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Clerkship Program - Medical Knowledge & Objectives

CLIPP Case Medical Knowledge Objectives

CLIPP is a set of online simulated patient encounters. CLIPP is designed to teach you the core knowledge content of the pediatric clerkship curriculum through interactive multimedia cases that will require you to make decisions about diagnoses and clinical management. Throughout the cases you will be provided with support from pediatric experts.

Required CLIPP Cases – 24 Total
Case Topic
Case 1 Evaluation and care of the newborn infant
Case 2 Infant well-child (2, 6, and 9 months)
Case 3 3 year old, well-child check
Case 4 8 year old, well-child check
Case 5 16 year old girl, health maintenance visit
Case 7 Newborn with respiratory distress
Case 8 6 day old with Jaundice
Case 10 6 month old with a fever
Case 13 6 year old with chronic cough
Case 14 18 month old with congestion
Case 15 6 week old with vomiting
Case 16 7 year old with abdominal pain and vomiting
Case 17 3 year old refusing to walk
Case 18 2 week old with poor feeding
Case 19 16 month old with a first seizure
Case 20 7 year old with headaches
Case 22 16 year old with abdominal pain
Case 23 11 year old with lethargy and fever
Case 24 2 year old with altered mental status
Case 25 2 month old with sleep apnea
Case 26 9 week old with failure to thrive
Case 28 18 month old with developmental delay
Case 29 Infant with hypotonia
Case 31 5 year old with puffy eyes

CLIPP Case #1

  1. Identify the known benefits of feeding human breast milk to infants.
  2. Understand the important elements of a prenatal history as they relate to the health of the unborn child, including the importance of maternal age.
  3. Recognize factors in the perinatal and newborn history that may put a neonate at risk for medical problems.
  4. Identify intrauterine factors that affect the growth of the fetus.
  5. Demonstrate knowledge of the indication for newborn screening for TORCH infections, including HIV.
  6. Understand factors that affect maternal to fetal HIV transmission and those that play a role in the prevention of vertical HIV transmission.
  7. Identify the key concepts used in the clinical evaluation of gestational age and stability at birth (e.g., the Ballard score and Apgar score)
  8. Identify what medications are routinely given to all newborns (e.g., vitamin K, hepatitis B vaccine, eye prophylaxis).
  9. Recognize the salient physical findings of congenital CMV infection and name potential long-term complications associated with this condition.

CLIPP Case #2

  1. Recognize appropriate growth patterns in infants up to 9 months of age using standard growth charts.
  2. Know the nutritional requirements for appropriate growth for infants at ages 2, 6 and 9 months, including caloric requirements, differences between formula and breast milk, and how and when to add solid foods to the diet.
  3. Use the Denver II or other screening test to evaluate the developmental milestones of the patient at 2, 6 and 9 months.
  4. Recognize the importance of prevention and anticipatory guidance during the well visits, including behavior, development, safety and immunizations.
  5. Develop a differential diagnosis for an asymptomatic abdominal mass and formulate a plan for evaluation.

CLIPP Case #3

  1. Describe the key components of a toddler well-child visit, including:
    • The importance of identifying parent concerns in order to effectively set priorities for the visit.
    • The role of the physician in guiding parenting skills through affirming and validating parent's efforts and recommending and facilitating modifications in parenting and behavior.
    • Nutritional assessment and recommendations for diet and feeding behaviors.
    • Assessment of dental health and common factors leading to childhood caries.
    • Methods for performing a physical examination tailored to the age and mood of the child.
    • Topics for anticipatory guidance, such as safety.
  2. List key developmental milestones for children between the ages of 3 and 5 years old.
  3. Identify eczema and discuss first-line therapy.
  4. Discuss the common causes and work-up of anemia in an otherwise healthy child, as well as first-line therapy of iron-deficiency anemia.

