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DEPARTMENT OF PAEDIATRICS Vitamine complex
Dr. D. Y. Patil Vidyapeeth (Deemed University) Pimpri, Pune – 18 DEPARTMENT OF PAEDIATRICS Syllabus for MBBS (1) Introduction : Paediatrics Including Neonatology The course systematic instruction in growth and development nutritional need of a child, immunization schedules and management of common diseases of infancy and childhood, space of social pediatrics and counseling. (2) Goal The board goal of the teaching of undergraduate in Pediatrics it to acquire adequate knowledge and appropriate skill for optimally dealing with major health problems of children to ensure their optimal growth and development. (3) Objective :- 3.1 Knowledge:- At the end of the course of student shall be able to 3.1.1. Describe the normal growth and development during Foetal life neonatal period childhood and adolescence and outline deviations thereof. 3.1.2. Describe the common pediatric disorders emergencies in terms of epiemoology etiopathgenesis, clinical manifestations. Diagnosis rational therapy and rehabilitation. 3.1.3. State age related requirement of calories nutrients fluids drugs etc. in health and diseases. 3.1.4. Describe preventive strategies for common infections, disorder malnutrition, genetic and metabolic disorders, poisonings, accidents and child abuse. 3.1.5. Out line National programmes relating to child health meluding immunization programmes. 3.2 Skills At the end of the course the student shall be able to : 3.2.1 Take a detailed pediatric history; conduct an appropriate physical examination of children including neonates make clinical diagnosis conduct common beside investigative procedures. Interpret common laboratory investigation results and plan and institute therapy. 3.2.2. Take anthropometrics measurements. Resuscitate newborn infants at birth prepare oral rehydration solution. Perform tuberculin test administer vaccines available under current national programmes. Perform venescction start an intravenous saline and provide nasogstric feeding. 3.2.3 Conduct diagnostic procedures such as lumbar puncture live and kidney biopsy, bone marrow aspiration, pleural tap and ascetic tap. 3.2.4 Distinguish between normal newborn babies and those requiring special care and institute early care to all newborn babies including care of preterm and low birth weight babies. Provide correct guidance and counseling in breast-feeding. 3.2.5 Provide ambulatory care to all sick children identity indications for specialized inpatient care and ensure timely referral of those who require hospitalization. (4) Integration The training in Pediatrics should prepare the student to deliver preventive, promotive curative rehabilitative services for care for children both in the community and at hospital as part of a term in an integrated form with other disciplines e.g. Anatomy, Physiology, Forensic Medicine, Community Medicine and Physical Medicine and Rehabilitation. (5) SYLLABUS FOR UNDERGRADUATE TEACHING DEPT. OF PAEDIATRICS Lectures in 4th Semester 5.1 Introduction to Pediatrics 5.2 Normal Growth 5.3 Normal development 5.4 Immunization 5.5 Introduction to newborn and normal newborn baby. 5.6 Temperature regulation in newborn. & Care of new born 5.7 Breastfeeding and lactation management. 5.8 Infant and child feeding (include complementary feeding) Weaning & Artificial feeding. 5.9 Normal Nutritional requirements 5.10 Normal fluid & electrolyte balance. 5.11 Anemias in infancy & Childhood I 5.12 Anemias in infancy & Childhood II 5.13 Vitamin def. A & D 5.14 Vitamin def. B & C 5.15 Diphtheria & Pertussis 5.16 Measles & Varicella 5.17 Worm Infestations. Clinical Training Tutorials cum demonstration (during first one week) (6) Subjects for demonstration: 6.1 Scope of Pediatrics, learning objectives and teaching schedule. 6.2 History taking – I (Present, past and family.) 6.3 History taking – II (Antenatal, development, immunization, feeding). 6.4 General physical examination 6.5 Anthropometry. 6.6 Normal development. Case discussion in wards with emphasis on history, general physical and systemic examination and demonstration of anthropometric techniques. Assessment (end of Posting): Examination skills especially recording of special features of Pediatric history and anthropometry. (7) Lectures in 6th Semester & 7th Semester 7.1 Bleeding and coagulation disorders in children 7.2 Childhood tuberculosis – pulmonary and extrapulmonary (2 lectures) 7.3 Hypoglycemia and metabolic diseases 7.4 Shock and anaphylaxis. 