Philippine Pediatric Society

CORE PEDIATRICS
1.0 GROWTH AND DEVELOPMENT (AMBULATORY SECTION/DEVELOPMENTAL
PEDIATRICS)

1.1. Anthropometrics

1.1.1. Normal
i. Know the prenatal and postnatal growth and development
ii. Use standard growth charts and monitoring

1.1.2. Abnormal (non-endocrine)

i. Know the factors affecting height
 Most common causes of short stature
 Familiar influence
ii. Recognize the causes of failure to thrive
 Organic
 Non-organic

1.2. Behavioral

1.2.1. Know the fine and gross motor, cognitive, socio-emotional and language
milestone at:
 8 weeks
 16 weeks
 52 weeks
 18 months
 24 months
 4 years
 5-9 years
 10-19 years

1.3. Abnormal growth and behavior

Know the principle of management.

2.0 NUTRITION AND NUTRITIONAL DISORDERS (GI SECTION)

2.1. Normal nutritional requirements

2.1.1. Recognize the age related requirements

i. Newborns
 Term
 Preterm
ii. Infancy
iii. Childhood
iv. Adolescence
Know that rickets may develop with low intake of calcium and
phosphorus
 Know the rationale for including medium-chain triglycerides in
the milk formula
 Know the protein requirements
 Know the iron requirements of adolescent girls

2.1.2. Know the iron, calcium, phosphorous and folic acid requirements in
different age group

2.2. Breastfeeding

2.2.1. Know the benefits of breast milk and breastfeeding

2.2.2. Know the diseases prevented by breast milk
2.2.3. Know the methods employed in lactation management
2.2.4. Recognize the problems in lactation and formulate solutions
2.2.5. Know which drugs are contraindicated in breastfeeding
2.2.6. Know the absolute and relative contraindications to breast feeding

2.3. Infant feeding

2.3.1. Know how to compute for the caloric requirement of an infant

2.3.2. Know the micronutrient requirements, their supplementation and
deficiencies
2.3.3. Recognize the differences between breast milk and artificial formula
2.3.4. Know the special formulas and their indication
2.3.5. Know the rationale for milk formula additives, LCPUFA, nucleotides,
taurine, probiotics and prebiotics
2.4. Deficiency states

2.4.1. Know the Waterlow Classifications

2.4.2. Recognize protein calorie malnutrition and its combinations
2.4.3. Recognize the presenting signs and symptoms of vitamin deficiency states
2.4.4. Know the signs and symptoms of hypervitaminosis A and D

2.5. Principles of nutritional support

2.5.1. Know the indications for peripheral alimentation
2.5.2. Know the advantages of enteral nutrition over parenteral nutrition

2.6. Nutritional problems in specific disease states

2.6.1. Acute gastroenteritis

 Recognize that secondary lactose intolerance may cause acute
gastroenteritis
 Understand the effectiveness of oral rehydration solutions in
treating acute diarrheal dehydration
 2.6.2. Hepatic disease
 Understand the effect of hepatic disease on nutrient digestion
and absorption

2.6.3. Nutritional support in chronic systemic diseases as in renal, cardiac,

hematologic and hepatic disease

2.6.4. Immunologic diseases

2.7. Obesity

2.7.1. Understand the generic risk factor for obesity

2.7.2. Know the available diagnostic procedure (e.g. BMI) and treatment
2.7.3. Understand that the most common cause is excess intake of food

2.8. Weight loss

2.8.1. Recognize the significance of a carefully obtained dietary history in the

evaluation of a child with failure to thrive
2.8.2. Recognize that chronic infection can be a cause of weight loss

2.9. Food additives

Recognize the role of artificial flavors and colors in the causation of urticaria and
angioedema
3.0 PREVENTIVE PEDIATRICS (AMBULATORY SECTION)

3.1. Know the measures on how to promote and maintain health

3.1.1. Proper nutrition

3.1.2. Good health habits
3.1.3. Healthy environment

3.2. Know prevention of diseases, disabilities and handicaps

3.2.1. Early detection of congenital anomalies

3.2.2. Prevention of specific diseases by:

 Genetic counseling
 Immunization and drug prophylaxis
 Anticipatory guidance in the prevention of accidents
 Prevention of drowning in swimming pools and beaches

3.3. Immunization (see Section 7)

4.0 GENETICS/DYSMORPHOLOGY (GENETICS)

4.1. General

4.1.1. Recognize the increasing detection of genetic abnormalities as a cause of

morbidity and mortality

4.1.2. Identify the different patterns of inheritance: autosomal dominant,

autosomal recessive, X-linked dominant, X-linked recessive, multifactorial
inheritance in a given prodigy

4.1.3. Apply general clinical principles in counseling for genetic disorders:

i. Negative family history
ii. Environmental factors
iii. Genetic heterogeneity
iv. Pleiotropism
v. Variable expression

4.2. Malformations

4.2.1. Identify the more common chromosomal abnormalities: Trisomies, Turner

phenotype, Fragile X
 Recognize the need for doing chromosomal analysis of both
parents

4.2.2. Recognize the role of certain agents, drugs, radiation, and infections in the
causation of fetal anomalies

4.3. Positional deformation

Recognize the intrinsically derived positional deformations: e.g. amniotic bonds, Potter
facies, craniosynostosis
5.0 FETUS AND NEWBORN (NEONATOLOGY SECTION)

5.1. Normal

5.1.1. Antenatal
 Identify perinatal/antenatal conditions associated with high risk
deliveries and know the impact of these illnesses on the fetus and
newborn (e.g. diabetes mellitus, thyroid disorders, perinatal
infections)

5.1.2. Know the methods of assessment of fetal well-being (e.g. fetal monitoring)

5.1.3. Identify the commonly used maternal drugs and their effects on the fetus
and newborn

5.1.4. Perinatal
i. Anticipation of low and high risk deliveries
 Familiarization with the equipments needed for resuscitation and
their proper usage (e.g. radiant warmers, suction machine,
intubation set)
ii. Know delivery room management
 Evaluation, decision making and prompt action
 Goals of resuscitation
 Inverted pyramid of resuscitation
 Sequence of resuscitation as recommended by the Neonatal
Resuscitation Program (NALS)

5.1.5. General care of the newborn

i. Know how to perform a through physical and neurological
examination
ii. Know gestational age assessment by Ballard/Dubowitz and correlate
with obstetric estimate
iii. Know routine newborn care
 Latching
 Temperature regulation
 Proper umbilical cord care
 Vitamin K prophylaxis
 Nutrition-emphasis on breastfeeding
 Rooming in

5.1.6. Identify the components of the newborn screening test and its clinical
implication

5.1.7. Know the difference between physiology and pathologic jaundice

5.2. Abnormal newborn

5.2.1. Know the diagnosis and management of:

i. Deviation from normal intrauterine growth (e.g. SGA, LGA, IUGR)
ii. Extremely low birth weight and premature babies
iii. Respiratory
 RDS and its complications (BPD, IVH, retinopathy, etc.)
 Air leaks (pneumothorax, pneumomediastinum)
 Persistent pulmonary hypertension
 Apnea
 Meconium aspiration
 Transient tachypnea of the newborn
 iv. Infection (e.g. sepsis, pneumonia, meningitis)
v. Major cardiac abnormalities (cyanotic and acyanotic heart disease)
vi. Neurological (e.g. asphyxia, seizures)
vii. Metabolic (e.g. hyponatremia, hypoglycemia, hypocalcemia)
viii. Gastrointestinal (e.g. NEC, atresia)
ix. Hypebilirubinemia – conjugated and unconjugated

5.3. Others

5.3.1. Know the basic principles of mechanical ventilation and recognition of

respiratory failure and the need to ventilate
5.3.2. Interpret blood gas analysis and be able to correlate clinically
5.3.3. Interpret chest X-ray studies
5.3.4. Develop the skill in performing the common neonatal procedures (e.g.
intubation, umbilical cannulation, lumbar puncture)
6.0 ALLERGY, IMMUNOLOGY AND RELATED DISORDERS (ALLERGY SECTION)

6.1. Know the basic anatomical, physiological and biochemical defenses of the body

6.1.1. Describe the 4 major components of the immune system: B cells, T cells,
phagocytic cells, complement proteins as to the following:
i. Functions
ii. Symptoms of defiency
iii. Diagnostic tests, starting with screening

6.2. Allergy

6.2.1. Know the immunologic mechanisms that produce change in host reactivity,
including role of the autonomic nervous system

