung biopsy
Bronchoscopy
Fluoroscopy
Chest ultrasonography
Ventilation / perfusion scan
Computed tomography
Magnetic resonance imaging
Written informed consent
containing:
106
Psychological support to the
patient and family
Importance and principles of asepsis
in the collection of biological
specimen
Interpretation of the results of
laboratory tests done
Correlation of laboratory test results
with the clinical data, differential
diagnosis and natural course of
the illness
Adverse clinical outcomes of
diagnostic tests
7. Establish the diagnosis using Criteria for the diagnosis of common Lecture-discussion Written exam
evidence respiratory diseases PBL Graded oral recitation
SGD Written report
Bedside teaching Practical exam
Oral exam
OSCE
CEC
MiniCEX
8. Outline a plan of treatment Relevance, availability, socio- Lecture-discussion Written exam
for emergency care, economic factors, rehabilitative PBL Graded oral recitation
definitive care, and long- care and schedule of follow-up in SGD Written report
term/rehabilitative care for the common respiratory diseases Bedside teaching Practical exam
various respiratory diseases Indications for hospitalization and Clinical performance rating
emergency care of patients with Oral exam
respiratory diseases OSCE
Steps in emergency care CEC
Respiratory resuscitation technique MiniCEX
107
and stabilization measures
Specific therapeutic agents:

Decongestants
Antihistamines
Cough suppressants
Mucolytics/expectorants
Anti-asthma agents
Antimicrobial agents
Oxygen
Methods of postural drainage,
bronchial clapping steam
inhalation and inhalational
therapy
Technique of oro- and naso-
pharyngo-tracheal lavage and
suctioning
Principles of pulmonary
rehabilitation
Recognition of complications and
need for referral
Mastoiditis
Retropharyngeal abscess
Pleural effusion
Lung abscess
Air leak
Atelectasis
Respiratory failure
Bronchiectasis
Cor pulmonale
108
9. Provide health education to Effects of respiratory disease to the SGD Clinical performance rating
families to prevent patient and his family and its Role play OSCE
occurrence of acquired implications to the community Bedside teaching MiniCEX
heart disease and its Actual patient encounters
complications Epidemiologic factors affecting the
occurrence, spread and chronicity
of respiratory disease
Role of medical, paramedical and
traditional health providers in the
management and control of
respiratory disorders
Interaction and dynamics between
the family and respiratory disease
Preventive measures
109
Section III: SELECTED TOPICS
ADOLESCENT RISK-TAKING BEHAVIORS

LEARNING ACTIVITIES EVALUATION METHODS
1. Describe the different Risk behaviors in adolescents Lecture-discussion Written exam
risk behaviors and related Reasons of concern for the physician SGD SGD output
factors Factors that relate to different risk PBL
taking behaviors: risk and
protective factors
Theories on risk taking behavior
(the teen brain)
2. Discuss national DOH goals for healthy adolescents Lecture-discussion Written exam
epidemiology on adolescent and youth development SGD SGD output
mortality and morbidity DOH current statistics on top 10
mortality and morbidity
PPS top 10 mortality and morbidity
in accredited hospitals
3. Analyze the impact of various Adolescent sexual behavior and teen Lecture Written exam
risk behaviors on the pregnancy SGD SGD output
adolescents Suicide and depression PBL
Alcohol use
Tobacco use
Drug use
Obesity and overweight and other
eating problems
Violence
4. Do risk assessment of given Assess developmental needs and Lecture Written exam
adolescent patients determine co-variation in risk behaviors Bedside teaching Clinical performance
5. Provide health guidance for Health guidance SGD Clinical performance
adolescent patients Communication skills Role play OSCE
Bedside teaching
112
CHILD PROTECTION