CLIPP Case #4

  1. Understand the factors that contribute to childhood obesity.
  2. Understand health implications of childhood obesity.
  3. Recognize the typical presentation of ADHD in children.
  4. Understand conditions that contribute to a child's failure in school.
  5. Understand the initial evaluation of childhood hypertension.
  6. Recognize the routine components of a health maintenance visit for a school- aged child.

CLIPP Case #5

  1. Understand the relevance of a teen health maintenance visit and know crucial issues to address when interviewing an adolescent in the clinical setting.
  2. Address confidentiality with the adolescent and parent, including the issues that can and cannot be broken in this confidentiality agreement.
  3. Discuss risk-taking activities with the adolescent alone (the HEEADSSS interview). This should be completed in a nonjudgmental manner.
  4. Understand the different causes of anemia and the causes of fatigue and/or easy bruising in childhood and adolescence.

CLIPP Case #7

  1. Obtain a neonatal history using appropriate sources: hospital chart, mother, nursing staff.
  2. Complete the physical examination of the newborn, including using the growth chart to assess gestational age.
  3. Recognize the symptoms of respiratory distress.
  4. Develop a differential diagnosis for neonatal respiratory distress.
  5. Determine appropriate investigations to evaluate neonatal respiratory distress.
  6. Recognize the effects of maternal diabetes on the neonate.
  7. Identify neonatal hypoglycemia.
  8. Recognize the factors that determine the neonate's readiness for discharge from the hospital.

CLIPP Case #8

  1. Recognize a newborn with jaundice.
  2. Review bilirubin physiology, including metabolism and toxicity.
  3. Identify important history items, physical-exam findings and laboratory data helpful in evaluating a newborn with jaundice, specifically including the following diagnoses:
    • physiologic jaundice
    • hemolytic (Rh or ABO incompatibility, red cell membrane or enzyme defects infection)
    • hematomas and bruising
    • breastfeeding-associated jaundice
    • liver disease (biliary atresia, neonatal hepatitis)
    • metabolic disease (hypothyroidism, hypoglycemia, galactosemia)
  4. Identify treatment options for hyperbilirubinemia and be aware of the American Academy of Pediatrics' practice guideline "Management of Hyperbilirubinemia in the Healthy Term Newborn."

CLIPP Case #10

  1. Recognize that meningitis must be considered in the differential diagnosis of any febrile infant, regardless of the absence of meningeal signs.
  2. Understand that the only reliable way to rule out meningitis in a febrile infant less than 6-12 months of age is with a lumbar puncture.
  3. Identify that urinary tract infections should be considered in the differential diagnosis of any febrile infant with a non-focal history and physical examination.
  4. Understand the only reliable method of diagnosing a urinary tract infection in an infant is a urine culture from a catheterized specimen (urine cultures obtained from bag specimens are unreliable).
  5. Know that empiric antibiotic therapy for an infant or young child with an uncomplicated urinary tract infection should cover predominantly enteric gram-negative bacilli, particularly E. coli. Infants with severe symptoms should receive parenteral antibiotics.
  6. Recognize that all infants with a urinary tract infection need to have an evaluation of their genitourinary tract. This consists of an abdominal and pelvic ultrasound, and a voiding cystourethrogram (VCUG).

CLIPP Case #13

  1. Obtain a focused and relevant history for a chief complaint of chronic cough in the pediatric patient.
  2. Describe the relevant physical exam findings in a complete pulmonary examination.
  3. Discuss the relevant differential diagnosis for chronic cough in a school-aged child.
  4. Understand the concept of atopy and its relationship to allergies and asthma.
  5. Discuss the basics of management of allergic rhinitis.
  6. Know the relevant work-up for a patient suspected of having asthma.
  7. Understand the fundamentals of an asthma action plan, including commonly used medications, peak flow monitoring and asthma education.
  8. Discuss the acute management of a patient experiencing an asthma exacerbation.