6.2.2. Understand the role of heredity in susceptibility to atopy

6.2.3. Know the general and specific diagnostic tools in allergic disorders:
i. History
ii. Physical examination
iii. In vitro testing: e.g. eosinophilia, RAST
iv. In vivo testing: skin testing

6.2.4. Know the general preventive measures for allergic disorders:

i. Breastfeeding
ii. Environmental control e.g. dust control, smoking
iii. Dietary restriction

6.2.5. Know the principles of management

i. Pharmacologic treatment: adrenergics, theophylline, antihistamine,
ketotifen, cromolyn sodium
ii. Immunotherapy

6.2.6. Know the following for each of the following specific allergic disorders:
 Common allergic agents/factors
 Clinical manifestations and criteria for diagnosis
 Preventive measures and management
 Complications

Specific allergic disorders:

i. allergic rhinitis
ii. eczema
iii. urticaria/angioedema/anaphylaxis
iv. adverse reaction to substances
 food and drugs
 contrast media
 hymenopthera

6.3. Asthma

6.3.1. Know the importance of asthma as a chronic illness in childhood and its
epidemiologic aspects
6.3.2. Understand the pathophysiologic and natural history of childhood asthma
6.3.3. Know the common triggers (inciters and inducers)
6.3.4. Understand the importance of pulmonary function tests, e.g. spirometry, in
monitoring asthmatic children
6.3.5. Know the proposed guidelines for management as given in the
International Asthma Consensus and the Philippine Asthma Consensus
6.3.6. Know the role of anti-inflammatory agents in asthma
6.3.7. Identify drugs used as relievers and controllers
6.3.8. Recognize the adverse effects of commonly used antiasthma drugs
6.3.9. Recognize the urgency of managing impending respiratory failure in
asthma
6.3.10. Know the importance of patient education in the long term management
7.0 INFECTIOUS DISEASES (INFECTIOUS DISEASE SECTION)

7.1. Immunizations

7.1.1. Active immunization

For each of the listed vaccines, know the following:
 Preparation
 Schedule
 Method of administration
 Contraindications
 Adverse effects

Vaccines
i. BCG
ii. Diphtheria, Pertussis, Tetanus (DPT)
iii. Diphtheria-Tetanus toxiods: difference between DT and Td
iv. Poliomyelitis, trivalent (live attenuated and inactivated)
v. Measles (live attenuated)
vi. Mumps (live attenuated)
vii. Rubella (live attenuated)
viii. MMR
ix. Varicella (live attenuated)
x. H. influenza B conjugated
xi. Hepatitis B (recombinant DNA; plasma derived)
xii. Hepatitis A
xiii. Typhoid
xiv. Rabies (duck embryo inactivated, vero cell purified)
xv. Influenza polyvalent
xvi. Pneumococcal polyvalent
xvii. Meningococcal
xviii. Rotavirus
xix. Various combination vaccines

7.1.2. Passive immunization

Know the following facts for each of the immunoglobulins listed:
 Indications
 Route of administration
 Adverse effects
 Contraindications

Immunoglobulins and Sera:

i. IM gamma globulin (IGM) normal, human
ii. IV gamma globulin (IVIG) normal, human
iii. Hepatitis B immune globulin (human)
iv. Varicella-zoster immunoglobulin (VZIG) human
v. Rabies immune globulin (human) vs. anti-rabies serum (equine)
vi. Tetanus immunoglobulin (human) vs. anti-tetanus serum (equine)
vii. Diphtheria antitoxin

7.2. General considerations

7.2.1. Know the thermoregulatory mechanism and the pathogenesis of fever

 Recognize the effect of immaturity or abnormality of
thermoregulatory centers on the development of fever, e.g. very
young infant

7.2.2. Know the diagnostic approach to the problem of:

i. Fever of unknown origin
 ii. Occult bacteremia

7.2.3. Know the following for sepsis:

i. Pathogenesis
ii. Diagnosis
iii. Complications, as shock and multiple organ malfunction syndrome
iv. Treatment: specific and supportive

7.2.4. Know the causes and management of infection in the immunocompromised

host and their unique clinical manifestations

7.2.5. Know the principles of chemoprophylaxis and infection control,

specifically in:
i. Nosocomial infections
ii. Infections associated with medical devices
iii. Travel precautions

7.3. General spectrum of infectious diseases in children

For each of the following common infections seen in children, know the:
 Etiology
 Incidence
 Incubation period
 Transmission
 Pathogenesis
 Clinical manifestations
 Diagnosis: microbiology, microbacteriology and serology and
other laboratory tests
 Complications
 Management including isolation procedures
 Prevention
 Prognosis

7.3.1. Common viral illnesses:

i. Measles
ii. Mumps
iii. Rubella
iv. Roseola infantum
v. Erythema infectiosum (fifth disease)
vi. Varicella-zoster
vii. Hepatitis A, B, C, D, E, G
viii. Rotavirus
ix. Rabies
x. Adenovirus, Norwalk agent
xi. Influenza
xii. Enteroviruses (ECHO, Coxsackie, Poliomyelitis)
xiii. Respiratory syncitial virus
xiv. Cytomegalovirus
xv. Herpes simplex
xvi. Epstein-Barr virus
xvii. Arbovirus e.g. H. Fever

7.3.2. Common bacterial infections

i. Tuberculosis
ii. Diphtheria
iii. Tetanus
iv. Pertussis
 v. Pneumonia
vi. Salmonella (typhoidal and non-typhoidal)
vii. N. gonorrhea
viii. N. meningitides (meningococcemia, meningitis)
ix. Shigellosis
x. E. Coli-various types
xi. Treponema pallidum-syphilis
xii. H. influenza type B infection
xiii. Streptococcal groups B and D
xiv. Campylobacter jejuni
xv. Yersinia enterocolitidis
xvi. Chlamydia
xvii. Non-tuberculous mycobacteria
xviii. Common bacterial causes of nosocomial infections: Klebsiella,
Enterobacter, Pseudomonas, CONS
7.3.3. Rickettsial and fungal infections
i. Rocky mountain spotted fever
ii. Candidiasis

7.3.4. Parasitic infection

i. Giardia lamblia
ii. Toxoplasma gondii
iii. Trichomonas
iv. Visceral larva migrans
v. Ascaris lumbricoides
vi. Enterobius vermicularis
vii. Ankylostoma
viii. E. histolytica
ix. Plasmodium sp. (Malaria)

7.4. Know the following for each of the groups of anti-infectious agents:
 Indications/contraindications
 Preparations
 Dosages and mode of administration
 Major adverse effects

7.4.1. Antibiotics
i. Betalactam antibiotics
 Penicillins – narrow and broad spectrum
 Cephalosporins
 Monobactam – aztreonam
 Carbapenems – imipenem

ii. Aminoglycosides – kanamycin, gentamicin, amikacin

iii. Macrolides – erythromycin, clarithromycin, azithromycin
iv. Lincosamides – clindamycin
v. Chloramphenicol
vi. Tetracyclines – doxycycline
vii. Vancomycin
viii. Nitro-imidazoles – metronidazole
ix. Sulfonamides including cotrimoxazole
x. Quinolones

xi. Anti-TB drugs

 1st line: isoniazid, rifampicin, pyrazinamide, ethambutol,
streptomycin
 2nd line: kanamycin, amikacin, ofloxacin, cycloserine
 Fixed dose combination
 7.4.2. Antivirals
i. Amantadine
ii. Acyclovir
iii. Ganciclovir, valaciclovir – know the required timing of
administration for effectivity
iv. Anti HIV: indinavir, lamivudine, ritornavin, saquinovir, zalcitadine,
zidovudine
v. Interferon

7.4.3. Antifungals
i. Amphotericin B
ii. Fluconazole
iii. Ketoconazole
iv. Nystatin
v. Flucytosine
vi. Griseofulvin
vii. Itraconazole

7.4.4. Antiparasites
i. Antihelminthics – albendazole, mebendazole, oxantel-pyrantel
pamoate
ii. Antimalarials – chloroquine, primaquine, quinine, sulfadoxine+
pyrimenthamine, tetracycline
iii. Chloriquine, secnidazole
iv. Antiscabies – permethrin, crotamiton

7.5. Know the current status of certain drugs not presently recommended for use in young
children: tetracycline and quinolones

7.6. Know the principles of judicious use of antimicrobial agents to address the issue of
increasing antimicrobial resistance
8.0 RESPIRATORY DISORDERS (PULMONOLOGY SECTION)