1. Recognize interpersonal Epidemiology Lecture “Child Abuse”

violence, child abuse and Human behavior Community visits Notebook-Reflections
neglect as a public health Definitions Agencies/institution visits SGD output
problem and an ethical Barriers to care SGD
concern Society myths
2. Discuss the primary, Strategies fo primary, secondary, Lecture “Child Abuse”
secondary & tertiary tertiary prevention of interpersonal SGD Notebook-Reflections
prevention of interpersonal violence, child abuse and neglect Case presentation
Enumerate the risks & protective
violence, different forms of Community visits
factors
child abuse and neglect Importance of the interaction between Agencies/institution
the child and the environment visits
Anticipatory guidance during Well Child Preceptorials
visits
Resources & programs available in the
community
Programs & policies of government eg.,
Breastfeeding, Parenting,
Conditional Cash Transfer
3. Diagnose interpersonal Appropriate history from child and Lecture Written exam
violence, the different forms family Case presentations Preceptorials
of child abuse & neglect Diverse clinical presentations, signs and Case studies SGD output
through appropriate medical symptoms 4R’s modules of the
history, physical findings and Laboratory examinations when Department of Health
laboratory exams when warranted
warranted Recording & documentation of
113
pertinent findings
4. Explain the micro and macro Neurobiological effects of abuse Lecture Written exam
effects of interpersonal Connection between violence, poverty, SGD Case studies with
violence and the different substance abuse, crime, educational Case studies reflections
forms of child abuse and attainment & health later in life Community visits
neglect
5. Discuss the legal and ethical Philippine laws on domestic violence Lecture Written exam
implications of interpersonal & child protection SGD Preceptorials
violence, different forms of Confidentiality Seminars Case report
child abuse and neglect Proper documentation
Reporting responsibilities
Role of the physician
Referral system
114
COMMUNITY PEDIATRICS

1. Identify the relevant data Purpose and importance of situational Community-guided tour Graded oral presentation
indicative of the child health analysis followed by assigned Written report
situation in the community Ecologic concepts of health and disease clinicians / consultants and Practical exam
and the factors responsible data categories in the health areas: discussion or field study Written exam
for it when asked to examine Demographic Project work
a hypothetical situation, after Health status Hands-on exercises or practice
a tour of the community Ecologic data sessions after Iecturette by
Health resources teacher
Health policy data Read handout, then class
Review of sources and methods of data discussion
collection, organization and Critique of report
presentation of data
Brief overview of vital and health
statistics
Appraisal of given information
Essentials in the preparation of a report
2. Identify possible sources of How to locate resources and type of Class discussion Observation
assistance using a list of resources (NGO, church, health center, Site visit Area mapping
locally available resources to DOH, NSO, school, hospital, market Seminar paper Written exam
solve problem/s identified place, police outpost)
and point out possible
obstacles when using these
resources
3. Administer first aid, diagnose Review major features of history of the Practice interview on Practical exam
and treat common childhood patients / health situations classmate or real patients Written exam
complaints Integrated Management of Childhood Video tape sessions and Oral exam
a. List question series to Illness (IMCI) diagnosis and management critiquing of history
explore specific protocol IMCI diagnosis and
complaint/s Life support in pediatric emergencies management using model
115
b. Ask follow-up questions to case
verify given history Return demonstration
c. Determine diagnostic
considerations and
therapeutic options after
completing the history
4. Refer complex cases for Assessing the need for referral Demonstrate referral process Practical exam
prompt intervention Referral possibilities and procedures using case model for Written exam
a. Identify sources of Reasons / indications for referral illustration
assistance and service Communication with professionals from
desired other disciplines and families
b. Complete referral forms
after identifying problems
faced
c. Explain necessity of referral
including arrangements to
be made with the family of
the patient and referral
center
5. Participate in health Brief overview of health education: Lecture-discussion Practical exam
promotion activities on the Communication process Demonstration Written exam
following sample topics: Principles and methods Instructional video Graded lecture
a. Child care and nutrition Selection and use of audiovisual aids demonstration
b. Basic sanitation and Steps in behavioral change
personal hygiene
c. Accident protection and
safety promotion
d. Vegetable gardening
e. Recognition of common
infections
f. immunization
116
6. Prepare a work plan to Steps in preparing the work plan Project work Graded oral presentation
address child health Purpose and activities Written report
problems Resources required Critiquing of sample of a
a. Formulate clear objectives Problems anticipated work plan
b. List all activities to be
carried out, specifying
dates of completion and
how they will be
accomplished
c. Lest required resources
and who will perform the
activities
7. Disaster preparedness Disaster preparedness program Disaster demonstration / drills Oral report
response Lecture - demo Written exam
8. Prepare an evaluation plan Why evaluate Project work Graded project
for a specific activity to assess Steps in evaluating Group study of an activity / evaluation report and
its effects / impact on a Methods of evaluation project for evaluation oral presentation
target Process and outcome evaluation
9. To train a new breed of 8 Elements of Primary Health Care Lecture Monitoring and
health workers that will serve Pillars of Primary Health Care Project proposal or seminar evaluation of the
as Primary Health Care Role modeling paper research study project
teachers Lecture demo on selected values
• Inculcate value formation
• Teaching children and
youth the value of early
responsibility, respect for
elders, love of God, family
and neighbor
117
10. Keeping vulnerable groups Strengthening of family ties and OFWs Lecture Monitoring and
informed and educated on Counseling formation Project proposal or seminar evaluation of the
available support system To identify children at risk (eg., children paper research study project
caught in arm conflict, street children)
118
EMERGENCY PEDIATRICS

