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Teacher's Guide COMSEP Clinical Case Ss TTeeaacchheerr’’ss GGuuiiddee CCOOMMSSEEPP CClliinniiccaall CCaasseess A Clinical Reasoning Case Based Review CCllaarrkk •• TTeemmpplleettoonn •• SSaanngguuiinnoo Teacher’s Guide COMSEP Clinical Cases A Clinical Reasoning Case Based Review Editors: Edward K. Clark, M.D. Director Pediatric Undergraduate Medical Education Associate Professor of Pediatrics Mercer University School of Medicine-Macon Campus Debbie A. Templeton Clerkship Administrator Mercer University School of Medicine-Macon Campus Co-Editor: Sandra M. Sanguino, M.D. Associate Dean for Student Programs and Career Development Associate Professor of Pediatrics Northwestern University Feinberg School of Medicine Introduction The Curriculum Taskforce has developed a user’s guide to the COMSEP Clinical Cases found on the COMSEP website. Some clerkship directors and educators use these problem sets to teach factual information and clinical reasoning. Others use these as teaching resources for residents and faculty who may be out of their comfort zone. The user’s guide is peer-reviewed and published as a password-protected document on the COMSEP website. The guides are written to address the learning objectives of junior medical students. The format of each user’s guide follows a template that includes definition of terms, review of important concepts, historical points, physical exam findings, clinical reasoning questions, and supplemental learning activities to not only provide answers but to supplement discussion for each case. i Table of Contents Subject: Section Editor Page Range Case Number: Author: Patient Presentation Page Numbers Behavior: Pages 1 - 18 Case 1: Buchanan: Concerned parents of a 3 year old not toilet trained 1 - 2 Case 2: Kennedy: 16 Month old with pallid breath holding spells 3 - 6 Case 5: Buchanan: 7 Year old with nocturnal enuresis 7 - 9 Case 6: Buchanan: 2 Year old refuses to eat 10 - 12 Case 8: Kennedy: 7 Year old with problems with behavior and attention 13 - 15 Case 10: Malouf: 2 Year old with temper tantrums 16 - 18 Child Abuse: Susanne Tropez-Sims Section Editor Pages 19 - 28 Case 2: Steffey: 2 Year old with broken arm 19 - 20 Case 3: Steffey: 7 Year old with vaginal discharge 21 - 23 Case 6: Tropez-Sims: 9 Month old with failure to thrive 24 - 26 Case 7: Tropez-Sims 18 Month old with burns 27 - 28 Chronic Illness and Disability: Judy Rowen Section Editor Pages 29 - 31 Case 7: Rowen: HIV exposed infant Pre and postnatal management/diagnosis 29 - 31 Common Acute Pediatric Illnesses: Edward Clark Section Editor Pages 32 -138 Sub-sections: Cough, Fever, Sore Throat, Otalgia, Abdominal Pain, Diarrhea, Rashes, Limb/Joint Pain, Heart Murmurs, Lymphadenopathy, Splenomegaly, Bleeding/Hematology, and Hematuria/Proteinuria Cough: Judy Rowen Section Editor Pages 32 - 54 Case 1: Rowen: 12 Year old with atypical pneumonia 32 - 34 Case 2: Rowen: 2 Month old with chlamydia pneumonitis 35 - 37 Case 5: Len: 4 Year old with cough and fever (bacterial pneumonia) 38 - 41 Case 6: Len: 2 Year old with a foreign body aspiration 42 - 44 Case 7: Kleschen & King: 1 Month old with cough and blue spells (pertussis) 45 - 49 Case 8: Silva: 7 Year old with a prolonged URI (sinusitis) 50 - 52 Case 9: Silva: 11 Year old with frequent coughing spells 53 - 54 Fever: Pages 55 - 61 