8.1. General

8.1.1. Stridor
i. Know the differential diagnosis of stridor in the newborn infant
ii. Know the difference in etiologies of stridor in infants vs. children
older than 2 years of age

8.1.2. Respiratory failure – acute and chronic

i. Know that newborns have an increased tendency for respiratory
muscle fatigue
ii. Know the clinical manifestations of impending respiratory failure
iii. Know that blood gas analysis should not delay the initiation of
cardiopulmonary resuscitation
iv. Know the pathogenesis, causes, types, clinical and laboratory
manifestations of chronic hypoxemia, polycythemia, pulmonary
hypertension, cor pulmonale, clubbing

8.1.3. Cough
i. Recognize the quality and timing of cough as a clue to diagnosis
ii. Recognize cough as a major manifestation of asthma
iii. Know the initial screening: evaluation of chronic cough should
include X-ray study of the chest, tuberculin test and pulmonary
function tests before resorting to other tests

8.1.4. Exercise intolerance

 Know that exercise intolerance may reflect more than pulmonary
disease: e.g. anemia, muscle weakness, deconditioning, cardiac
disease, psychogenic causes

8.1.5. Apnea
i. Distinguish between central and peripheral apnea
ii. Distinguish between apnea and periodic breathing

8.1.6. Wheezing
i. Know that “all that wheezes is not asthma”
ii. Know the differential diagnosis of recurrent wheezing such as
asthma, reflux, foreign body aspiration

8.1.7. Tachypnea
 Know that respiratory rates differ at various ages and that normal
variations occur with sleep, eating and activity in normal children

8.1.8. Hemoptysis
 Know the differential diagnosis of hemoptysis in children

8.1.9. Cyanosis
i. Know the common extrapulmonary causes of cyanosis (e.g. right to
left shunt, methemoglobenemia)
ii. Know how to differentiate central from peripheral cyanosis

8.1.10. Chest pain

 Know that chest pain in children is generally not
cardiopulmonary in origin

8.1.11. Upper respiratory tract infection

  Know that URTI and obstruction in young infants who are
obligate nose breathers may lead to respiratory distress

8.1.12. Others
i. Know how to differentiate restrictive from obstructive pulmonary
diseases
ii. Know that passive exposure to cigarette smoke and environmental
pollutants (garbage fumes, etc) in home increases the chance of lower
respiratory illness in children

8.2. Upper airway

8.2.1. Common colds

i. Know the microbiology of the common colds (viral etiology)
ii. Know that common colds mimics influenza hence aspirin should be
avoided because of its association with Reye Syndrome

8.2.2. Epiglottitis
i. Recognize the presenting signs and symptoms characteristic of
epiglottitis
ii. Differentiate the clinical findings of viral croup vs. epiglottitis
iii. Know the treatment of epiglottitis, drug/s of choice, alternative drugs,
ineffective drugs
iv. Know that dangers in use of tongue blade for examination, blood
extraction and spinal tap
v. Know that it is potentially fatal

8.2.3. Foreign bodies

 Distinguish between a foreign body in the upper airway and
infectious process

8.2.4. Croup
 Recognize the signs and symptoms of croup

8.3. Lower airway

8.3.1. Vascular anomalies

i. Recognize the variables presentation of vascular anomalies affecting
the airway
ii. Know the diagnostic modalities that enable identification of vascular
anomalies obstructing the airway

8.3.2. Bronchitis
i. Recognize clinical manifestation
ii. Know how to differentiate an acute from chronic bronchitis

8.3.3. Bronchiolitis
i. Know the association of bronchiolitis and asthma
ii. Recognize the clinical manifestations of bronchiolitis
iii. Know the indications for hospital admission for a child with
bronchiolitis

8.3.4. Aspiration Syndrome

i. Know the pulmonary complications of gastro-esophageal reflux
ii. Know that recurrent aspiration can occur with swallowing disorders
independent of gastro-esophageal reflux
iii. Know the likely pathogens of aspiration pneumonia and the
corresponding antimicrobial of choice
 8.3.5. Bronchiectasis
i. Know the etiology of bronchiectasis
ii. Know the differential diagnosis of bronchiectasis

8.3.6. Tracheomalacia
 Know that tracheomalacia can occur as a complication of chronic
mechanical ventilation in neonates

8.4. Parenchymal

8.4.1. Pneumonias
i. Know the pathophysiology, likely pathogen in different age groups,
clinical and laboratory findings of pneumonia
ii. Know the appropriate therapy for different types of pneumonia, e.g.
mycoplasma vs. chlamydia vs. respiratory syncitial virus vs. bacterial
pneumonia; community vs. hospital acquired; typical vs. atypical
iii. Know ehich organisms are likely to cause the pleural anf
parenchymal complications of pneumonia
iv. Distinguish between pneumonia and a sequestered lung
v. Know the radiographic findings in complicated pneumonia and when
to request for follow-up chest X-ray
vi. Know the DOH-CARI program

8.4.2. Tuberculosis
i. Know the presenting signs and symptoms of tuberculosis and its
protein nature
ii. Know how to prevent, diagnose and treat different classes of
tuberculosis
iii. Explain direct observation therapy and its role in TB control
iv. Know that X-ray findings may be normal in some cases of PTB

8.5. Diaphragmatic hernia

i. Recognize the clinical manifestations of diaphragmatic hernia
ii. Know the appropriate therapy for diaphragmatic hernia
iii. Know that persistent pulmonary hypertension complicates the post-
operative course of most children with diaphragmatic hernia

8.6. Adult respiratory distress syndrome

 Know causes, clinical manifestations and treatment

8.7. Pleural fluid

i. Know the pathophysiology of pleural fluid effusion in certain
diseases (e.g. DHF, malignancy, pneumonia, CHF)
ii. Know when to do therapeutic thoracentesis and closed tube
thoracostomy drainage
iii. Understand what indices best distinguish exudative from transudative
pleural effusions
iv. Understand the causes of chylothorax

8.8. Pneumothorax
i. Know the signs and symptoms of tension pneumothorax
ii. Know the causes and appropriate therapy in a child with
pneumothorax

8.9. Cor pulmonale

i. Know that the cor pulmonale is potentially reversible
ii. Know the situations in which cor pulmonale occur
8.10. Immunocompromised patient
i. Know that the diagnosis of pneumonia in an immunocopromised host
may require aggressive procedures including bronchoscopy
ii. Know the pulmonary manifestations of AIDS, e.g TB, lymphoid
interstitial pneumonia and atypical infections

8.11. Sudden infant death syndrome

 Recognize a child with an acute life-threatening event (ALTE,
near miss sudden infant death syndrome)

8.12. Diagnostic techniques

i. Know life-threatening radiographic findings (e.g. tension
pneumothorax, tension hemothorax)
ii. Know the importance of spirometry
iii. Know how to interpret blood gas analysis result
9.0 GASTROINTESTINAL DISORDERS (GI SECTION)

9.1. General: For each of the following signs and symptoms of digestive tract disorders,
know the following:
 Pathophysiology/pathogenesis
 Age-related differences
 Distinction between functional and organic causes
 Importance of non-digestive tract causes of some GI symptoms in
children
 Management: general and specific
 Recognize the disorders that will need pediatric surgical referral

9.1.1. Vomiting
i. Know the common causes in the different age groups
ii. Be aware of the entity of cyclic vomiting

9.1.2. Diarrhea
i. Know the different types of diarrhea seen in children: infectious, non-
infectious, chronic non-specific, dietary protein intolerance and
intractable diseases

9.1.3. Constipation
 Know how to distinguish between simple constipation and
Hirschsprung disease in the newborn period

9.1.4. Abdominal pain

i. Know the distinguishing features of acute abdominal pain in children
ii. Know the difficulty in evaluating chronic or recurrent abdominal pain
in children
iii. Recognize the importance of intestinal parasitism in the causation of
abdominal pain particularly in Filipino children
iv. Know the use and abuse of anticholinergics in the treatment of
abdominal pain
v. Know the likely sites and kind of pain from blunt abdominal trauma

9.1.5. Gastrointestinal bleeding

i. Know the appropriate tests for blood in vomitus and stool
ii. Know the age-related differential diagnosis of rectal bleeding
iii. Know the differential diagnosis of bright red blood, coffee ground
material and occult blood passed per orem or per rectum
iv. Know the importance of rectal examination in evaluating rectal
bleeding