1. Recognize the seriously ill Basic principles of triaging Lecture-discussion Written exam
and/or injured child Age-related anatomy and normal Modules Oral exam
physiology SGD SGD output
Focused clinical history taking and PBL Clinical performance
physical examination Actual patient encounter Mini-CEX
Pattern recognition for
physiological and clinical
decompensation
High risk clinical features
2. Diagnose common pediatric Common pediatric medical Lecture-discussion Written exam
medical emergencies emergencies and their causes: Modules Oral exam
a. Shock (hypovolemic, SGD SGD output
cardiogenic, distributive PBL Clinical performance
and obstructive) Preceptorials Mini-CEX
b. Respiratory distress and
Bedside teaching
failure (pulmonary and
non-pulmonary) Self-directed learning
c. Upper airway obstruction
d. Asthma and status
asthmaticus
e. Bronchiolitis
f. Pneumonia
g. Rhythm disturbances
h. Congestive heart failure
(congenital and acquired)
i. Gastrointestinal bleeding
119
j. Abdominal pain
k. Acute gastroenteritis and
dehydration
l. Fluid and electrolyte
disturbances
m. Gut obstruction (partial
and complete)
n. Renal failure (acute and
chronic)
o. Urinary tract infection in
infants
p. Seizures and status
epilepticus
q. CNS infection
r. Anaphylaxis
s. Sepsis and septic shock
t. Diabetic ketoacidosis
3. Recognize common Clinical presentation of common Lecture-discussion Written / oral exam
childhood injuries and childhood injuries: Modules CEC
pattern of injuries a. Head injury SGD
b. Fractures and soft tissue PBL
(Please see Module on Injuries) injury Preceptorials
c. Lacerations and wound
Bedside teaching
management
d. Motor vehicular accidents Self-directed learning
e. Burns
f. Poisoning
g. Drowning and near
drowning
h. Animal bites
120
i. Non-accidental injuries
4. Describe the pathophysiology Pathophysiology of common Lecture Written exam
of the common pediatric pediatric medical emergencies SGD Oral exam
medical emergencies PBL SGD output
Self-directed learning
5. Outline the plan of Basic life support (infant, child and Lecture-discussion Written exam
management for pediatric adult) Video presentation SGD output
medical and traumatic Principles of pediatric advanced life SGD CEC
emergencies support PBL
Structured approach to the acutely Demonstration-return
ill and/or injured child: demonstration
a. Airway Module simulation
b. Breathing Problem-based discussion
c. Circulation ER team participation
d. Drugs and disability
Self-directed learning
e. Exposure
f. Fluids
Specific emergency treatment for
each condition
Timely referral to subspecialties
6. Outline complications Common pediatric medical Lecture-discussion Written exam
associated with common emergencies SGD Oral exam
pediatric medical and Common childhood Iinjuries PBL SGD output
traumatic emergencies Self-directed learning
7. Perform common pediatric Bag-mask ventilation Lecture-discussion Clinical performance
procedures Basic cardiopulmonary Video presentation Practical exam
resuscitation Demonstration-return OSCE
121
IV cannulation demonstration DOPS

Nasogastric/orogastric tube Actual patient encounter
insertion
Lumbar puncture
Foley catheter insertion
Basic suturing and wound dressing
Spine and neck immobilization and
hard collar application
Splinting techniques
Basic foreign body removal
122
ENVIRONMENTAL PEDIATRICS AND POISONING