Case 1: Buchanan: 2 Week old with fever, evaluation and management 55 - 56 Case 2: Buchanan: 7 Month old with fever, evaluation and management 57 - 58 Case 5: Latch: 7 Year old with rubeola 59 - 61 Sore Throat: Marta King Section Editor Pages 62 - 74 Case 1: Marquez: A 6 Year old with streptococcal pharyngitis 62 - 66 Case 2: Goerl & King: A 9 Year old with viral pharyngitis 67 - 70 Case 3: King: 14 Year old with infectious mononucleosis 71 - 74 ii Table of Contents, Continued Otalgia: Pages 75 - 77 Case 2: Spinner & Clark: 15 Month old with otitis media with effusion 75 - 77 Abdominal Pain: Pages 78 - 91 Case 1: Adame: 10 Month old with intussusception 78 - 81 Case 2: Adame: 3 Year old with acute gastroenteritis 82 - 86 Case 4: Butani: 8 Year old with HSP 87 - 89 Case 5: Butani: 14 Month old with abdominal mass 90 - 91 Diarrhea: Pages 92 - 95 Case 1: Adame: 6 year old with Bacterial AGE complicated by HUS 92 - 95 Rashes: Pages 96 - 111 Case 1: Gold: 4 Year old with urticaria 96 - 98 Case 2: Latch: 4 Year old with eczema 99 - 100 Case 3: Gold: 18 Month old with impetigo 101 - 102 Case 4: Melman: 5 Year old with a dog bite 103 - 105 Case 5: Melman: 2 Year old with a bat bite 106 - 108 Case 6: Hawkins: 15 Year old with acne 109 - 111 Limb / Joint Pain: Pages 112 - 118 Case 2: Soep: 12 Year old with knee pain Osgood Schlatter Syndrome 112 - 113 Case 3: Soep: 7 Year old with hip pain and limp, differential and evaluation 114 - 115 Case 6: Soep: 5 Year old with arthritis of a knee, differential and evaluation 116 - 118 Heart Murmurs: Pages 119 - 122 Case 1: Raunikar: 5 Year old with a heart murmur: innocent vs pathologic 119 - 120 Case 2: Raunikar: 1 Month old with systolic murmur (PPS) 121 - 122 Lymphadenopathy: Pages 123 - 125 Case 2: Pan: 6 Year old with a single lymphadenitis 123 - 125 Splenomegaly: Pages 126 - 127 Case 2: Pan: 2 Year old with sickle cell disease and splenic sequestration 126 - 127 Bleeding/Hematology Pages 128 - 131 Case 1: Rouce: 2 Year old with ITP 128 - 131 Hematuria/Proteinuria: Adam Weinstein Section Editor Pages 132 - 138 Case 1: Weinstein: 10 Year old with hematuria 132 - 135 Case 2: Weinstein: 3 Year old with proteinuria 136 - 138 iii Table of Contents, Continued Fluid & Electrolyte Management: Edward Clark Section Editor Pages 139 - 163 Case 1: Clark: 6 Year old requiring maintenance fluids 139 - 142 Case 3: Patterson: 7 Month old with AGE, assessment of dehydration 143 - 145 Case 4: Butani: Infant with dehydration and fluid replacement 146 - 149 Case 5: Weinstein: 2 Month old with hyponatremic dehydration and seizures 150 - 152 Case 6: Weinstein: Hypernatremic 9 Month old: seizures after fluids 153 - 155 Case 7: Weinstein: 9 Month old dehydration treatment with oral rehydration 156 - 158 Case 8: Weinstein: 9 Year old-DKA fluid and electrolyte management 159 - 161 Case 9: Butani: 9 Month old with dehydration and initial fluid management 162 - 163 Growth and Development: Pages 164 - 172 Case 1: Lewin: 3 Month old with poor weight gain 164 - 166 Case 2: Lewin: 15 Month old with speech delay 167 - 169 Case 9: Hawkins: 14 Year old with primary amenorrhea 170 - 172 Health Supervision: Penny Murata Section Editor Pages 173 - 192 Case 1: Sanguino: Prenatal visit topics 173 Case 3: Murata: 12 Month old health check: immunization contraindications 174 - 176 Case 4: Murata: 12 Month old health check: immunizations