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(NORMAL CONDITIONS AND GENERAL PRINCIPLES OF CARE)

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discourage use of infant walkers, window and stair safety, water safety, constant supervision, hazards of
strangers and animals, dealing with strangers, poisoning ingestion, pedestrian safety, street safety, sports
safety; avoidance of violence, cigarette, alcohol or drug use; childproof home (electrical appliances,
poisons, medicines, gun), preparation parents for emergency service, advise first aid treatment, prevention
of burns and scalds '5 6
34

1.8.5 J   d6 ! 7, developmental milestones, promote, bonding and
attachment, normal drive for autonomy, how to state clearly "no" and "yes", plays & toys, self-comforting
behaviors, positive outcome of desirable behavior, "time-out", promotion of responsibility, prevention of
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phimosis, labial adhesion, torticollis, tongue-tie, strabismus, myopia, hyperopia, diaper rash, seborrheic
dermatitis, geographic tongues, dental caries, enuresis, night crying, obesity weight loss or poor weight
gain, irregular menstruation, premature sexual development, acne, dysmenorrhea, vaginal / urethral
discharge, etc. common orthopedic problems (metarsus adductus, knock knees, bowlegs, congenital hip
dislocation, tibia torsion, scoliosis, flat feet, Osgood-Schlatter disease) '5 6
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39

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2.5 Femoral anteversion
2.6 Bow-legs  knock-knees
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1.3.10 Growth patterns
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1.6 =4CID5?=4C
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56
2.2 Cervical dysplasia
2.3 Hepatitis
2.4 Anemia
2.5 Hyperlipidemia
2.6 Tuberculosis
2.7 Hearing screening
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(
Technical & Procedural skills  !;# %& 2 #$)
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1.1 Abdominal: chronic abdominal pain
1.2 Cardiovascular: risk factors, hyperlipidemia, hypertension, chest pain, syncope
1.3 Dermatologic: acne, viral exanthems, dermatoses eczema
1.4 Endocrinology: physiologic goitre, constitutional delay growth and adolescent
1.5 Genitourinary: adolescent gynecology, STD, HIV, sexuality, family planning
dysmenorrhea, mild dysfunctional uterine bleeding, irregular mense, vaginitis, cervicitis,
STDs, uncomplicated pelvic inflammatory disease (PID), epididymitis, UTI, pregnancy
diagnosis
1.6 Musculoskeletal: kyphosis, scoliosis ≤ 20 o, Osgood-Schlatter disease
1.7 Neuropsychiatry: headaches, dizziness, uncomplicated school phobia and truancy,
uncomplicated attention deficit disorder, uncomplicated LD, adjustment reaction, parental-
adolescent reaction, psychosomatic disorders, problems in parents and peer relationship,
sexual behavior
1.8 Pulmonary: asthma, mild and moderate
1.9 Development and behavioral problems: adolescent turmoil, parental-adolescent reaction
1.10 Risk taking behaviors: substance abuse, injuries, violence
1.11 %* V : obesity, breast fibroadenoma, gynecomastia

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1.1 Cardiovascular: mitral valve prolapse, pathologic heart murmurs
1.2 Dermatologic: cystic or nodular acne
1.3 Endocrinology: hyper-or hypothyroidism, galactorrhea, unusual hirsutism or virilism,
abnormal growth, delayed puberty, unstable diabetes mellitus
59
1.4 Genitourinary: pregnancy, ectopic pregnancy and abortion, primary and secondary
amenorrhea of undetermined etiology, severe dysfunctional uterine bleeding, polycystic
ovary syndrome, ovarian cysts and tumors, testicular torsion, scrotal mass, varicocele,
hydrocele, HIV, GU trauma, Bartholinˆs abscess, complicated PID
1.5 Musculoskeletal: patella dislocation, scoliosis > 20 o, bone tumors
1.6 Neuropsychiatric: anorexia nervosa, bulimia, chronic fatigue syndrome depression,
suicidal idea, learning disabilities, substance abuse including anabolic steroids, psychosis,
conduct disorders (
  )
1.7 %* V : breast masses
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3.2 Communication skills and self-esteem building
3.3 Education and career / vocational planning
3.4 Expected growth and pubertal changes
3.5 Injury and violence, particularly related to motor vehicle safety, helmet use, weapon
avoidance or safety, water safety
3.6 Nutritional issues, particularly related to prudent diet, anemia risk in menstruating
adolescents, vitamin D and calcium nutritional deficits in adolescents, and risks of obesity,
anorexia, and bulimia
3.7 Sexuality (particularly STD), pregnancy, contraceptive use, date rape
3.8 Tobacco, alcohol, and other substance abuse
3.9 Transition to adult health care services
60
1.7  FD 2_ 6i6j5? 7
(GROWTH, DEVELOPMENTAL BEHAVIORAL PEDIATRICS)

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1. 
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1.1 Underweight, poor weight gain from child-rearing
1.2 Constitution growth delay
1.3 Familial short stature
1.4 Malnutrition
1.5 Intrauterine growth retardation
1.6 Growth retardation from chronic illness
1.7 Simple obesity
61

<=
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1.1 Growth retardation from endocrine disorders
1.2 Growth retardation from metabolic disorders
1.3 Tall stature from endocrine disorders
1.4 Tall stature from metabolic disorders
1.5 Growth disorders from bone diseases
1.6 Endogenous obesity