1. Explain the concept of pediatric Pediatric environment health Lecture-discussion Written exam
environmental health Physical and human environment SGD SGD output
Vulnerability of the pediatric age group PBL
to environmental toxins
2. Discuss the vulnerability of Critical windows of vulnerability in the Lecture-discussion Written exam
children to environmental different age groups SGD SGD output
toxicants PBL
3. Identify the common Sources of exposure and clinical Lecture-discussion Written exam
environmental threats to the presentation of common toxicities: SGD SGD output
health of children Lead PBL
Mercury
Arsenic
Indoor and outdoor air pollution
Environmental tobacco smoke
Pesticides
Drinking water contamination
Endocrine disruptors
Food contaminants
Herbs, dietary supplements
Noise
Electric and magnetic fields
Ionizing radiation
Biphenyls and dioxin
4. Recognize specific physical Physical examination findings that may Lecture demonstration Written exam
examination findings that may signal environment toxicant Discussion Direct observations
signal environment toxicant exposure:
exposure A. Pallor
B. Cyanosis
C. Hyperkeratosis
123
D. Chloracne
E. Mee’s lines
F. Gingival lines
G. Wheezing
H. Chronic abdominal pain and colic
I. Diarrhea
J. Seizures
K. Attention deficit-hyperactivity
disorders
L. Development delays
5. Integrate environmental issues or Daily environmental issues or concerns Lecture-discussion Written exam
concerns into health supervision Diet SGD SGD output
(ie,, well and sick child visits, Hobbies PBL MiniCEX
continuity clinic, in-patients, etc.) Child and adolescent employment Bedside teaching OSCE
Actual patient encounters Clinical performance
6. Provide anticipatory guidance to Preventive measures Lecture-discussion Written exam
prevent and abate exposures SGD SGD output
PBL MiniCEX
Actual patient encounters Clinical performance
7. Apply the principles of risk Principles in risk assessment Lecture-discussion Written exam
assessment to common SGD OSCE
environmental toxicants PBL
Bedside teaching
8. Demonstrate the skills for risk Communication skills Role play Project report
communication in relation to Bedside teaching
environmental pediatrics Actual patient encounters
124
9. Encourage parents to seek Health education SGD Clinical performance
solutions to their environmental Environmental health advocacy PBL
concerns through education Role play
from their health care provider Actual patient encounter
local and national resources and
organizations
125
ETHICAL ISSUES IN PEDIATRICS

LEARNING ACTIVITITIES METHODS
1. Discuss basic concepts in Faith theory in relation to medicine Lecture Oral exam
medical ethics The human person as an individual SGD Written exam
requiring dignity and respect PBL SGD output
Rights of children
2. Explain the bioethical Bioethical principles: Lecture-discussion Oral exam
principles Autonomy / paternalism SGD Written exam
Informed consent PBL
Truth telling
Stewardship
Withholding information, privacy and
confidentiality
Beneficence and maleficence
Double effect
Totality
Cooperation
Justice
3. Apply the principles of Oath of Hippocrates Lecture-discussion Oral exam
medical ethics Philippine Medical Association / PBL Written exam
in physician-patient Philippine Pediatric Society Medical Code Bedside teaching Written report
relationship of Ethics Actual patient contact Clinical performance rating
Physician-physician relationship (consult OSCE
and referrals)
Physician-nurse relationship
Physician-student relationship
Assent of children
Truth telling and professional secrecy
Proxy decision making and informed
consent
Issues regarding professional fees and
126
LEARNING ACTIVITITIES METHODS
honoraria
4. Elaborate on principles of Allocation of scarce resources / poverty- SGD Reflection paper
ethics in physician-God related issues PBL
relationship Relationship with pharmaceutical firms
Virtues of a physician
Rights to religious belief
5. Discuss issues regarding life, Sanctity of life Lecture Oral exam
death and dying Care of terminally ill child: palliative / SGD Written report
hospice care Actual patient encounters Reflection paper
Care of defective newborn / special Bedside teaching SGD output
children Clinical performance
Withdrawing and withholding life- OSCE
prolonging treatment
Ethical and legal issues in organ
Transplantation
6. Discuss ethical and legal Legal issues Lecture-discussion Written exam
issues involving research in SGD SGD output
children PBL Reflection paper
7. Discuss the Human Genome Implication of gene therapy Lecture Written exam
project Advantage and disadvantages of SGD, PBL SGD output
screening and counseling Case study
8. Recognize the role of Role of Bioethics Committee and Review Lecture Written exam
bioethics committee/ Board SGD, PBL SGD output
Institutional Review Board Case study
(IRB)
9. Demonstrate ethical and Ethical principles Bedside teaching MiniCEX
professional practice in all Professionalism Actual patient encounters Clinical performance
dealings with patients, their MSF
families and the other
members of the healthcare
team
127
GENETICS