CLIPP Case #14

  1. Identify age-appropriate approaches to the acutely ill toddler.
  2. Describe findings associated with a normal tympanic membrane, acute otitis media (AOM) and otitis media with effusion (OME) using proper techniques and skills.
  3. List management options for uncomplicated AOM.
  4. Recognize the indications and methods for performing an age-appropriate hearing screen.
  5. List management options for OME. (serous middle ear effusion).

CLIPP Case #15

  1. Assess the appropriate feeding patterns for a healthy 6-week-old infant.
  2. List the important historical and review of systems questions relevant to an infant with vomiting.
  3. List signs and symptoms of clinical dehydration, and be able to calculate an approximate percentage of dehydration.
  4. Know the common conditions in the differential diagnosis of vomiting in a 6-week-old infant.
  5. Order relevant tests to determine the likely cause of vomiting and to ascertain the degree and type of dehydration.
  6. Describe the most common etiologies for gastroenteritis in infants.
  7. Know how to calculate the total fluid deficit and understand the most appropriate type of fluid for replacing the deficit, including bolus, maintenance and replacement therapy.
  8. Know the indications for oral versus parenteral fluid replacement therapy.

CLIPP Case #16

  1. For a school-aged child presenting with dehydration:
    • Estimate the percent dehydration based upon relevant physical exam findings.
    • Discuss 3 types of dehydration and appropriate rehydration method for each.
    • Calculate the bolus fluids, volume deficit and daily maintenance needs based on the child's weight.
  2. For a school-aged child presenting in DKA:
    • List the common presenting signs and symptoms of type 1 diabetes and diabetic ketoacidosis.
    • Discuss the pathophysiology of diabetic ketoacidosis and the resulting impact on fluid, electrolyte and acid-base status.
    • Understand the principles of early management, including rehydration, electrolyte monitoring and insulin therapy.
    • Know the complications of DKA and DKA treatment.
    • Compare and contrast type 1 and type 2 diabetes in children.
  3. Discuss 3 normative cultural health beliefs in the Latino culture and their impact on medical care.

CLIPP Case #17

  1. Be able to construct a differential diagnosis for painful limp in a pediatric patient.
  2. Know the presentation, work-up and treatment of transient synovitis and septic arthritis of the hip.
  3. Have a general framework for completing a musculoskeletal exam in the pediatric patient.
  4. Recognize the role of evidence-based medicine in daily medical practice.

CLIPP Case #18

  1. Identify the steps in the evaluation of a heart murmur in infancy or childhood.
  2. Recognize the signs and symptoms of congestive heart failure in an infant.
  3. Understand the pathophysiology of a ventricular septal defect.
  4. Know the principles of management of CHF in an infant.

CLIPP Case #19

  1. Identify the causes of acute seizures in children.
  2. Recognize the historical and physical examination information important in the diagnosis of acute childhood seizures, both febrile and afebrile.
  3. Review diagnostic studies needed in the evaluation of the child with seizures and fever.
  4. Understand the approach to the diagnosis of conditions causing fever in toddlers.
  5. Differentiate a simple febrile seizure from a complex febrile seizure.
  6. Know the principles of managing a child with a febrile seizure.
  7. Understand the importance of counseling and follow-up in the child with a febrile seizure.

CLIPP Case #20

  1. List key features in the history of the child with headaches.
  2. List the elements of a thorough neurologic exam and interpret abnormalities.
  3. Discuss the differential diagnosis of headaches in children.
  4. Discuss the differential diagnosis of ataxia in children.
  5. Identify signs and symptoms of increased intracranial pressure.
  6. List things to consider when conveying difficult news to a patient and family.

CLIPP Case #22

  1. Know the ethical responsibilities in caring for adolescent patients.
  2. Be able to conduct a focused acute-care visit for an adolescent patient.
  3. Be able to obtain a comprehensive pain history for abdominal pain.
  4. Be able to obtain a sexual history in an adolescent patient using the HEADSS screening tool.
  5. Review the physical examination findings suggestive of an acute abdomen.
  6. Construct a differential diagnosis for acute abdominal pain in an adolescent.
  7. Review the presentation of and risk factors for pelvic inflammatory disease.