7.5 Adolescent growth and normal puberty. 7.6 Other childhood malignancies (neuroblastoma, Wilms tumor, lymphoma). 7.7. Mental retardation. 7.8 Behavioral disorders. 7.9 Meningitis (CNS infections) 7.10 Hydorcephalus and neural tube defects 7.11 AFP (polio and GBS) 7.12 Enteric fever and malaria 7.13 Immunization. 7.14 Common childhood poisonings (Paediatric emergencies –surgical –2 lectures) 7.15 Genetics (8) Lectures in 8th Semester 8.1 PEM and its management.-2 lectures 8.2 Acute diarrhea and treatment of dehydration 8.3 Hypothyroidism in children. 8.4 Congestive heart failure – diagnosis and management. 8.5 Congenital heart disease -acyanotic and cyanotic (2 lectures) 8.6 Rheumatic heart disease. 8.7 Hypertension in children, including hypertensive emergencies. 8.8 Acute respiratory infections. 8.9 Bronchial asthma including status asthmatics. 8.10 Nephrotic syndrome. 8.11 Acute glomerulonephritis and hematuria. 8.12Liver disease – acute infections and chronic liver disease and portal hypertension (2 lectures) 8.13 Leukemia 8.14 Seizure disorders including status epileptics. 8.15 Cerebral palsy. (9) Lectures in 9th Semester 9.1 Birth asphyxia. 9.2 Low birth weight babies and high risk neonates. 9.3 Neonatal respiratory distress. 9.4 Jaundice in newborn. 9.5 Neonatal infections.- TORCH group 9.6 Neonatal convulsions and birth injuries 9.7 Bleeding in newborns 9.8 Downs syndrome, Noonans, Turners syndrome 9.9 Medical ethics. 9.10 Pediatric prescription and rational drug therapy. 9.11 JRA 9.12 Surgical Problems 2 lectures LECTURES – 1 hour duration each. Total Lectures – during the course – (100 Lectures) i.e. 100 hours teaching during the entire course. TUTORIALS : 12 (2 hrs. each) 9th Semester (10) COURSE CONTENT Vital statistics Definition and overview of Pediatrics with special reference to age-related disorders. Population structure, pattern of morbidity and mortality in children. Matenal, perinatal, neonatal, infant and preschool mortality rates. Definition, causes, present status and measures for attainment of goals. Current National Programs such as ICDS, RCH, Vitamin A prophylaxis, UIP, Pulse polio, ARI, Diarrhea Control Program, etc. Other National programs Growth and Development Normal growth from conception to maturity. Anthropometery – measurement and interpretation of weight, length/height, head circumference, mid-arm circumference, use of weighing machines, infantometer. Interpretation of Growth Charts: Road to health card and percentile growth curves abnormal growth patterns-failure to thrive, short stature. growth patterns of different organ systems such as lymphoid, brain and sex organs. normal pattern of teeth eruption. Principles of normal development. important milestones in infancy and early childhood in the areas of gross motor, fine motor, language and personal –social development. 3-4 milestones in each of the developmental fields, age of normal appearance and the upper age of normal. Preventable causes and assessment of developmental retardation. Psychological and behavioral problems. Measurement and interpretation of sitting height. US:LS ratio and arm span. Age-independent anthropometric measurement principles and application. Sexual maturity rating. Nutrition Normal requirements of protein, carbohydrates, fat, minerals and vitamins for newborn, children and pregnant and lactating mother. Common food sources. Breastfeeding-physiology of lactation, composition of breast milk, colostrum, initiation and technique of feeding. Exclusive benefits. Characteristics and advantages of prelacteal feed, top milk and bottle feeding. Feeding of LBW babies. infant feedings/weaning foods, method of weaning. assessment of nutritional status of a child based on history and physical examination. Protein energy malnutrition – Definition, classification according to IAP/Well come Trust, acute versus chronic malnutrition. Clinical features of marasmus and kwashiorkor. Causes and management of PEM including that of complications. Planning a diet for PEM. Vitamins-Recognition of vitamin deficiencies (A,D,K,C,B-Complex). Etiopathogenesis, clinical features, biochemical and radiological findings, differential diagnosis and management of nutritional rickets and scurvy. Hypervitaminosis A and D. Characteristics of transitional and mature milk (fore and hind milk) Prevention and management of lactation failure and feeding problems. Definition, causes and management of obesity. Immunization National Immunization Programme. Principles of Immunization. Vaccine preservation and cold-chain. Types, contents, efficacy storage, dose, site, route, contra-indications and adverse reactions of vaccines- BCG, DPT, OPV, Measles, MMR, and Typhoid: Rationale and methodology of Pulse Polio Immunization. Investigation and reporting of vaccine preventable diseases. AFP (Acutre Flaccid Paralysis) surveillance. Special vaccines like Hepatitis B, H influenza-b, Pneumocococcal, Hepatitis A, Chicken pox, Meningococcal, Rabies. Infectious Diseases Epidemiology, basic pathology, natural history, symptoms, signs, complications investigations, differential diagnosis, management and prevention of common bacterial, viral and parasitic infections in the region, with special reference to vaccine preventable diseases: Tuberculosis, poliomyelitis, diphtheria, whooping cough, tetanus including neonatal tetanus, measles, mumps, rubella, typhoid, viral hepatitis, cholera, chickenpox, giardiasis, amebiasis, intestinal helminthiasis, malaria, dengue fever, AIDS. Kala-Azar, leprosy, chlamydia infection Hematology Causes of anemia in childhood. classificaiton based on etiology and morphology,. Epidemiology, recognition, diagnosis, management and prevention of nutritional anemia-iron deficiency, megaloblastic. Clinical approach to a child with anemia with lymphadenopathy and or hepatosplenomegaly. Epidemiology, clinical features, investigaions and management of thalassemia. Approach to a bleeding child. Diagnosis of acute lymphoblastic leukemia and principles of treatment. clinical features and management of hemophilia, purpura. Diagnosis and principles of management of lymphomas. Types, clinical features and management of acute hemolytic anemia. Respiratory System Clinical approach to a child with cyanosis, respiratory distress, wheezing, significance of recession, retraction. Etiopathogenesis, clinical features, complications, investigations, differential diagnosis and management of acute upper respiratory infections, pneumonia with emphasis on bronchopneumonia, bronchiolitis, bronchitis, acute and chronic otitis media. Etiopathogenesis, clinical features, diagnosis, classification and management of bronchial asthma. Treatment of acute severe asthma. Pulmonary tuberculosis-infection versus disease, difference between primary and post-primary tuberculosis. Etiopathogenesis, diagnostic criteria in children versus adults. Diagnostic aids-technique and interpretation of Mantoux test and BCG test. Radiological patterns, chemo-prophylaxis and treatment. Diagnosis and management of foreign body aspiration. Differential diagnosis of stridor. Pathogenesis, clinical features and management of pneumothorax, pleural effusin and empyema. Multidrug resistant tuberculosis, bronchiectasis , pulmonary cysts Gastrointestinal tract Clinical approach to a child with jaundice, vomiting, abdominal pain, bleeding, hepatosplenomegaly. Acute diarrhea disease- Etiopathogenesis, clinical differentiation of watery and invasive diarrhea, complications of diarrheal illness. Assessment of dehydration, clinical differentiation of watery and invasive diarrhea, complications of diarrheal illness. Assessment of dehydration, treatment at home and in hospital. Fluid and electrolyte management. Oral rehydration, compostion of ORS. Clinical features and management of acute viral hepatitis, causes and diagnosis of chronic liver disease. Common causes of constipation. Abdominal tuberculosis Causes, clinical features and management of portal hypertension, Reyes syndrome ,Celiac disease. Drug induced hepatitis Central Nervous System Clinical approach to a child with coma, convulsions, mental retardation. Clinical diagnosis, investigations and treatment of acute pyogenic meningitis, encephalitis and tubercular meningitis. Seizure disorders – Causes and types of convulsions at different ages. Diagnosis, categorization and management of epilepsy (broad outline). Febrile convulsions-definition, types, management. Causes, diagnosis and management of cerebral palsy. Acute flaccid paralysis-Differentiation between Polio and Gullian-Barre syndrome. Microcephaly, hydrocephalus, chorea Infantile tremor syndrome, infantile hemiplegia Cerebellar diseases and Ataxia Cardiovascular system Clinical