1. Realize the burden of genetic 1. Health impact of birth defects and SGD SGD output
disorders in childhood inborn errors of metabolism locally PBL
(incidence, diagnostic delays, barriers
to effective genetic services)
2. Discuss ways for prevention of genetic
disorders (ie., folic acid, genetic
counselling, birth defects surveillance
initiatives)
2. Recognize the role of genetic General organization of the human Lecture-discussion Written exam
factors in health and disease genome and the structure and SGD SGD output
function of genes PBL
Human genome, gene, gene activity
during development and in
normal and pathological cell
function
Patterns of inheritance
Principles and genetic basis of
mitochondrial inheritance and
disease
Nature of mutations and how they
contribute to human genetic
variation and disease
Concepts and clinical relevance of
genetic imprinting and
uniparental disomy
Factors that affect the development
of the phenotype in single gene
disorders including variable
128
expressivity and incomplete
penetrance
Genes and Diseases
Clinical manifestations of common
Mendelian disorders
Basic principles of inborn errors of
metabolism
Principles of multifactorial
inheritance
How genes interact with other genes
and how various environmental
factors contribute to disease
Genetic polymorphisms, gene
mapping, linkage analysis and
association studies and their use
in medicine
Chromosomes and chromosomal
abnormalities
Organization of genes into
chromosomes, chromosomal
replication in mitosis and meiosis,
transmission of chromosomes
from parent to child
Clinical features of common
numerical, structural and mosaic
chromosomal abnormalities
Population genetics
How principles of population
genetics account for varying
frequencies of particular
mutations in population, effects
129
of consanguinity and continuing
occurrence of new mutations
Population screening for genetic
disease:
Newborn screening
Carrier screening
Presymptomatic screening
3. Elicit a comprehensive Features in a patient’s medical history Lecture Written exam
history, family medical that suggest the presence of a genetic SGD SGD output
history, disease PBL Mini-CEX
Family history with pedigree using Preceptorials OSCE
appropriate and acceptable symbols Bedside teaching CEC
Patterns of inheritance and other signs Actual patient encounters
suggestive of a genetic disease in a
family history
4. Perform a thorough physical Features in the physical examination or Lecture Written exam
examination laboratory investigations that suggest SGD SGD output
the presence of a genetic disease PBL Mini-CEX
Preceptorials OSCE
Bedside teaching CEC
5. Identify patients with strong Mendelian and Non-Mendelian Lecture Written exam
inherited predispositions to disorders, chromosomal SGD SGD output
common disease and abnormalities and inborn PBL Mini-CEX
facilitate appropriate errors of metabolism Preceptorials OSCE
assessment of other at-risk Bedside teaching CEC
family members Actual patient encounters
6. Select appropriate diagnostic Diagnostic tests for various genetic SGD Written exam
tests conditions PBL SGD output
OSCE
130
CEC
7. Discuss ways to prevent Prevention of genetic disorders: folic SGD Written exam
genetic disorders acid, genetic counseling, birth defects PBL SGD output
surveillance initiatives Role play Clinical performance
OSCE
CEC
8. Outline appropriate Principles of management of genetic Lecture Written exam
management of genetic conditions SGD SGD output
conditions PBL Clinical performance
Preceptorials Mini-CEX
Actual patient encounters CEC
131
INTEGRATED MANAGEMENT OF CHILDHOOD INFECTIONS