CLIPP Case #23

  1. Describe:
    • How to determine if a patient is emergently ill.
    • The differential diagnosis of a lethargic child.
    • The different types of shock.
    • The actions needed to perform the ABCs.
    • The principles of choosing the right fluids.
    • The principles of effectively breaking bad news to a patient and a patient's parents.
  2. Be able to demonstrate how to recognize an emergently ill child.
  3. Reflect on the challenges of dealing with patient criticism.

CLIPP Case #24

  1. Identify the patient who needs immediate medical attention and intervention.
  2. Take an initial history for a hospital admission.
  3. Distinguish the vital signs of a normal 2-year-old from those of an ill 2-year-old.
  4. Interpret the results of commonly ordered tests: CBC, electrolytes, glucose and an abdominal radiograph.
  5. Discuss the appropriate use and interpretation of lead-screening tests.
  6. Describe epidemiology and developmental vulnerability for poisoning and accidental ingestions of infants, toddlers and children.
  7. Describe the manifestations, toxicity and basic management of ingestions of lead.
  8. Identify the environmental sources of lead and discuss the clinical and social importance of lead poisoning.

CLIPP Case #25

  1. Be able to formulate a differential diagnosis for an infant with apnea or ALTE (apparent life-threatening event).
  2. Know how to obtain an appropriate history, including social history, for an infant with suspected shaken-baby syndrome.
  3. Know the physical signs and symptoms of shaken-baby syndrome.
  4. Know the necessary laboratory and radiological studies to order for an infant with physical abuse and shaken-baby syndrome.
  5. Know the ethical and legal responsibility of health care workers to report suspected child abuse.

CLIPP Case #26

  1. Identify abnormal infant growth patterns using standard growth charts.
  2. Define failure to thrive in infancy and discuss its causes.
  3. Apply knowledge of feeding options and of infant nutritional requirements to the management of an infant who has poor weight gain.
  4. Explain the mechanism whereby cystic fibrosis causes malnutrition.
  5. List and discuss the most common clinical characteristics of infants who have cystic fibrosis.
  6. Discuss the basic genetics of CF.

CLIPP Case #28

  1. Perform an initial developmental screening examination.
  2. Interpret information obtained from parents about childhood development.
  3. List common causes of developmental delay in children.
  4. Outline an organized approach to evaluating a child with developmental delay using history, physical and laboratory assessments.
  5. Identify unique features of the neurological examination in children and findings that are "pathological" and warrant further investigation.
  6. Review factors related to prematurity that impact growth and development in children.
  7. Summarize the definition and types of cerebral palsy. Differentiate these conditions from other causes of mental retardation.

CLIPP Case #29

  1. Recognize the common physical findings in Down syndrome.
  2. Understand the epidemiology of Down syndrome.
  3. Identify the common complications of Down syndrome.
  4. Identify the laboratory tests used to confirm the diagnosis of Down syndrome.
  5. Recognize appropriate "anticipatory guidance" in the management of children with Down syndrome.

CLIPP Case #31

  1. Use the history and physical exam findings to limit the differential diagnosis for periorbital edema.
  2. Use the history and physical exam findings to limit the differential diagnosis for generalized edema.
  3. Discuss the differential diagnosis for proteinuria.
  4. State the characteristic laboratory findings seen with nephrotic syndrome.
  5. Discuss how the pathophysiology of nephrotic syndrome results in the characteristic laboratory findings.
  6. Discuss the appropriate evaluation (including indications for renal biopsy) and initial management of a 5-year-old child who presents with the first episode of nephrotic syndrome.
  7. Discuss the prognosis for a 5-year-old girl who presents with her first episode of nephrotic syndrome.
  8. Discuss common complications of nephrotic syndrome, both in terms of the disease itself and management.