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64
families
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stridor, foreign body aspiration, hypertension, hypotension
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1.11 ! *G%H " : Limb pain limp, arthralgia, joint swelling, inability to move an
extremity, trauma to the neck, back or extremities, back pain
1.12 '$: Ataxia, coma, lethargy, confusion, fainting spells, seizures, headache,
weakness or paralysis, bulging fontanel, stiff neck, head trauma, dizziness
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metabolism)
1.5 ,%% / 3!: Acute abdomen, peritonitis, bowel obstruction, ileus,
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parenteral rehydration), constipation,biliary tract disease, inflammatory bowel disease,
upper and lower GI bleeding, pancreatitis, foreign body in GI tract
1.6 'K
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paraphimosis, testicular torsion, epididymitis, STD, edema, renal lithiasis, acute illness in
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1.7 
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ectopic, abortion)
1.8 *% / !": Sequestration and chest syndrome, fever in a child with leukemia,
anemia, thrombocytopenia, coagulopathy, hemophilia with acute trauma, possible tumor
(masses)
1.9 H 6 7*G%: Otitis media / externa, pharyngitis, cervical adenitis, peritonsillar /
retropharyngeal abscess, cellulitis (especially facial /orbital), sinusitis, meningitis,
encephalitis, sepsis / bacteremia, fever without source, infected wounds, and bites
1.10 '$: Altered mental status, migraine and muscle contraction headache, febrile
seizures, afebrile seizures, status epilepticus, paresis / paralysis, ataxia, shunt malfunction /
infection, increased intracranial pressure
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globe, hyphema
1.12 %%H#'˜ Z: Gait disturbances, sprains, strains, fractures, arthritis, bone and joint
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1.13 H6  
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1.14 : Respiratory failure, pneumonia, asthma, status asthmaticus, pneumothroax,
bronchiolitis, pleural effusion, smoke inhalation, BPD, severe asthma
91
1.15   / 3!: Burns, closed head injury, skull fractures, soft tissue injury including
lacerations, abrasions and contusions, common dental injuries
1.16  ) / 1 % 6: Ingestion / poisoning, bite and sting injuries, submersion,
electrical injury, heat and cold injury
1.17  6
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% *% : Bradycardia, tachycardia, cardiopulmonary arrest,
hypertension, hypotension, rhythm disturbance, poor capillary perfusion
1.2.2 ,%%: Abdominal distension, acute gastrointestinal hemorrhage,
peritoneal signs, vomiting
1.2.3 *% : Petechiae, purpura, polycythemia, anemia, neutropenia, thrombocytopenia
1.2.4 '$: Altered mental status, coma, delirium, encephalopathy, seizures,
thermoregulatory abnormalities, acute weakness, tetany
1.2.5 16: Anuria, hematuria, oliguria, polyuria
1.2.6 $" : Tachypnea, dyspnea, apnea, cyanosis, increased or
decreased respiratory effort, poor air movement, stridor, wheezing, pulmonary
edema

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1': Submersion injury, shock (cardiogenic, hypovolemic, septic, toxic), burns (thermal,
electrical), common intoxications
1.2 
% *% : Congestive heart failure, pericardial effusion, cardiac tamponade
95
1.3 
H7  Fluid Electrolyte  Metabolic: Severe dehydration, diabetic ketoacidosis,
syndrome of inappropriate ADH, diabetes insipidus
1.4 ,%%3!: Stress ulcer, massive GI bleeding, abdominal trauma, acute
abdomen, pre-op and post-op management
1.5 *% : Disseminated intravascular coagulation (DIC)
1.6 H 6 7*G%: Sepsis, meningitis, encephalitis
1.7 '$: Head injury, acute increased intracranial pressure, cerebral edema, status
epilepticus
1.8 $" : Adult respiratory distress syndrome (ARDS), respiratory failure /
impending respiratory failure, status asthmaticus, pneumothorax, upper airway obstruction
(infectious, structural, foreign body)

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1.1 CBC, differential count, platelets, indices
1.2 Blood chemistries: electrolytes, calcium, magnesium, glucose
1.3 Liver function tests
1.4 Renal function tests
1.5 Arterial blood gases
1.6 Coagulation studies, platelets, PT/PTT, fibrinogen, FDP, d-dimers (DIC screen)
1.7 Urinalysis
1.8 CSF analysis
1.9 Cultures and other diagnostic tests for infectious agents
1.10 Drug level and toxicologic studies
1.11 Chest X-ray
1.12 Abdominal series
1.13 Skeletal surgery
1.14 Cervical spine film
1.15 CT scan
96
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1.4 Intracranial monitoring
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2.3 Basic ventilator management
2.4 Analgesics, sedative and paralytics
2.5 Enteral and parenteral nutrition
2.6 Blood and blood product transfusion
2.7 Vasoactive drugs (pressor and inotropics)

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3.1 Maternal infection / exposure to infection during pregnancy
3.2 Fetal exposure to harmful substances: alcohol, tobacco, drugs
3.3 Maternal insulin-dependent diabetes, pregnancy-induced glucose intolerances
3.4 Multiple gestation
3.5 Placental abnormalities
3.6 Pre-eclampsia, eclampsia
3.7 Chorioamnionitis
3.8 Polyhydramnios, oligohydramnios
3.9 Premature labor, premature ruptured membrane
3.10 Complications of anesthesia and delivery practices
3.11 Fetal distress during delivery
3.12 Postpartum maternal fever/infection
3.13 Chronic diseases in mother