1. Discuss the IMCI approach in Epidemiology of the top 10 morbidity Reading reference Written exam
the management of common and mortality among the under-5 Case-based SGD
pediatric diseases in the children
Objectives of IMCI
Philippines.
Steps (Assess, Classify, and Treat) in the
IMCI approach to management of
childhood diseases
2. Assess and classify a sick General danger signs ICATT (IMCI Direct observation
child (2 months to 5 years) Four major symptoms Computerized Adaptive OSCE
according to the IMCI • Cough and difficulty of breathing Training Tool) material Recording of patient
• Diarrhea and dehydration Community exposure encounters using a pediatric
approach
• Fever card to monitor number and
• Ear problem classification of patients
Malnutrition and anemia seen
Other problems
Need for immunization, vitamin A
supplementation and deworming
3. Assess and classify a sick Major concerns ICATT material Direct observation
young infant (0 to 2 months) • Signs of serious bacterial infection Community exposure OSCE
according to the IMCI • Jaundice Recording of patient
• Diarrhea and dehydration encounters using a pediatric
approach
Feeding and malnutrition card to monitor number and
Other problems classification of patients
Need for immunization seen
132
OBJECTIVES CONTENT SUGGESTED SUGGESTED EVALUATION
TEACHING-LEARNING METHODS
ACTIVITIES
4. Treat the sick child and young IMCI treatment guidelines on drugs, Actual patient Direct observation
infant according to the IMCI fluids and feeding care/case studies OSCE
approach Guidelines on referral Demonstration and
return-demonstration
on immunization
techniques
5. Demonstrate counseling and Importance of drug completion Actual patient care Direct observation
communication skills to Administration of drugs (how and when Role play OSCE
mothers and caregivers to give) and immunization
Advice on feeding and fluids
Advice on follow-up
Counseling and communication skills
133
PHARMACOLOGY AND THERAPEUTICS

1. Discuss the unique Comparative anatomy and physiology of the following Lecturette Written exam
anatomic and physiologic systems: SGD Oral presentation
features that distinguish Skin Plenary report, open forum Recitation
children from adults Gastrointestinal
Central nervous system
Cardiovascular system
Respiratory
Renal
Endocrine
2. Explain how these Absorption Lecturette Written exam
anatomic and physiologic Distribution SGD Oral presentation
features influence drug Metabolism Plenary report, open forum Recitation
handling and response in Excretion
children
3. Explain how some Protein-calorie malnutrition Lecturette Written exam

pathologic states that Obesity SGD and case exercises Oral presentation
affect drug handling Edema Plenary report, open forum Recitation
require dose adjustment Dehydration
Acidosis
Renal and hepatic insufficiency
Hyperbilirubinemia
Principles of pharmacokinetics
134
4. Describe the different Levels of drug interaction: Lecturette Written exam
levels of drugs interaction In-vitro drug incompatibility SGD and case exercises Oral presentation
and cite example Absorption Plenary report, open forum Recitation
Distribution
Metabolism
Excretion
5. Explain commonly Adverse drug reactions (ADRs): Lecturette Written exam
encountered adverse drug Definition SGD and case exercises Multiple choice questions
reactions Types of ADRs Plenary reports, open forum Oral presentation
Common ADRs in children Recitation
6. Explain the adverse effects Adverse drug reactions in the fetus and Lecturette Written exam
of drugs on the fetus and lactating infant SGD and case exercises Multiple choice questions
lactating infant when given Plenary reports, open forum Oral presentation
to mothers Recitation
135
PREVENTIVE PEDIATRICS

1. Provide anticipatory Newborn, infant, childhood, Role playing Class participation
guidance to patients and and adolescence Reporting
parents on health anticipatory guidance
maintenance practices in Newborn screening
an ambulatory care setting Serologic screening tests
a. Discuss anticipatory Vision and hearing
guidance packages Blood pressure
according to age Dental hygiene
groups PPD screening test
b. Discuss screening tests
routinely used in health
care maintenance visits
2. Recommend and Principles of immunization and Lecture Written exam
administer indicated vaccination coverage Case presentation Observation
childhood vaccinations at Indication / contraindication Simulation Practical exam
various age groups and Adverse events
situations Vaccination procedure
a. Discuss principles of
immunization and
vaccination based on
immunologic,
epidemiologic, and
biochemical rationale
b. Discuss the Expanded
Program of
Immunization
(EPI) of the Philippines
c. Discuss other vaccines
available but not
136
included in EPI
3. Monitor growth and Anthropometric monitoring Simulation Practical exam
development of patients (weight, length / height, Role play Class participation
head circumference)
Behavior and other
developmental
considerations, eg,
tantrums, toilet training,
school readiness, play / toy
/other socialization activities
4. Explain the nutritional Food groups, breastfeeding and Buzz group Class participation
requirements according to artificial feeding, weaning
age group and aspects of
nutrition
5. Obtain thorough, adequate Growth and development Simulation Observation
and dynamic data Immunization history Oral exam
Nutrition history Rating scale
Family history
Personal and behavior profile
137
BOARD OF TRUSTEES, 2013-2014
OFFICERS
President MELINDA M. ATIENZA, M.D.