9.1.6. Abdominal distention/abdominal mass

i. Diagnose causes of increased abdominal content as to fluid. Gas or
solid
ii. Know the urgency in diagnosing abdominal masses in children

9.1.7. Jaundice
i. Know how to evaluate prolonged jaundice in neonatal and post
neonatal period
ii. Distinguish between physiologic and breastfeeding/breastmilk
jaundice
iii. Know the approach to diagnosis and management of neonatal
cholestasis
iv. Know the natural history and clinical picture of the hepatitidis
 v. Know the multiple etiologies of chronic active hepatitis in an older
child

9.1.8. Gastro-esophageal reflux (chalasia)

 Know the importance of GER in relation to esophagitis and
respiratory problems

9.1.9. Other specific disorders

i. Recognize the clinical picture of hypertrophic pyloric stenosis
ii. Know the management of ingestion of corrosive substances
iii. Know the management of foreign body in the esophagus
iv. Recognize esophageal atresia and TE fistula
v. Recognize the gastrointestinal disorders that will need pediatric
surgical referral
vi. Know the pathophysiology of peptic ulcer disease, both primary and
secondary
vii. Know the importance of Helicobacter pylori in the causation of
primary ulcer disease and its management
viii. Recognize the signs and symptoms and management of acute primary
and secondary peritonitis
10.0 FLUIDS, ELECTROLYTES AND ACID-BASE (PEDIATRIC INTENSIVE
CARE/RENAL SECTION)

10.1. Composition of body fluids

10.1.1. Know the normal composition of body fluids

10.1.2. Understand the homeostatic mechanisms that maintain normal volume,

composition and tonicity

10.1.3. Intracellular/extracellular
 Know the determinants of plasma osmolality

10.1.4. Electrolytes
 Recognize the major intracellular and extracellular cations and
anions
 Know the daily requirements for Na and K
 Know the age related differences in normal plasma HCO3
concentrations

10.2. Acid-base physiology

 Identify the type of disorder, whether metabolic of respiratory,
simple or mixed

10.3. Electrolyte abnormalities

10.3.1. Sodium
i. Decreased sodium
 Recognize diseases associated with hyponatremia and
increased/decreased urinary sodium
 Know the causes of factitious hyponatremia
 Know the appropriate management
 Anticipate complications

ii. Increased sodium

 Know the causes if hypernatremia
 Know the appropriate management
 Anticipate CNS complications

10.3.2. Potassium
i. Understand the renal and extrarenal processes that regulate
extracellular K concentration

ii. Know that signs and symptoms of K imbalance are more likely seen
with acute changes in extracellular K concentration rather than
chronic changes

iii. Decreased K
 Recognize the different hypokalemic states
 Know the signs and symptoms and treatment
 Recognize the electrocardiographic rhythm abnormalities

iv. Increased K
 Recognize the different hyperkalemic states
 Recognize the ECG rhythm abnormalities
 Know the emergency treatment of hyperkalemia
 10.3.3. Magnesium

10.3.4. Chloride

10.4. Know the principles of fluid and electrolyte therapy

10.4.1. Oral vs. parenteral therapy

10.4.2. Phases of fluid and electrolyte therapy of dehydration

11.0 RENAL DISORDERS (NEPHROLOGY SECTION)

11.1. Generalities

11.1.1. Normal function

i. Know the difference of the neonatal renal function from older
children
ii. Know that premature infants can have increased fractional excretion
of sodium

11.1.2. Proteinuria
i. Recognize the differential diagnosis of patients with proteinuria
ii. Know when to refer a child with proteinuria

11.1.3. Hematuria
i. Recognize the differential diagnosis and prognosis of patients with
persistent microscopic hematuria with or without persistent
proteinuria
ii. Know when to refer a child with microscopic hematuria

11.1.4. Dysuria
 Recognize the importance of perineal inspection in children

11.1.5. Incontinence
 Recognize when incontinence is pathologic and its differential
diagnosis

11.2. Specific disorders

11.2.1. Infection of the urinary tract

i. Know that UTI is a primary consideration in all children with
unexplained fever beyond three days
ii. Know that urine culture is the gold standard in the diagnosis of UTI
iii. Risk factors that will predispose to recurrent infection (e.g. VUR
obstruction, neurogenic bladder, etc)
iv. Know the appropriate antibiotic and duration of treatment for acute
UTI
v. Know the indication for long term prophylaxis of the urinary tract

11.2.2. Acute glomerulonephritis

i. Understand the pathogenesis of post-infectious glomerulonephritis
ii. Understand that acute post-streptococcal nephritis does not usually
progress to chronic nephritis and nephrotic syndrome
iii. Know the time sequence of the natural history of acute post-
streptococcal glomerulonephritis as to resolution of
hypocomplementemia, hematuria and proteinura

11.2.3. Nephrotic syndrome

i. Know the criteria for diagnosis of nephrotic syndrome
ii. Know the signs and symptoms of minimal change nephrotic
syndrome
iii. Plan a treatment program for a young child with minimal change
nephrotic syndrome
iv. Recognize the continued good prognosis in frequently relapsing
nephrotic syndrome if the proteinuria continues to resolve with
corticosteroid therapy
 11.2.4. Multisystem diseases with renal manifestations
i. Henoch-Schonlein purpura (HSP)
 Know the clinical presentation of HSP
 Emphasize the renal manifestions and long term sequelae

ii. Systemic lupus erythematosus (SLE)

 Know the different criteria that would lead to the diagnosis of
SLE

iii. Hemolytic uremic syndrome (HUS)

 Recognize the signs and symptoms of HUS
 Know the laboratory findings in children with HUS
 Know the underlying diseases and organisms associated with
HUS

iv. Other diseases

 Goodpasture syndrome
 Polyarteritis nodosa

11.2.5. IgA nephropathy

 Plan the follow-up of a child with IgA nephropathy

11.3. Other renal conditions

11.3.1. Acute renal failure

11.3.2. Chronic renal failure

i. Understand the major complications of chronic renal failure
ii. Know that growth failure is common in children with chronic renal
failure

11.3.3. Urolithiasis
 Plan the evaluation of a child with renal stones
11.3.4. Renal tuberculosis

11.3.5. Renal tubular acidosis

11.3.6. Diabetes insipidus
i. Recognize the signs and symptoms of diabetes insipidus in children
ii. Recognize the association between cranial injury surgery and diabetes
insipidus
iii. Know the nephrogenic diabetes insipidus and its management

11.4. Hypertension

11.4.1. Generalities
i. Emphasize that 80% of secondary hypertension in children is renal in
etiology
ii. Know the etiology of hypertension in children (renal vascular,
neuroblastoma)
iii. Know the differential diagnosis of hypertension in children

11.4.2. Renal
 Know that small renal scars can cause hypertension

11.4.3. Others
i. Vascular
ii. Know the other types of hypertension:endocrine, neurologic and
essential
12.0 CARDIOVASCULAR DISORDERS (PEDIATRIC CARDIOLOGY SECTION)

12.1. General aspects

12.1.1. Recognize the common clinical manifestations of cardiovascular disorders

and their onset such as:
 Cyanosis
 Dyspnea in relation to feeding
 Decreased volume with each feeding
 Irritability
 Seizure/syncope

12.1.2. Identify ancillary procedures which are useful in the initial evaluation

12.1.3. Know the treatment of CHF and other related medical complications

12.2. Specific CV disorders

12.2.1. Congenital heart disease

i. Cyanotic CHD
 Identify the presence of cyanotic CHD which may manifest in
neonatal period
 Know the complications of polycythemia
 Identify the clinical features if tetralogy spell and its emergency
treatment

ii. Acyanotic CHD

 Know that cardiogenic shock may be the initial finding in
neonate with acyanotic heart disease
 Know the treatment of cardiogenic shock

12.2.2. Acquired infective endocarditis

i. Identify patients at risk for infective endocarditis. Know the drug of
choice for prophylaxis

ii. Rheumatic fever/RHD

 Identify the clinical manifestations
 Make a correct diagnosis based on Jones criteria
 Know the treatment of rheumatic fever

iii. Myocarditis/pericarditis
 Know the clinical presentation and management
 Identify probable causes and predisposing factors

iv. Rate and rhythm disorders

 Understand the clinical significance of prolonged QT interval
 Know the clinical presentation of rate and rhythm disorders

v. Other diseases affecting the heart

 Know other systemic diseases which may affect the heart e.g.
Kawasaki disease
 Know the clinical manifestations which may mimic other
diseases
 Know the initial treatment