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1': Intrauterine growth failure, large for gestational age, hypothermia, hyperthermia,
100
prematurity (various gestational ages), feeding problems, poor post-natal weight gain,
lethargy, irritability, jitteriness, history of maternal infection or exposure
5.2 
: Respiratory distress (flaring, grunting, tachypnea), cyanosis, apnea,
bradycardia, heart murmur, hypotension, hypovolemia, dehydration, poor pulses, shock
5.3 +
 ": Common skin rashes /conditions, birthmarks, hyper-and hypopigmented lesions,
discharge and / or inflammation of the umbilicus, proper skin care for extreme prematures
5.4 ,%%: Gastric retention or reflux, vomiting, bloody stools, distended abdomen,
hepatosplenomegaly, abdominal mass, failure to pass stool, diarrhea
5.5  #! / !6% [(!: Metabolic derangements (glucose, calcium, acid-base, urea,
amino acids, '5 6 ), apparent congenital defect or dysmorphic syndrome
5.6 1
 *% : Jaundice in a premature or seriously ill neonate, petechiae, anemia,
fetomaternal transfusion, polycythemia, abnormal bleeding, thrombocytopenia, neutropenia
5.7 ! *G%H ",": Birth trauma related fractures and soft tissue injuries, congenital
hip dislocation, torticollis, birth defects and deformities
5.8 '$: Hypotonia, seizures, early signs of neurologic impairment, microcephaly,
macrocephaly, spina bifida, birth-trauma related nerve damage
5.9  ! [(!31!I: Poor attachment, postpartum depression, anxiety
disorders, teen parent, substance abuse, child abuse and neglect
5.10 * #Z / 'K
: Edema, decreased urine output, abnormal genitalia, renal mass,
hematuria, urinary retention

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1.1 : Hyaline membrane disease, transient tachypnea, meconium aspiration,
amniotic fluid aspiration, persistent pulmonary hypertension of the newborn, pneumonia,
airleak syndrome, chronic lung disease, atelectasis
1.2 
% *% : Congenital heart disease (cyanotic and acyanotic; PDA, VSD,
AV canal, tetralogy, transposition '5 6 ), congestive heart failure, SVT, complete heart
block
101
1.3  #!6,%!1$,%: Infant of a diabetic mother, common chromosomal anomalies,
neonatal screening programs for hypothyroidism, PKU '5 6
1.4 ,%%H7 : Feeding plans and nutritional management of high
riskneonates of those with special needs (cleft lip / palate, other facial anomalies), breast
feeding support for mothers and infants with special needs (high risk premature, maternal
illness, multiple birth, '5 6 ), complications of umbilical catheterization, hepatitis,
gastroesophageal reflux, meconium plug, necrotizing enterocolitis
1.5 *% ,
'%%"*% : Indications for phototherapy, exchange transfusion in
the premature or ill neonate, erythroblastosis fetalis, hydrops fetalis, coagulopathy of the
newborn, hemophilia, vitamin K deficiency, DIC.
1.6 H 6 7*G%: Intrauterine viral infections, group B streptococcal infections, neonatal sepsis
and meningitis, herpes simplex, infant of HIV, hepatitis, syphilis, nosocomial infections in
the NICU, central line infections, isolation procedures for contagious diseases in mother /
infant 7, varicella
1.7 '$: Ischemic hypoxic encephalopathy, intraventricular hemorrhage,
retinopathy of prematurity, hearing loss in high risk newborns (prevention and screening),
drug withdrawal, central apnea, seizures, hydrocephalus, spina bifida
1.8 3!: ('! ,
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emergencies 7, necrotizing enterocolitis, perforated viscus, intestinal obstruction,
diaphragmatic hernia, esophageal or gut atresia, gastroschisis, omphalocele, Pierre-Robin
syndrome, hypoplastic left heart, duct-dependent congenital heart lesions; pre-op and post-
op care
1.9 16: Acute renal failure
1.10  G  %H$$Z: Hyponatremia, hypernatremia, hyperkalemia,hypomagnesemia

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2.2 Direct and indirect Coombs tests
102
2.3 Neonatal drug screening
2.4 Cranial ultrasound
2.5 Abdominal x-rays for placement of umbilical catheter
2.6 Chest x-rays for endotracheal tube placement, heart size, and vascularity

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1.5 Electric and manual breast pumps
2. !I%%,"7G  
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2.5 Extracorporeal membrane oxygenation / nitric oxide therapy
2.6 Amniocentesis
2.7 Exchange transfusion
2.8 Central hyperalimentation

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based medicine)
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3 F1225?
3.1 _ 3
(INFECTIOUS AND PARASITIC DISEASES) ICD 10, I; A00-B99
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1.1 Microbiology
1.1.1 Clinical microbiology
1.1.2 Microbial virulence factor
1.1.3 Endotoxin and exotoxin
1.2 Immunology of infectious diseases
1.2.1 Immunologic response to infection
1.2.2 Basic immunology in immunization
1.2.3 Host defense mechanism
1.2.4 Host parasite relationship
1.2.5 Serologic study and skin test (principle and preparation)
1.2.6 Immunologic disorder
1.3 Host response to infection
1.4 Antimicrobial drugs
1.4.1 Principle of antimicrobial therapy
1.4.2 Pharmacodynamic and pharmacokinetic
1.4.3 Antimicrobial susceptibility test
1.4.4 Mechanism of drug resistance
2. %# $
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107