features, diagnosis, investigation, treatment and prevention of acute rheumatic fever. Common forms of rheumatic heart disease in childhood. Differentiation between rheumatic and rheumatoid arthritis. Recognition of congenital acyanotic and cyanotic heart disease. Hemodynamics, clinical features and management of VSD, PDA, ASD and Fallot’s tetralogy. Recognition of congestive cardiac failure in infants and children. Hypertension in children-recognition, etiology, referral. Diagnosis and management of bacterial endocarditis, pericardial effusion, myocarditis Genitourinary system Etiopathogenesis, clinical features, diagnosis, complications and management of acute post-streptococcal glomerulonephritis and nephrotic syndrome. Etiology, clinical features, diagnosis and management of urinary tract infection –related problems. Etiology, diagnosis and priciples of manages of acute renal failure. Causes and diagnosis of obstructive uropathy in children. Diagnosis and principles of management of chronic renal failure Causes and diagnosis of hematuria. Renal and bladder stones Hemolytic – uremic syndrome. Endocrinology Etiology clinical features and diagnosis of diabetes and hypothyroidism, hyperthyroidism and goiter in children. Delayed and precocious puberty. Neonatology Definition – live birth, neonatal period, classification according to weight and gestation, mortality rates. Delivery room management including neonatal resuscitation and temperature control. Etiology, clinical features, principles of management and prevention of birth asphyxia. Birth injuries – causes and their recognition. Care of the normal newborn in the first week of life. Normal variations and clinical signs in the neonate. Breastfeeding – physiology and its clinical management. Identification of congenital anomalies at birth with special reference to Anorectal anomalies, tracheo-esophageal fistula, diaphragmatic hernia, neural tube defects. Neonatal jaundice: causes, diagnosis, principles of management superficial infections, sepsis. Low birth weight babies – cause of prematurity and small –for-date baby, clinical features and differentiation. Principles of feeding and temperature regulation. Problems of low birth weight babies. Identification of sick newborn (i.e.,) detection of abnormal signs – cyanosis jaundice, respiratory distress, bleeding seizures, refusal to feed, abdominal distension, failure to pass Meconium and urine. Recognition and management of specific neonatal problems – hypoglycemia, anemia, seizure, necrotizing enterocolitis, hemorrhage. Common intra-uterine infections. Transportation of a sick neonate. Pediatric Emergencies Status epilepticus Status asthmaticus / Acute severe asthma. Shock and anaphylaxis. Burns Hypertensive emergency Gastrointestinal bleeding. Comatose child Congestive cardiac failure. Acute renal failure. Fluid - Electrolyte Principles of fluid and electrolyte therapy in children. Pathophysiology of acid-base imbalance and principles of management Genetics Principles of inheritance and diagnosis of genetic disorders Down’s syndrome. Behavioral Problems Breath holding spells, nocturnal enuresis, temper tantrums, pica,thumb sucking Pediatric Surgical Problems Diagnosis and timing of surgery of cleft lip/palate, hypospadias, undescended testis, tracheo-esophageal fistula, hydrocephalus, CTEV, umbilical and inguinal hernia, anorectal malformation, hypertrophic pyloric stenosis Therapeutics Pediatric doses, drug combinations, drug interactions, age specific choice of antibiotics, etc. Suggested Model for –Internal Assessment Semester Theory Theory Weightage Clinical (End Weightage for for internal of posting internal assessment assessment) assessment 3rd/4th - History/Anthro pometry 6th Short answer 2.5 Short case + 2.5 +MCQ Viva/Spots 8th 2.5 Short case+ 2.5 Spots Pre-final Short essay 5 2case+ Spots 5 MCQ/short answer Total 10 10 Clinics : - 4th Semester – 4wks 6th Semester – 2 wks 8th Semester – 4 wks 9th Semester – 2 wks Total 12 wks Recommended Text books 1. Essentials of Paediatrics by O.P. Ghai 2. Short text book of Paediatrics by Suraj Gupte Final Examinations Paper – 1 Pattern – MCQ – 30 mins – 14 marks Main Paper – 2 hrs 30 mins – 26 Marks Total – 40 Marks Practicals – long case - 20 Marks short case – 10 Marks Viva - 10 Marks Total - 40 Marks Grand Total (Theory + Practical + Internal Assesment) – 100 Marks
"DEPARTMENT OF PAEDIATRICS Vitamine complex"