13.0 COLLAGEN, VASCULAR AND OTHER MULTISYSTEM DISORDERS

(RHEUMATOLOGY SECTION)
13.1. General
13.1.1. Remember that early diagnosis may not be always possible because
diagnostic manifestations can take time to develop

13.1.2. Recognize the more common clinical manifestations and complications

associated with each diseases

13.1.3. Know that the diagnosis may be based on certain acceptable criteria and by
the meticulous exclusion of other diseases

13.1.4. Recognize that a complete history and physical examination are very
important in determining the diagnosis

13.1.5. Enumerate and select the appropriate laboratory examinations which are
specifically helpful in the establishment of the diagnosis

13.1.6. Formulate a plan of management for each disease condition which should
include the medications and their adverse effects and follow-up with regard
the progression/remission of the disease and rehabilitation

13.1.7. Know the prognosis

13.2. Specific conditions

13.2.1. Rheumatic diseases

13.2.2. Systemic lupus erythematosus

13.2.3. Juvenile rheumatoid arthritis

13.2.4. Dermatomyositis

13.2.5. Scleroderma

13.2.6. Other arthritis syndromes

 Ankylosing spondylitis
 Post-infectious arthritis
 Arthritis of inflammatory bowel disease

13.2.7. Vasculitis syndromes

 Henoch Schonlein Purpura
 Takayasu arteritis

14.0 METABOLIC AND ENDOCRINE DISORDERS (ENDOCRINOLOGY SECTION)

14.1. General

14.1.1. Know the signs and symptoms of the more common errors of metabolism:
amino acids, lipids, carbohydrates, purine, and pyrimidine, as seen in the
neonatal period and beyond: e.g. MSUD, gaucher disease, galactosemia,
mucopolysaccharidoses, particularly those that have been reported locally

14.1.2. Know the available screening tests in the neonatal period

14.2. Specific metabolic conditions

14.2.1. Plan the evaluation of a child with signs and symptoms of hypoglycemia

14.2.2. Recognize the signs and symptoms of hyperammonemia

14.3. Growth

14.3.1. Short stature – recognize the multiple factors that may result in short stature
i. GH deficiency
ii. Hypothyroidism
iii. Other specific conditions

14.3.2. Tall stature – know the normal (familial, constitutional) and abnormal
variants of tall stature e.g. pituitary gigantism, hyperthyroidism

14.3.3. Know the indications for bone age determination, its interpretations and
limitations
14.4. Sex differentiation

14.4.1. Normal – know Tanner stages of sexual development

14.4.2. Abnormal – know the clinical manifestations of:

i. different types of congenital adrenal hyperplasia
ii. precocious puberty

14.5. The thyroid gland

14.5.1. Know the manifestations of congenital hypothyroidism and the importance

of early detection and treatment

14.5.2. Know the natural history of Hashimoto’s thyroiditis

14.5.3. Know the spectrum of goiters as to functional state, congenital or acquired,

endemic or sporadic
i. Know the importance of iodine in the diet
ii. Know the management of the different types of goiter

14.5.4. Recognize the clinical picture of hyperthyroidism

14.6. Disorders of calcium and phosphorous metabolism

14.6.1. Know the clinical manifestations of early and late neonatal hypocalcemia
and its management

14.6.2. Know the clinical picture of familial hypophosphatemia: non-nutritional

rickets
 14.6.3. Know the pathophysiology, clinical picture and management of Vitamin D
deficiency rickets

14.7. Disorders of the adrenal glands

14.7.1. Know the clinical picture of hyperfunction of the adrenal glands resulting
in Cushing syndrome and the role of prolonged administration of ACTH or
hydrocortisone or its analogues in Cushingnoid syndrome

14.7.2. Know the manifestations of adrenocortical deficiency and Addison’s

disease and the complication of an adrenal crisis

14.8. Diabetes mellitus in children

14.8.1. Know the natural history of insulin dependent diabetes mellitus (type 1)

14.8.2. Know the principles of effective management: insulin, diet and exercise

14.8.3. Know the value of Hgb A 1c as an index of long term glycemic control
15.0 DISORDERS OF THE BLOOD/NEOPLASMS (HEMATOLOGY-ONCOLOGY
SECTION)

15.1. Erythrocyte disorders

15.1.1. General aspects

 Recognize physiologic anemia of infancy and understand that
further laboratory evaluation is unnecessary
 Understand hyperbilirubinemia in newborns

15.1.2. Nutritional anemia

 Understand that iron deficiency is the most common cause of
anemia in childhood
 Understand the need to look for bleeding as a cause of anemia in
a child with normal diet

15.1.3. Hemolytic anemia

 Understand isoimmune hemolytic disease of the newborn (ABO,
Rh)
 Know the incidence and manifestations of G6PD deficiency

15.2. Hemoglobin
 Know the different disorders such as thalassemia syndromes

15.3. Leukocyte disorders

 Know the clinical manifestations of leukemia

15.4. Platelet disorders

 Know the quantitative disorders of platelets, their clinical
management, diagnostic tests of each

15.5. Coagulation disorders

 Understand various forms of coagulopathies
 Identify PT and PTT as important parts of the work-up of a
patient with increasing bruising

15.6. Solid tumors

 Know the clinical management, diagnostic work-up of the more
common solid tumors such as:
- Lymphoma - Wilm’s tumor - Bone tumors
- Neuroblastoma - Brain tumors - Retinoblastoma

15.7. Transfusion medicine

 Know the indications, reactions of whole blood and component
transfusion

16.0 GENITAL SYSTEM DISORDERS (NEPHROLOGY SECTION)

16.1. Generalities
 Know how to diagnose inguinal mass, genital discharge and
bleeding

16.2. Male

16.2.1. Congenital abnormalities

 Recognize abnormal position of the urethral orifice and when to
refer
 Distinguish between undescended testes, retractile testes, hernia
and hydrocoele

16.2.2. Acquired abnormalities

 Recognize the signs and symptoms of testicular torsion
 Recognize the importance of ultrasonography in the diagnosis of
testicular torsion
 Know the signs and symptoms of urethritis

16.3. Female

16.3.1. Congenital abnormalities

 Know the signs and symptoms of imperforate hymen

16.3.2. Acquired abnormalities

 Know the signs and symptoms of ovarian torsion
 Know the differential diagnosis of vulvovaginitis

17.0 NEUROLOGIC DISORDERS (NEUROLOGY SECTION)

17.1. Generalities

17.1.1. Headache
i. Know the elements of history that characterizes migraine headache
ii. Know the elements of history that characterizes the headache of
concurrent illness
iii. Know the values and limitations of ancillary neurodiagnostic tests in
the evaluation of headache
iv. Recognize the potential dangers of using narcotics to treat chronic or
recurrent headache

17.1.2. Altered level of consciousness

i. Know the common causes of altered level consciousness
ii. Recognize the signs and findings of drug abuse with ingestion (i.e.
substance swallowed as opposed to injected, smoked, sniffed, etc)

17.1.3. Ataxia
 Know the common sign of ataxia

17.1.4. Movement disorders (involuntary/paroxysmal/post-infectious)

i. Know that diphenhydramine reverses symptoms of drug induced
movement disorders
ii. Know that Tourette syndrome is associated with learning disabilities
and attention deficit dystonia
iii. Differentiate chorea from dystonia
iv. Recognize post-encephalitic movement disorders
 17.1.5. Increased intracranial pressure
i. Know the causes, signs and symptoms and initial management of
increased intracranial pressure
ii. Know the most common types of intracranial tumors in children
iii. Know at least two causes of pseudotumor cerebri
iv. Recognize signs of brain herniation
v. Know the contraindications for lumbar tap

17.1.6. Weakness
i. Distinguish among causes of neuromuscular weakness by physical
examination
ii. Know the values and limitations of ancillary neurodiagnostic tests in
the evaluation of weakness

17.2. Infection

17.2.1. Meningitis
i. Know the etiologies of meningitis in various age groups
ii. Distinguish the cerebrospinal fluid findings in bacterial, including
TB, fungal and viral meningitis
iii. Know the methods of rapid diagnosis of untreated and partially
treated meningitis
iv. Know the appropriate treatment of meningitis
v. Know the management of cerebral edema in meningitis
vi. Know the indications for diagnostic imaging in patients with
meningitis
vii. Recognize signs of complications, such as subdural effusion and
empyema