1.1 $
1': Fever in neonate, immunocompromised host, fever without localizing
features or associated with rash / petechiae / purpura
1.2 : Ear pain, sore throat, runny nose, cough, sinus pain, stridor, chest
pain, dyspnea, tachypnea
1.3 ,%%: Vomiting, diarrhea, abdominal pain
1.4 'K
: Urinary pain or frequency, hematuria, penile or vaginal
discharge
1.5 ! *G%H ",": Painful or swollen joints and bones, limp, puncture
wounds, skin changes, pain, or erythema
1.6  G*%": Adenopathy with or without fever or pain
1.7 )
$: Conjunctival drainage, orbital swelling or redness
1.8 7,%"': Tooth pain, facial swelling
1.9 '$": Convulsions, stiff neck, alteration of consciousness

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1.1 %$" systemic
1.1.1 Viral exanthems: Measles, varicella, herpes simplex, parvovirus, rubella
1.1.2 Zoonoses /arthropod borne: Dengue, malaria, JE, scrub typhus, murine
typhus, rickettsial infection
1.1.3 %* V: Infectious mononucleosis syndrome (7, EB virus, CMV,
toxoplasma), RSV, influenza, enterovirus, adenovirus, Burkholderia
pseudomallei
1.2 %]%


1.2.1 $" ,
 : URI, pharyngitis, otitis media and externa,
sinusitis, facial cellulitis, mastoiditis
1.2.2 7,%"' / %%: Herpetic gingivostomatitis, herpangina, oral thrush,
tonsillar-pharyngitis, glossitis enteroviral enanthems, Koplikˆs spots,
diphtheria, mumps parotitis
1.2.3 $" ,
": Croup syndrome
108

1.2.4 $" ,


,": Pneumonia (including chlamydia, mycoplasma,
bacteria, viral), bronchiolitis, bronchitis, pertussis, pulmonary
tuberculosis, tracheitis (child with endotracheal tube)
1.2.5 $" %: Esophagitis, enteritides (bacteria, viral and parasitic,
giardia, E. histolytica, cryptosporidiosis, antibiotic associated colitis,
hepatitis)
1.2.6 16: UTI (pyelonephritis, cystitis, urethritis)
1.2.7 %

* #Z: Urethritis, vaginitis, epididymitis, orchitis, cervicitis
1.2.8 ! *G%H ",": Osteomyelitis (acute), septic arthritis, tropical
pyomyositis
1.2.9 '$": Aseptic meningitis, post-varicella encephalitis,
tetanus, rabies, bacterial meningitis, JE
1.2.10 +
 ": Bacterial (impetigo, cellulitis, furuncles, erysipelas,
carbuncles), dermatophytes, candida (oral and diaper), infestations
(scabies, lice), viral (warts, venereal warts, molluscum contagiosum,
herpes simplex)
1.2.11 6: Conjunctivitis, blepharitis, sty, preseptal cellulitis
1.2.12 ' 6: Pinworms, toxocara canis, ascariasis, hookworm,
microsporidium, cryptosporidium, Entamoeba histolytica, giardia,
tapeworm, Brugia malayi, trichuriasis, free living amoeba,
strongyloidiasis, cysticercosis, trichinosis, gnathostomiasis,
opisthorchiasis, paragonimiasis
1.3 ,"6!,!%
1.3.1  Z: CMV, rubella, syphilis, parvovirus B19, varicella,
toxoplasma, herpes simplex virus (HSV), lymphadenitis (bacterial,
tuberculous)
1.3.2 ' 
- Viral: varicella, enterovirus, HIV, HSV
- Bacterial: sepsis, group B strept., focal infections (scalp, mastitis,
omphalitis),
tuberculosis
- Fungal: candida
109

1.3.3 $ /
,%  : Potential occult bacteremia
1.3.4
, : Cervicitis, vaginitis, genital ulcer/adenopathy, urethritis,
epididymitis / orchitis, cutaneous (syphilis, warts), PID, HIV, human
papilloma virus

<=
3.1.6  
F1 vH?3C?CH 
=D 
#
] 
) H *%
6,"V $6%"'()*%,"6,%+'/
1'"+7
7Y
>43?@
1. !I 
]     )*G %"6 !
LYL ,"6, %+'/
1  %, "
!! 
$1!,,% 6,%1' G
1.1 %$" systemic
1.1.1 Zoonoses / arthropod borne: Brucella, leptospirosis, lyme, malaria,
rabies, scrub and murine typhus
1.1.2 %* V : Prenatal exposure to or congenital HIV, AIDS, disseminated or
active tuberculosis, systemic fungal infections, disseminated gonococcal
infection, endotoxin shock, fever of unknown origin, fever and
neutropenia, fever in immunocompromised patient, Kawasaki disease
1.2 %]%


1.2.1 $" ,
 : Orbital cellulitis, mastoiditis
1.2.2 7,%"' / %%: Peritonsillar abscess, retropharyngeal abscess, dental
abscess
1.2.3 $" ,
": Epiglottitis, bacterial tracheitis
1.2.4 $" ,
,": Fungal pneumonia, empyema, lung abscess
1.2.5 
% *% : Endocarditis, thrombophlebitis, pericarditis,
myocarditis, acute rheumatic fever
1.2.6 $" %: Gastritis, hepatic abscess, cholangitis, hemolytic uremic
syndrome, parasites
1.2.7  7,%"$%": Appendicitis, peritonitis, abscess
1.2.8 16: Renal and perinephric abscess
1.2.9 %