and steroid use 177 - 178 Case 5: Belkowitz and Oliveros: Newborn metabolic screening 179 - 181 Case 7: Belkowitz: 4 Month old health check: immunization complications 182 - 184 Case 8: Belkowitz and Malkin: 9 Month old: routine hemoglobin screening 185 - 187 Case 9: Brown: 3 Year old and TB testing 188 - 189 Case 11: Murata: 12 Month old and lead screening 190 - 192 Issues Unique to Adolescence: Kirsten Hawkins Section Editor Pages 193 - 208 Case 5: Levine: 13 Year old female without menarche 193 - 196 Case 7: Levine: 14 Year old female desires contraception 197 - 199 Case 11: Peterson: 16 Year old female with PID 200 - 202 Case 12: Peterson: 15 Year old female with an eating disorder 203 - 206 Case 13: Fortune and Kaul: 16 Year old: mother refuses to leave the room 207 - 208 Issues Unique to Newborn: Edward Clark Section Editor Pages 209 - 238 Case 1: Clark: Newborn Apgar scores 209 - 211 Case 2: Clark: 6 Hour old infant with tachypnea 212 - 214 Case 4: Wilson: Term infant with physiologic jaundice at 48 hours 215 - 218 Case 6: Head: Newborn with no passage of meconium at 24 hours 219 - 221 Case 7: Hudson: Newborn and reasons to breastfeed 222 - 224 Case 8: Patterson: LGA infant of a diabetic mother 225 - 227 Case 9: Patterson: Neonatal Abstinence Syndrome 228 - 231 Case 10: Head: Parental guidance on neonatal circumcision 232 - 234 Case 11: Hudson: Anticipatory guidance for the newborn 235 - 236 Case 13: Hudson: The approach to a SGA infant 237 - 238 iv Table of Contents, Continued Nutrition: Denise Salerno Section Editor Pages 239 - 255 Case 4: Best: 4 Month old breast fed infant: weaning and supplemental foods 239 - 241 Case 5: Best: 5 Day old with breastfeeding concerns 242 - 246 Case 6: Best: 2 Month old: discuss vitamin and fluoride supplementation 247 - 249 Case 7: Beeler: 5 Year old with obesity 250 - 252 Case 9: Beeler: 15 month old and counsel on “switching” to nonfat milk 253 - 255 Pediatric Emergencies: Becky Latch Section Editor Pages 256 -282 Case 1: Latch: 3 Year old with stridor from foreign body aspiration 256 - 258 Case 2: Latch: 4 Month old with fever and petechiae 259 - 261 Case 3: Cohen: 3 Year old with asthma exacerbation 262 - 266 Case 4: Kidd: 14 Month old with seizures 267 - 269 Case 5: Bolden: 4 Year old with loss of consciousness and emesis after fall 270 - 273 Case 6: Bolden: 18 month old with an accidental burn 274 - 276 Case 7: Neal: 4 Year old with foreign body aspiration 277 - 279 Case 8: Nguyen: 15 Year old with depression and suicidal ideation 280 - 282 Poisoning: David Eldridge Section Editor Pages 283 - 291 Case 2: Eldridge: 2 Year old with an ingestion of an alkaline solution 283 - 285 Case 3: Eldridge: 2 Year old unresponsive from an unknown ingestion 286 - 288 Case 4: Eldridge: 2 Year old with an iron overdose ingestion 289 - 291 Prevention: Sandy Sanguino Section Editor Pages 292 - 296 Case 2: Miryala: Sexually active 16 year old anticipatory guidance 292 - 294 Case 9: Miryala: Prevention of SIDS in a newborn 295 - 296 Therapeutics: Pages 297 - 304 Case 1: Chasnovitz: Management of a 3 year old with an acute otitis media 297 - 298 Case 3: Chasnovitz: Management of a 4 year old with possible UTI 299 - 301 Case 8: Chasnovitz: Management of a 2 year old with eczema 302 - 304 v Page | 1 BEHAVIOR Behavior, Case #1 Written by Gray M.
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