17.2.2. Encephalitis
 Know the clinical course of different types of encephalitides
including SSPE

17.2.3. Abscess
i. Know that a CT-scan should be done before examination of
cerebrospinal fluid in suspected brain abscess
ii. Know medical management of brain abscess and when surgical
intervention is needed

17.3. Developmental malformation/static neurologic deficit

17.3.1. Malformations
i. Know that myelomeningocoele is usually associated with
hydrocephalus
ii. Know that evaluation for urologic and orthopedic anomalies
associated with myelomeningocoele should take place during the
early newborn period
iii. Recognize the signs and symptoms of shunt malfunction in
hydrocephalus
iv. Recognize signs of cord tethering in dermal sinuses

17.3.2. Cerebral palsy (CP)

i. Know the risk factors associated with cerebral palsy
ii. Know the disabilities of associated with cerebral palsy, i.e. cognitive,
skeletal, visual communication, sensory, motor, seizure, activity,
behavioral, oral function, nutrition

17.4. Seizures
 17.4.1. Generalities
i. Know that perinatal asphyxia may cause epilepsy and motor
abnormalities (CP)
ii. Know the most common causes of acute seizures in the different age
groups
iii. Distinguish among breath holding spells, tics, syncope, gastro-
esophageal reflux, neonatal apnea and seizure activity
iv. Know the indications for anticonvulsant therapy for seizures
v. Know the adverse effects of anticonvulsants

17.4.2. Febrile seizures

i. Know the risk factors associated with febrile seizures related later to
epilepsy
ii. Know the diagnostic criteria and management of febrile seizures
iii. Know that brain imaging, X-ray study of the skull and ECG are
usually not indicated for febrile seizure
iv. Know that focal spikes on EEG are not consistent with febrile seizure

17.4.3. Infantile spasms

i. Know the predisposing factors for symptomatic infantile spasm
ii. Know that ACTH is the treatment of choice for infantile spasm

17.4.4. Absence seizure

i. Know the characteristic of absence
ii. Know the importance of hyperventilation in the initial diagnosis of
absence

17.4.5. Complex partial seizure

 Recognize characteristics of CPS

17.4.6. Myoclonic seizures

 Distinguish non-epileptic myoclonus (sleep) from true myoclonic
seizures

17.4.7. Status epilepticus

 Know the causes and management of status epilepticus

17.5. Acute stroke syndrome

 Know the causes and recognize acute stroke syndrome

17.6. Spinal cord diseases

i. Know that an imaging test must be done emergently in acute spinal
cord syndrome to rule out a mass lesion
ii. Know that lumbar tap should not be done prior to
neurologic/neurosurgical consultation in suspected spinal cord disease

17.7. Guillain-Barre syndrome

i. Know that paralysis is usually symmetric in Guillain-Barre syndrome
ii. Know that respiratory compromise may occur early and rapidly in
GBS
iii. Know that cranial nerves may be affected

17.8. Bronchial plexus injuries at birth

 Know the prognosis of Erb and Klumpke palsies

17.9. Neurodiagnostic testing

 Know the value and limitations of neurodiagnostic techniques
such as magnetic resonance imaging (MRI), computed
tomography, (CT), ultrasonography, evoked potentials,
electromyography, and electroencephalography (EEG)
18.0 MUSCULOSKELETAL DISORDERS (RHEUMATOLOGY SECTION)

18.1. General

18.1.1. Know that the key to an accurate diagnosis is a complete history and a
thorough physical examination

18.1.2. Recognize the common complaints/manifestations attributable to

musculoskeletal disorders such as gait, limping, pain

18.1.3. Understand that radiography is the principal diagnostic tool for evaluation
of the musculoskeletal system and the basis for the selection of the
appropriate radiographic method

18.2. Developmental

18.2.1. Know the role of poisoning in utero on the joint and muscle contraction and
its effect on the tortional adjustment of the long bones, especially the lower
extremities which may completely resolve by age 3-4 years

18.2.2. Know that any condition that produces a neurologic abnormality may cause
a secondary delay in developmental milestones and an alteration in skeletal
growth

18.2.3. Be aware that hips at birth may be dislocated. Hip dislocation tends to
occur after delivery which is aptly termed as Developmental Dysplasia of
the Hip (DDH)
 Know the presenting manifestations and physical findings in hip
dislocation or DDH

18.2.4. Know that skeletal dysplasias are a genetically and clinically heterogeneous
group of disorder of skeletal development and growth

18.2.5. Know the clinical features of osteogenesis imperfecta which is the most
common cause of genetic osteoporosis

18.3. Congenital

18.3.1. Know the classification of clubfoot into congenital, teratogenic and

positional and that early treatment is critical
18.3.2. Know that metatarsus adductus is a common problem

18.3.3. Know the classification of congenital scoliosis and the associated defects of
the spinal cord

18.3.4. Know that no treatment for plano valgus is required in childhood

18.4. Acquired

18.4.1. Review the metabolism of calcium, phosphorous and magnesium in

relation to bone and cartilage formation

18.4.2. Know that the usual offending organisms in puncture wound of the foot are
Pseudomonas aeruginosa and Staphyloccocus aureus

18.4.3. Recognize that torticollis noted at birth may be secondary to traumatic

lesions of the sternocleidomastoid muscle
18.4.4. Know that fractures in children account for 10-15% of all childhood
injuries and the factors that predispose them to develop fracture

18.4.5. Know that bone scanning may be positive before any X-ray changes occur
in osteomyelitis

18.4.6. Know that back pain may be the presenting complaint in children with
tumor of the vertebral column or the spinal cord

18.4.7. Know that Legg-Calve-Perthes disease commonly occurs between 3 to 10

years of age

18.4.8. Understand that the etiology of Osggod-Schlatter disease may be related to

overuse of the quadriceps

18.4.9. Know the presenting symptoms of slipped upper femoral epiphysis

19.0 SKIN DISORDERS

19.1. General

19.1.1. Know the different disorders involving the epidermis, dermis,

subcutaneous tissues, sweat glands, hair, nails, and mucous membrance
19.1.2. Define hirsutism, hypertrichosis, hypotrichosis and alopecia
19.1.3. Be aware that abnormalities of the skin and its appendages in children may
be manifestation of generalized skin disease, systemic disease, drugs or
trauma
19.1.4. Know the principles of diagnosis and treatment of skin disorders

19.2. Newborn skin

19.2.1. Know the commonly seen benign and transient skin findings in newborns
and their significance
19.2.2. Identify cutaneous defects seen in the newborn

19.3. Vascular disorders

19.3.1. Know that hemangiomas are the most common tumors of infancy
19.3.2. Know the different types of vascular malformations and the commonly
assoullous ciated syndrome

19.4. Pigment disorders

 Know the different common hypo/hyperpigmented lesions and
possible associated syndrome/disease

19.5. Vesiculobullous disorders

 Know the different lesions characterized by blister formation

19.6. Infectious rash

Know the likely etiology, diagnosis and treatment of the following:

19.6.1. Impetigo
19.6.2. Scabies
19.6.3. Fungal infection
19.6.4. Staphylococcal scalded skin syndrome
19.6.5. Pediculosis
19.6.6. Molluscum contagiosum

19.7. Neuro neous syndrome

 Know that skin lesions are prominent manifestations of
neurofibromatosis and tuberous sclerosis

19.8. Others
 Know the different dermatologic manifestations of nutritional
disorders as Vitamin C deficiencies, niacin deficiency, protein-
calorie malnutrition and essential fatty acid deficiency
20.0 DISORDERS OF EYE, EAR, NOSE AND THROAT

20.1. Eye

20.1.1. General
 Know the basic as well as the special diagnostic procedures used
in eye examination

20.1.2. External disorders

i. Know the common disease conditions affecting the lids, conjunctivae,
lacrimal system and the cornea including congenital anomalies
ii. Differentiate preseptal from orbital cellulites and their respective
treatment
iii. Recognize the manifestations and treatment of congenital
nasolacrimal duct obstruction (CNLDO)

20.1.3. Internal disorders

i. Know the common disease conditions affecting the pupil, iris, uveal
tract, aqueous and vitreous humor, retina and optic nerve including
congenital anomalies
ii. Recognize the clinical signs and symptoms of glaucoma
iii. Know that the cause of anisocoria may be local or neurologic
iv. Know that congenital cataracts may be associated with congenital
infections
v. Know that retinopathy of prematurity is a retinal vasculopathy almost
exclusively seen among prematures which may result to blindness
vi. Recognize the presenting signs of retinoblastoma
vii. Differentiate between papilledema and optic atrophy as to causes and
ophthalmologic findings