* #Z: Complicated PID, tubo-ovarian abscess
1.2.10 ! *G%H ",": Osteomyelitis, septic arthritis, myositis
110

1.2.11 '$": Brain abscess, epidural, subdural, and paraspinal


abscess, encephalitis, transverse myelitis, peripheral neuropathies
(diphtheria, botulism, tetanus), Guillain-Barre syndrome, poliomyelitis
1.2.12 +
 ": Staphylococcal scalded skin syndrome
1.2.13 6: Keratitis, endophthalmitis
1.3 Special hosts
1.3.1 Immunocompromised hosts: 
'K" %#  empiric
treatment / management (7, AIDS, chemotherapy, steroid suppression,
malignancy)
1.3.2 $ : Toxoplasmosis (intrauterine), perinatal herpes, perinatal
systemic fungal, varicella

<=
3.1.7 _ 3@A 7    Human Immunodeficiency Virus 

#
]$ %*%  %" ) $6 7*G% HIV 6%  ,"6,%1'"+7
7Y
>43?@
1. %#  pathophysiology, natural history, %% "$'c 6 7*G%
]
H%  +'/
 HIV
2. 'K"  perinatal transmission %" HIV, $ %*%  %" 
$ %*%*  
]H %,"7G ,"6,% +'/
 $1!,!% 
 prophylaxis
3. %#  staging %" HIV infection H 76
7G
 $"%"'c 6  7, CD4 counts
 )H $
1' 
!I("'.%" 6 7*G%]
H%
4.        )   $ 6 7*G % HIV ,
!  +  7 
7Y !I, " 6, % !* % 

$[%
5.  "
!!I %![  %! (informed consent)  6

HIV ! 
" $”!$
%"
 $# +'/

6. 
# post exposure prophylaxis
7.       ) opportunistic infection H ]%, " " Pneumocystis carinii
pneumonia (PCP), Penicillium marneffei
111

<=
3.1.8 AH=~  
#7'c 7
%,"!!
>43?@
1. %# *%7'c 7
6 7*G%$,% 7, 6
 $ 6 1
 6 7*G% )
LH 
!$G"1%%d$# “
(pharmacokinetics  pharmacodynamic, spectrum of activity), d$# “" ", drug
interactions  %"
2. %#  7'c 7
 [("
!I(" Static vs. bactericidal drugs, susceptibility
test, MIC / MBC, combinations / synergy  monitoring for toxicity /efficacy
3. 
' '"%" Patterns %" microbial antibiotic resistance ''
7'c 7
*%!!
4.  "
!  
%!

!!,V  7'c 7
$7,%V

<=
3.1.9 3H? 34H_ 
#7
 [ *%'.%" H $
,%   (
 
 !" !)

<=
3.1.10 24   
 !H 6 7*G%
I *%I $G"  
>43?@
1. %#  %" 
 
 !6 7*G % H" (Nosocomial
infection)
#  
'c 6 %" $!+H 6 7*G%
2. %# 'c 6 6! standard precaution  transmission based precaution
3. %# 
$"'c 6   $'/
  H" *%I G" "

4. 
] )
6 7*G%$!%V  I G" "

5. %#  
$"'c  6 $1  +  
  !H [( "
!I( "   Prophylaxis $
!! I G" "
 H" 
6. 
,"%!$$ !
'.%" 6 7*G%)
$,%"$
'$3%* V *% $%%'I " Z 
7. %,"7G  Chemo-prophylaxis  immuno-prophylaxis  6 7*G%$
,% 7, *%!!%"% 6% 
!$G"%,"7G  gamma globulin   
$!! ! 6 $!+H %%
112

8.  '() 

, *% 
  '.%" H $6 6,%$"3! #Z
9. %#  
#   Prophylaxis  L $  !+  H $  !% 7,  1 
 Y,
meningococcus 6% % *%6% 

<=
3.1.11 F?H?~2 
#6
$"%"'c 6 $ 7
 )
6 7*G%  
>43?@
1. 
 ' L$"%"'c 6 
2.  "
,!I specimen ,"1'"%"'c 6   ,"6
7*G%
6,"V 7,  $ 1
 chlamydia  mycoplasma 1 %,"I6%"!!
3. %# '6Z$"   $ rapid diagnostic techniques 
7*G%H $!% 7, particle agglutination, rapid strept tests,  monoclonal FA tests
4. %#   '  6Z $"   $  serologic tests 7, Western
immunoblot  ELISA
5. %#  1'7$"  %"$ molecular biologic tests 7, PCR,
Southern blot, in situ hybridization
6.  "
!       !'  7 $"      +
 Z
susceptibility test 7, MIC, MBC, synergy and antagonism
7. %# %"' 'c 7
 [!  serum bactericidal titers
8. 7*%H 6 7*G%H 6 6,%% 6$6%""6,%$
"#L 
"

3.2 _ 7? ?H=


(MALIGNANT NEOPLASM) ICD 10, II; C00-C97
<=
3.2.1 H ?=w3@6} !
!*G \ 
 *G%"%$
,%   !I 1''6Z 
7'c 6 1 
>43?@
1. %# $ Y ) *G%"%  
2. %# 7 !  *G%"% $,%  
3. %# 
!+ '6 $" #! (genetics)  '  '"   H! 
(molecular biology) $%1   *G%$,%  
113