Vice President MILAGROS S. BAUTISTA, M.D.
Secretary ALEXANDER O. TUAZON, M.D.
Assistant Secretary MA. NOEMI T. SALAZAR, M.D.
Treasurer SALVACION R. GATCHALIAN, M.D.
Assistant Treasurer ANITA G. MARASIGAN, M.D.
Immediate Past President GENESIS C. RIVERA, M.D.
MEMBERS
BENITO P. ATIENZA, M.D.

JOSELYN A. EUSEBIO, M.D
MA. ANTONIA S. GENSOLI, M.D.
KATHRYN RUBY C. LAGUNILLA, M.D.
MAY B. MONTELLANO, M.D.
MA. LOUISA U. PERALTA, M.D.
FLORENTINA U. TY, M.D

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Philippine Pediatric Society, Inc.

A Curriculum for Undergraduate Pediatric Education

A Curriculum for Undergraduate Pediatric Education

Copyright Reg. No. O2014-174

The Philippine Pediatric Society, Inc. (PPS)

The Filipino Children

CARMELO A. ALFILER, MD, MD, FPPS, FPSN, FPNSP

MELFLOR A. ATIENZA, MD, MHPEd, FPCP, FPSG, FSDE

MELINDA M. ATIENZA, MD, MHPEd, FPPS, FPSPME

MILAGROS S. BAUTISTA, MD, FPPS, FPAPP, FPCCP

MELINDA M. ATIENZA, MD, MHPEd

Continue the good work.

FERNANDO S. SANCHEZ, JR., M.D., MPH

HON. EDGARDO T. FERNANDO, MD

Chair: CARMELO A. ALFILER, MD

Resource Person: MELFLOR A. ATIENZA, MHPEd, UP-NTTC for Health Professionals

Action Plans: (1) To produce a core syllabus in undergraduate Pediatrics

Child Neurology Society of the Philippines (CNSP) Rosalina Q. De Sagun, MD

INVITED SUBSPECIALTY GROUPS AND EXPERTS

Pediatric Rheumatology Leonila F. Dans, MD, Cherica A. Tee, MD

PEDIATRIC DIAGNOSIS AND PROCEDURES ORGAN SYSTEM DISORDERS

DATA GATHERING, RECORDING AND PRESENTATION ALLERGY

Joselito Matheus (Chair) Agnes Gonzalez-Andaya

PEDIATRIC PROCEDURES Leonila Dans

Ronald LImchiu Rebecca Castro

Ofelia De Leon Joseph Vincent Alba

Jossie Rogacion (Chair)

ADOLESCENCE Melanie Alcausin

Jonathan Cu PEDIATRIC PHARMACOLOGY AND

NATIONAL CAPITAL REGION

1. Ateneo de Manila University

CORDILLERA ADMINISTRATIVE REGION

13. Baguio Central University

29. Silliman University Medical School REGION 9

31. Gullas College of Medicine 35. Mindanao State University

37. Davao Medical School of Medicine

FACILITATOR SUBSPECIALTY SOCIETIES AND SECTIONS

Philippine Society of Newborn Medicine (PSNbM)

Data Gathering, Recording and Presentation……………………………………………………………..…………….……………………………………………. 5

Section II: ORGAN SYSTEM DISORDERS……………………………………………………………………………………………………………………………………………………………. 28

Section III: SELECTED TOPICS…………………………………………………………………………………………………………………………………………………………………………….. 110

Adolescent Risk-Taking Behaviors………………………………………………………………………………………..………………………………………………….. 112

Board of Trustees, 2013-2014……………………………………………………………………………………………………………………………………………………………………………. 138

Undergraduate Pediatric Education Curriculum

SGD Small group discussion

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

Reference values for age and sex

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

3. Discuss the Appropriate physical activity at various Lecture Written exam

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION

OBJECTIVES CONTENT SUGGESTED TEACHING- SUGGESTED EVALUATION