20.1.4. Miscellaneous
i. Recognize the presenting manifestations of error of refraction
ii. Be aware that strabismus is one of the most common eye problem in
children
iii. Be able to evaluate trauma to the eye and the presence of foreign
body
iv. Be aware of the fact that eye pathology may be a manifestation of a
systemic disease or part of a syndrome
v. Recognize the eye manifestations of vitamin A deficiency

20.2. Ears

20.2.1. General
i. Know the techniques for hearing evaluation at different ages
ii. Recognize conditions that contribute to conductive hearing loss in
children
iii. Identify the neonatal high-risk groups for sensorineural hearing loss:
excessive hyperbilirubinemia, congenital perinatal infection,
craniofacial deformities and family history of hearing loss, neonatal
asphyxia, birth weight less than 1500 grams
iv. Know the clinical presentation and treatment of benign paroxysmal
vertigo

20.2.2. External ear

i. Know the etiology and treatment of otitis media
ii. Recognize the presentation of foreign body in the ear

20.2.3. Internal ear

 i. Know that impacted cerumen is a common cause of apparent deafness
ii. Know the predisposing factors to otitis media with effusion in
children
iii. Know the etiology and treatment of acute and chronic otitis media
iv. Recognize mastoiditis and the intracranial complications of middle
ear disease

20.3. Nose

20.3.1. General
i. Know the diagnosis and treatment of epistaxis
ii. Recognize the signs and symptoms of choanal atresia
iii. Know the conditions associated with nasal polyps in children such as
asthma, allergic rhinitis and chronic sinusitis
iv. Know the physical examination findings and the management of
trauma of the nasal septum
v. Recognize the presentation of foreign body in the nose

20.4. Sinuses

20.4.1. Acute
 Recognize the intraorbital and intracranial complications of acute
sinusitis such as brain abscess

20.4.2. Chronic
 Recognize the signs and symptoms of chronic sinusitis including
night cough

20.4.3. Trauma
 Know that trauma involving fracture of the frontal sinus requires
surgical repair and that delay may lead to infection

20.5. Throat

20.5.1. Know the appropriate management of exudative tonsillitis to prevent its

non-suppurative complications
20.5.2. Recognize the physical examination findings, diagnosis and treatment of
peritonsillar and retropharyngeal abscess

20.6. Mouth

20.6.1. Know the developmental anomalies of dentition

20.6.2. Describe the appropriate dental care to prevent caries

20.6.3. Know the various conditions which predispose to persistent or recurrent

thrush in children over 6 months of age such as immunodeficiency,
prolonged antibiotic use and AIDS

20.6.4. Distinguish the clinical manifestations of herpangina, gingivostomatitis and

aphthous ulceration

20.6.5. Recognize the clinical problems associated with cleft lip and palate such as
feeding, speech, hearing, dental and middle ear disease

20.7. Neck

20.7.1. Cervical lymphadenopathy

  Know the etiology and management of acute and chronic cervical
lymphadenitis according to age

20.7.2. Laryngitis/hoarseness
 Know the differential diagnosis of hoarseness

20.7.3. Neck masses

 Know the differential diagnosis of neck masses in children

20.7.4. Torticolllis
See Section 18.4.3

20.8. Surgical intervention/chronic airway obstruction

20.8.1. Tonsillectomy and adenoidectomy

i. Know the indications for tonsillectomy and adenoidectomy
ii. Recognize the serious outcomes that may be associated with tonsillar
or adenoidal hypertrophy or both: obstructive sleep apnea, fatigue
associated with sleep deprivation, cor pulmonale, failure to thrive
associated with poor feeding or obstructive breathing

20.8.2. Myringotomy and tympanostomy replacement

 Know the indications for inserting tympanostomy tubes in
children with otitis media with effusion
21.0 ADOLESCENT MEDICINE/GYNECOLOGY (ADOLESCENT MEDICINE)

21.1. Adolescent development

21.1.1. Physiologic
i. Know that between the ages 10 and 19 years adolescents undergo
bodily changes under hormonal control
ii. Know that there is a genetic influence on the timing of puberty
(including age ay menarche)
iii. Know the Sexual Maturity Rating (SMR) or Tanner stages

21.1.2. Psychological growth and development

i. Know that the adolescent “loner” who does not identify with a peer
group may be in psychologic difficulty
ii. Know that the rate of emotional and cognitive development does not
always parallel the rate of physical maturation

21.1.3. Sexuality
i. Know that biologic maturation and social pressures combine to
determine sexual maturity
ii. Know that they start to choose of the three sexual paths: celibacy,
monogamy or polygamous experimentation during adolescence

21.1.4. Cognitive and moral development

i. Understand that adolescents question and analyze the perceived
morality, often embracing the behavior standards of the peer group
ii. Realize that sometimes their perception if right and wrong is absolute
and unquestionable

21.1.5. Social development

 Understand that an unwillingness to follow advice characterize
the independence of early and mid-adolescence

21.2. Health issues of adolescence

21.2.1. Health maintenance

i. Know that self-examination of the Female breast should be taught for
early detection of breast cancer
ii. Know that self-examination of the testicles should be taught for early
detection of testicular cancer

21.2.2. Gynecology
i. Know the most simple and cost efficient diagnostic tools for detection
of the sexually transmitted disease
ii. Differentiate primary from secondary amenorrhea and their respective
etiologies

21.2.3. Other health concerns

i. Know the problems commonly encountered among adolescents such
as accidents, depression and eating disorders, and alcohol and
substance abuse
ii. Know that menstrual aberration is the most common athletic
gynecologic problem
iii. Know that the most important gynecologic need of the mentally
handicapped adolescent is knowledge of perineal hygiene

21.2.4. Teenage pregnancy

  Understand that pregnancy is the result of increased sexual
activity

21.2.5. Behavioral health issues

i. Know the most common type of lethal accidents among adolescents
ii. Recognize that adolescents view “pressure” to be among their health
concerns and that “pressure” may come from school (expectations or
teachers), peers, love relationships, family (parents or siblings), or
other adults
22.0 ABUSE (CPU)

22.1. Child abuse

22.1.1. Epidemiology
 Know the incidence of child abuse and neglect in the Philippines

22.1.2. Identify the existence of risk factors that lead to child abuse

22.1.3. Recognize the primary and secondary preventive efforts for child abuse and
neglect

22.1.4. Know the diagnosis and treatment of physical abuse, sexual abuse,
emotional abuse, neglect and failure to thrive

22.1.5. Be aware of the need for mandatory reporting of any suspicion of child
abuse to proper authorities

22.1.6. Know the laws pertaining to child abuse and children at risk
 RA 7610: Protection Against Child Abuse
 PD 603: Child Welfare Code
 RA 8505: Rape Crisis Centers
 RA 8353: Anti-rape Law
 RA 8369: Family Court Law

22.2. Substance abuse

22.2.1. Epidemiology
 Know the approximate prevalence of major drugs which are
abused in the Philippines

22.2.2. Risk factors

 Identify the risk factors that interacts and contribute to substance
abuse such as availability, social, cultural and individual factors

22.2.3. Evaluation by interview

i. Recognition of drug-related dysfunction

 Recognize the need to evaluate for abuse as possible
etiology/concomitant of a wide range of adolescent dysfunction,
e.g. delinquency, school failure, promiscuity, running from home,
family conflict, depression, suicide attempts

ii. Methods of questioning adolescents

 Understand the requisites for privacy and confidentiality in
eliciting a drug history from an adolescent

22.2.4. Laboratory evaluation

i. Ethical and practical
 Understand the role of urine screening in caring for an adolescent
with a known drug use problem

ii. Applicability and limitations

22.2.5. Role of the primary care practitioner

i. Anticipatory guidance
  Understand that every adolescent, not only those who are
currently using drugs, should be counseled regarding the potential
dangers of drug use and methods to minimize those dangers

ii. Office counseling

iii. Evaluation and preparation for referral

22.2.6. Referral for treatment

i. Knowledge regarding modalities

ii. Subsequent obligation

 Understand the obligation of the primary care practitioner to
periodically reassess the progress of a patient referred for
substance abuse treatment