<=
3.2.2 Fx=_ !I
])*G%"6 H !"
 *G%"%$,%  
, 1  %!$G"6!+'/
*%,"6,%+7
7Y]
H
>43?@
1. %# %% ",  
],   ), LZH

$[% / +$$ (G  
 
 / H 6,%1' G
1.1 Leukemia (ALL, AML, CML)
1.2 Brain tumor
1.3 Hodgkinˆs  non-Hodgkinˆs lymphoma
1.4 Neuroblastoma
1.5 Wilms tumor
1.6 Retinoblastoma
1.7 Histiocytosis syndrome
1.8 Soft tissue sarcomas / rhabdomyosarcoma
1.9 Bone tumors (osteosarcoma and Ewing ˆs sarcoma)
1.10 Liver cancer
2. 
]H , %#  *  $"%"'c 6  )*G%"6
%!$G"$,"6,%+'/
,+7
7Y]H 1 !! !*%%
% "6,%1' G$%'5  *%","7G*H !" +'/

2.1 6,%! G*%"H6
2.2 '
3)*G%"
2.3 '
6! 
2.4 6H6 !!H6
2.5 !%  $%"
2.6 !%  7,%"%
2.7 1*G%"
2.8 7
2.9 G  , +%!"
3. %# 
$[% / +] $,% $  ! 7,
cyclophosphamide, vincristine, adriamycin / doxorubicin  methotrexate '5 6
114

4. %# 
$[% / +$ (G 
")H !"   

,
$,% 7,  66 (learning disabilities), 
,%"$"6,%!1$,% 
 !"$6 ! (second cancers) '5 6
5. 
] )*G%"6 %!$G"$,"6,%,+7
7Y]H 1 
!! !*%
,+'/
!
 / H 6,%1' G
5.1 
]] $"H !" 7, superior vena cava syndrome (SVC) obstruction,
tumor lysis syndrome, hyperleukocytosis, cord compression '5 6
5.2 
," ,
 +'/
H !"$%, 
,") 7, !1""
1  ! (febrile neutropenia), 6 7*G%, 
*% %%! '5
6

<=
3.2.3 AH11 !I   ,+'/
 /  !  / +' %"
%"+'/
H !"1 %,"I6%"!!
>43?@
1. %#  
$, #    H !"  
, 6,7 1 
I6%"
2. %# + ) LZH %"H !"6,7 1 I6%"!!
3.    'c 6 6
%"+ '/
H ! " 
,  "1   )1  I6 %" 
!$G "
psychological support ,,%!,  % 
%"+'/

4. )' ' %",+'/
H !"  $1 I6%"!!
<=
3.2.4  7? 7 5C1 ? !I
]H !"!
*% 
6,%! G*%" H %3)L$"   6
$"%"'c 6  1 
%,"I6%"!! %!$G" )*G%"6 *%,"6,%+7
7Y]H 6,%1'
>43?@
1. %# )L$"  $7 
]H acute and chronic leukemia, histiocytosis
syndrome  H Hodgkinˆs  non Hodgkinˆs lymphoma 1 
2. %# 
#6
$" %"'c 6  *%
] H !"! * % 
6, %!
G*%"1 I6%"!! 7, complete blood count (CBC), ',")L%"
[Z!"
!$G"%! 3) 6
1  6 7 G  *G%6
 (biopsy)
'5 6
115

3.  )*G%"6 *%,"6,%+7


7Y]H 6,%1'

<=
3.2.5 ?H= (solid tumor) !I
] )*G%"6
H  *G%"% $,%  1  ,"6,%+7
7Y]H 6,%1'
>43?@
1. %# )L$"  $!)L H  *G%"% 6,7 1 7, !% 
$%" % 6!6
  6H' %% "$"'$ %[ 
*% %%6!6
'5 6
2.  
 ] H  *G % "% $  , %     7, neuroblastoma, Wilms tumor,
retinoblastoma, brain tumor, hepatoblastoma, rhabdomyosarcoma '5 6 H %3
'
6 6
,"  6
$"%"'c 6 $!!
3. * %7
#6
$" %"'c 6  *%
]  H '! %"H
(staging) 1 I6%"!!
!$G" complete blood count (CBC), 6
'K

 $6  $16 I," 6
 
 * "
!I" (ultrasound), 
I," %!
6%Z (CT scan),  tumor markers 6
7 G  *G%$"
#
$ (biopsy) '5 6
4. %#  )H !" *G%"%6,7 1 %,"I6%" 
!$G"
+,6 , ]"")  !
5.  )*G %"6 , 
, " ,
 +'/
H !" *G%"%  *%,"6,%
+7
7Y]H 6,%1'

3.3 _ =3H? 