22.2.7. Specific substances

i. Amphetamines or amphetamine-like substance and metamphetamine
(shabu)
ii. Marijuana
iii. Alcohol
iv. Cocaine
v. Cannabis
vi. Opioids
vii. Tobacco and cigarettes
viii. Barbiturates
ix. Hallucinogen
x. Volatile hydrocarbons (rugby) and gases
23.0 BEHAVIORAL DISORDES (DEVELOPMENTAL PEDIATRICS/AMBULATORY)

23.1. Recognize special population at risk for developing mental and behavioral disorders

23.1.1. Children of overseas Filipino workers

23.1.2. Children exposed in difficult situations both natural and man-made
23.1.3. Children of dysfunctional families

23.2. Psychosocial issues and problems

23.2.1. Sleep disorders

i. Identify the difference between sleep walking, night terrors and
nightmares
ii. Plan management approach to sleep disorders

23.2.2. Enuresis
i. Define enuresis and its classification into primary and secondary
enuresis
ii. Recognize the theories in the etiology of this condition
iii. Develop a therapeutic plan for children with enuresis

23.2.3. Encopresis
i. Understand the etiology of encopresis
ii. Propose a plan for treatment of encopresis including psychological,
educational, and behavioral approaches

23.2.4. Colic and feeding problems

i. Understand the etiology of colic and feeding problems
ii. Develop a therapeutic plan for children with colic and feeding
problems

23.2.5. Age-related disorders

i. Recognize the different psychological problems in the different age
groups

ii. Develop a therapeutic plan for children with the following conditions
including psychologic, educational and behavioral approaches:

 Infancy – Colic
Feeding
Rocking movements and head banging
Temperament
 Toddlers and preschool
Toilet training
Habits – Thumb sucking
Masturbation
Temper tantrums, breath-holding
 Middle childhood - School phobia
- Know that separation anxiety is the essential feature of
school phobia
- Understand the etiologic rule of mother-child passive
dependent
- Devise a therapeutic plan for management of school
phobia
 Adolescence – Sexuality
Acting out, antisocial behavior

iii. Specific problems, conditions

  Separation anxiety and school refusal
 Depression and suicide
i. Recognize that depression and suicide are psychiatric
illness that may occur in children and adolescents
ii. Recognize the essential features of depression in children
and adolescents
iii. Recognize that risk-taking behaviors may be an indication
of suicidal ideas
iv. Recognize when to refer to psychiatrist
 Sleep disorders
 Gifted child

23.3. Disorders of cognition, language, learning and attention

23.3.1. Developmental delay, mental retardation

23.3.2. Communication disorders

i. Autistic spectrum disorder
ii. Language disorders not due to autistic spectrum disorder

23.3.3. Learning disorders

23.3.4. Disorders of attention and impulse control

 Attention deficit/hyperactivity disorder (ADHD)
i. Know the diagnostic criteria of ADHD
ii. Recognize that attention deficit disorder may occur with or
without hyperactivity
iii. Know approach to management of ADHD
24.0 CRITICAL CARE (PEDIATRIC INTENSIVE CARE)

24.1. Recognition of impending systemic failure

24.1.1. Know the general signs and changes

 Sensorial change (level of consciousness)
 Color
 Respiratory effort
 Capillary refill
 Temperature
 Pulse (character)
 Heart rate
 Blood pressure
 Urine output

24.2. Emergency life support

24.2.1. Airway
i. Know the proper position
 Head tilt, chin lift
 Jaw thrust
ii. Maintain airway patency

24.2.2. Apply adequate breathing management

i. Mouth to mouth
ii. Bag mask ventilation
iii. Intubation

24.2.3. Know the management of circulation

i. Chest compression
- two-finger compression
- thumb method compression
- heel of hand compression
ii. Know the guidelines for fluid resuscitation

24.3. Common conditions requiring emergency life support

24.3.1. Recognize and manage shock

 Hypovolemic
 Septic
 Cardiogenic
 Neurogenic
 Anaphylactic
24.3.2. Respiratory failure secondary to:
 Respiratory
 Cardiac
 Metabolic
 Neurologic
 neuromuscular

24.3.3. Cardio-pulmonary failure/arrest

24.3.4. Plan approach to trauma and accidents

25.0 EMERGENCY CARE (DR. RIBAYA)

25.1. Trauma
 25.1.1. Recognize different types of laceration and its proper management (e.g.
approximation of vermillon border of the lip)
25.1.2. Know the care and dangers of punctured wounds
25.1.3. Know the common bone fracture and dislocation in children
25.1.4. Understand the manifestation and management of minor and major head
injuries

25.2. Burns

25.2.1. Know how to assess extent of burn

25.2.2. Plan outpatient treatment of minor burns
25.2.3. Know when to refer to burn specialist

25.3. Seizures

25.3.1. Recognize the etiologies of seizures in children

25.3.2. Plan proper diagnostic approach of seizures
25.3.3. Recognize management guidelines in use of major anticonvulsants (e.g.
status epilepticus)

25.4. Near-drowning
 Describe the steps in the management of near-drowning in
children

25.5. Bites and stings

25.5.1. Know the indications for rabies prophylaxis e.g. observation period of
biting animal
25.5.2. Know the approach to management of human/dog/cat/snake/insect/rodent
bites

25.6. Anaphylaxis/shock
 Recognize plan for management

25.7. Poisoning
See Section 26
26.0 POISONING (TOXICOLOGY)

26.1. General

26.1.1. Know the principles in the diagnosis and management of acute poisoning
i. History taking
ii. Physical examination
iii. Laboratory examination
iv. Management
 Emergency measures
 Prevent absorption of the poison
 Hasten elimination
 Use of antidotes
 Supportive measures

26.2. Specific poisoning

 Paracetamol
 Alcohols
 Opioids
 Isoniazids
 Phosphorous/nitrate (watusi)
 Hydrocarbons (kerosene and other petroleum distillates)
 Organophosphates/carbamates – insecticides
 Theophylline
 Anticholinergic substances
 Salicylates
 Acids and alkali (corrosives)
 Paralytic shellfish
27.0 SPORTS MEDICINE

27.1. Enumerate the different mechanisms of injury in sports

27.2. Enumerate the common injuries encountered in common specific sports

27.3. Know the principles in prevention, management and rehabilitation of sports injuries
28.0 PHARMACOLOGY (DR. CONNIE SISON /HOW)

28.1. Pharmacokinetics

28.1.1. Developmental issues

i. Recognize the difference in drug handling at various stages of growth
and development
ii. Recognize that proper drug therapy differs between adults and
children
iii. Identify the various teratogenic agents and their possible fetal
abnormalities

28.1.2. Know the mechanisms by which specific drug act

28.2. Adverse effects

28.2.1. Explain adverse perinatal effects of drugs

28.2.2. Recognize drugs that are contraindicated during breastfeeding
28.2.3. Know the various types of adverse effects e.g. hypersensitivity, toxicity,
idiosyncratic (pharmacogenetic) side effects, etc.
28.2.4. Know drugs with abuse potential

28.3. Know the specific drugs (as listed in Phil. Nat’l Drug Formulary) in relation to 28.1
and 28.2
 Antibiotics
 Analgesics/antipyretics
 Anticonvulsants
 Corticosteroids
 Cardiovascular drugs e.g. vasopressors, inotropic agents, anti-
arrhythmics
 Diuretics
 Antiasthma
29.0 ENVIRONMENTAL HEALTH (DR. IRMA MAKALINAO)

29.1. Recognize the unique vulnerability of children to various environmental hazards

depending on the developmental stage

29.2. Identify the most common environmental threats to children viz:

29.1.1. Air pollution

29.1.2. Water pollution
29.1.3. Food pollution
29.1.4. Pesticides and other toxic chemicals
29.1.5. Radiation

29.3. Emphasizes the role of the pediatricians as an educator and advocate in the protection
of children from harmful effects in the environment
30.0 ETHICAL ISSUES IN PEDIATRICS (DR. CECIL MARAMBA)

30.1. Know basic concepts of medical ethics

30.2. Identify bioethical principles

30.2.1. Autonomy
30.2.2. Informed consent/truth telling/confidentiality
30.2.3. Beneficence/non-maleficence
30.2.4. Withholding/withdrawing life support

30.3. Know and demonstrate principles of professional ethics according to the PPS and
PMA Codes of Ethics

30.4. Ethical decision making

30.4.1. Discuss issues regarding life, death and dying

30.4.2. Know palliative care, quality of life and good clinical practice
30.4.3. Know the role of hospital bioethics committee

30.5. Research in children

 Know the ethical and legal requirements of doing research in
children

Revised Mar ‘08