(DISEASES OF THE BLOOD AND BLOOD FORMING ORGANS) ICD 10, III; D50-D77
<=
3.3.1 H?=w3@6} !
!*G \ 
*% %


"*% !I !'6Z 
7'c 6 1 
>43?@
1. %# "[Z7 6,"V $'5 ,
'% %"*% 
!$G"1$
 !
"$%, 
!   '6 1 
2. %# H "" $%"! *%  "1 
3. %# " Z,
'%
!+ '6 $,%%"œH!H 1 
4. %# ',")L $%"! *% 
7 6,"V 1 
116

5. %# 1$
 ! Y6 H6 $" %"[Z! *% 7 6,"V (growth
factors and cytokines) 1 
6. %# 1$
 !*%  (hemostasis)   !*% (thrombosis) 1 

!$G"'K$
%"1 ,[Z+ "% *% , 'K "6
%"*%
(coagulation)
7. %# 
! Y$"  %" blood group  HLA system 1 

<=
3.3.2  !I 
 / +6
$"
%"'c 6 $"H 6
$$+ '6 %%
'6
>43?@
1. %# ' '"%" ,'6 6,"V $"H 6
$  '6  7,
"%6,"V  1 
7, hemoglobin, hematocrit, mean corpuscular volume (MCV), white blood cell,
platelet, coagulogram '5 6
2. '+6
$"%"'c 6 $"H 6
$1 %,"I6%"

<=
3.3.3 
622C=gHH= ? !I
]
 )H *% $,% 
6 %"1 H 1!,6%","6,%+'/
1'"+7
7Y
>43?@
1.
] )
 / H 6,%1' G1  
6 %"1 H 1!,'5 6%","6,%
+'/
1'"+7
7Y
1.1 
H 6" (anemia)
1.1.1 Iron deficiency
1.1.2 Thalassemia / hemoglobinopathies : trait and diseases
1.1.3 Glucose-6- phosphate dehydrogenase deficiency (G-6-PD)
1.2. 
*% %%", (bleeding disorders)
1.2.1 Acquired platelet dysfunction with eosinophilia (APDE)
1.2.2 Idiopathic thrombocytopenic purpura (ITP)
1.2.3 Idiopathic vitamin K deficiency
1.2.4 Hemophilia
1.2.5 Von Willebrand disease
1.2.6 Disseminated intravascular clotting (DIC)
117

<=
3.3.4 
3C?C=?H 
=D !I
])
*G%"6 1   'KY$"H 6
$%"+'/
$
,"6,%+7
7Y
>43?@
1.
])*G%"6 %!$,"6,%+'/
,+7
7Y]H !*%

,+'/
!
 / H 6,%1' G
1.1 
H 6" ([ ) % *%$ 1
 '.!$ 3.3.3
1.2 
*% %%", % *%$1
 '.!$ 3.3.3
1.3 Neutropenia  aplastic anemia
1.4 Hemophilia $!
$[% $ Y 7, ! life- threatening bleeding 6%"
1 +,6 *%I% _K ! inhibitor '5 6
1.5 
 / H $6%") 3) 7, stem cell transplantation '5 6

<=
3.3.5 5K4 7 !I
]
 / H $!
!+ '6

7#6   H  7
#$ H H$"%"'c 6 $!!

!$G" )
 / H G V 1 I6%"
>43?@
1. %# 
!6%"6!'6   [(!  metabolism %"#6   1 6G"6,


$    H6  I("
,
2. %# )L Y$"  %"
 #6 
!I("H H 6"
#6 (iron deficiency anemia)
3. * %7
#6
$" %"'c 6 1  %, "I 6 %"!! 6
%"
(screening test) 
]H 6 6!+)
 #6
4. )
 #61 %,"I6%"!! 7,   % #6
$ $    ,,%!,+' %" 6 6!+)'5 6
<=
3.3.6 __F?C1 K3o  = !I
] H H 6"6,
 #[!œH!H + '6 1 H %3'
6 6
,"6
$"
%"'c 6 $!! 
!$G"  )     
 !'.%" 
 H G1 I6%"
118

>43?@
1.
]H H 6"#[!1  H 
]H 
[ %* V $,%
 1 
2. *%7
#6
$"%"'c 6 1 %,"I6%"!! 6

(trait) 
]H (disease)
3. %# 
#)H G1 %,"I6%"!!6!
! "%"H 3)\\ 

!%!%" % 
 +  
!$G"*% *% 
6 !!
4.     (counseling) , ! +' %"   )+'/
 I,$% $"
 #!
 !'.%"  H G1 %,"I6%"

<=
3.3.7  ?C=F5? 7  !I

]H *% %%",$ 


!+ '6 %" *% $,%1  H %3)L$"
  6
$"%"'c 6 $!!
!$G") LZH 1 
I6%"
>43?@
1.
]H *% %%",$ 
!+ '6 %"  *% $,%1  (ITP 
APDE) H 
]H 
*% %%",%* V
2. *%7
#6
$"%"'c 6 1 %,"I6%" !! 
]H ITP
 APDE
3. )H ITP  APDE 1 I6%"

<=
3.3.8  ?C=F5?2257?5? 
!I
]H *% %%",$ 
!+ '6 %""6
%"*% $
,%1  H %3)L$"   I,$% $" # !6
$"
%"'c 6 $!! 
!$G") LZH '.%" 1!, H G1 
I6%"!!
>43?@
1.
]H *% %%",$ 
!+ '6 %""6
%"*% $,%1 
(hemophilia, von Willebrand disease, idiopathic vitamin K deficiency,  DIC) H 

]H 
*% %%",%* V
119

2. *%7
#6
$"%"'c 6 1 %,"I6%"!!  
]H 6,
%," G 1 , bleeding time, coagulogram, specific factor assay, fibrin degradation
product
3. )]H 1 I6%"!! 6,H 7, ,
'%%"
*% $ $ , _ 6%Z! 
6!   heparin '5 6
4.     (counseling) , ! +' %"  )
'.%"
 *% %%[G[ %# I,$% $" #!  '.%"  H !,
1 %,"I6%"

<=
3.3.9 3C25?  !I*% ,
'%%"
*% 1 %,"I6%"!!
>43?@
1.  %,"7G  *% ,
'%%"*% (! *%  "  *%  !
coagula-tion factors) 1 %,"I6%"!! 
!$G"%"
$[% $
% (G 1 
2. %#  7
#%* $%7$ $ *% ,
'%%"*% 1 
7, erythropoietin , cytokines 6,"V '5 6
3. %# I("+ 
!$G"
#%"%"! *% 
%%*% ,
'%%"
*% 1  
!$G"]"",,
'%%"*% ,% 1',+'/


<=
3.3.10 <? $$%"!$Z '.%" H $

*%  ,
'%%"*%
>43?@
1.    ,,%!,+' %"
'.%" 1!, H H 6" #6
 7, '$ %  !#6 6! Z   % !
1!,6 7*G%# '% '5 6
2.   $" # ! (Genetic counseling)  + '/
H *% 1  7, hemophilia
thalassemia, G-6-PD deficiency '5 6
3. '.%" 
*% %%",
6! K 1 H 
6! K  $
$
120

3.4 _6H_2?_

=24H
(ALLERGY AND DISORDERS INVOLVING THE IMMUNE MECHANISM) ICD 10,
D80-D89
<=
3.4.1 H?=w3@6} !
!
!
$36Z*G \
%"H ! H "H $
1! ! !I 1''6Z 
'c 6 " 1 
>43?@
1. %#  1''6Z 
7'c 6 

$36Z*G \ 6,%1' G
1.1 Host defense mechanism and its development
1.1.1 Lymphocyte (T-B cell)
1.1.2 Macrophage and mononuclear cell
1.1.3 Polymorphonuclear cell (PMN)
1.1.4 Immunoglobulin
1.1.5 Complement
1.2 Gell and Coombs hypersensitivity
1.3 Allergic inflammation (mast cell, eosinophil, lymphocyte, IgE, mediators etc)
1.4 Principle of allergen immunotherapy
1.5 Pharmacology of drugs used in various allergic disorders
1.6 Cytokines
1.7 Transplantation immunology and major histocompatibility complex (MHC)

<=
3.4.2  !
!
J  # 
$
)L$"  
H !  ! ! "%$ 
'6 

+ '6 1 
>43?@
1.  !%# J  # 
$%"! ! $G" cellular,
humoral phagocytic  complement
2. ,"7G% % " +'/
$'5 H !  
!$G"+'/
$!
!,%"%"
! !
121

3. %# 
#6
$"  %"'c 6 
! '+ 7, $ % *%

!+ '6  ! ! $ %+
 "*% 6% %",7 
$ %! $"+
 " 6
*% (RAST) 6
!I'%

<=
3.4.3 
62 3 gHH= ? !I
])H
! $!%V [("1!,'5 6%","6,%+7
7Y
>43?@
1. !I
] # 
$ )$I6%"

6,%1' G
1.1 !%!  / 1[ %
1.2 6%! 
1.3 +* !  (atopic dermatitis)
1.4 H * 7 $1!, "
1.5 ! )  angioedema
1.6 %
1.7 
1.8 !"6,%
1.9 Anaphylaxis

<=
3.4.4 
62 3 H?3C?C !I
] )
*G%"6 !
LYL ,"6,%1'"+7
7Y
>43?@
1. %# # 
$ 
] )*G%"6 6%  ,"6,%+7
7Y

6,%1' G
1.1 
 '.!$ 3.4.3 $!% " *%)
1!,1 +
1.2 +'/
$6%"$ %+
 "*%6$"! *%*%$ %  
! !
1.3 Hereditary *% severe angioedema
1.4 Anaphylaxis
1.5 Latex allergy
1.6 +'/
$!! ! ,%"
1.7 Serum sickness
122

<=
3.4.5  Allergic Rhinitis and Conjunctivitis !I
])H
allergic rhinitis  conjunctivitis
>43?@
1. %,"7G % 
! Y$"  $ % 6,%1' G
1.1   eosinophils  G!
1.2 
eosinophils  *%
1.3 $ %+
 "$G"
# (prick)  delayed hypersensitivity
1.4 6
 specific IgE 7, RAST
1.5   IgE  *%
2. ) 
1 %,"!!: Antihistamines, topical steroids, topical cromolyn
3(),+'/
 % 


#
 !,%!   "
%!
(environmental control)
3. %,"7G ,"+'/
$Z+7
7YH ! 
4.  immunotherapy 6  %"$Z+7
7YH !  
!$G" )
+'/
$ 'c   "]
5. 
]  H    )6%!   6% 6 7*G % %#  

!! #Z
,"!%!  7G "% 1[ %H *

<=
3.4.6 _ !I
] )H * $1!, "1 
>43?@
1. %#   H 'K"6,% H *
2.
]% ! H $[% '!
! "%"H
3. 
]H +'/
$!% wheezing
4. 'K," !$$ %%   
#"'K ",

5. %# G 6% )+'/
$G"L$!%% L$1!,!%% 
!$G"
77 6,"V (metered dose inhalers, steroids, cromolyn)
6. ,"7G+" "%"$7 )H %*
7. *%6
 '+$"%"'c 6  7, arterial blood gas, pulse oximeter, 
6
!I'%
123

7.  %# ,+'/


*% % 

'K6  %% 
 !
 "
%!
  $'% H 7 peak flow meter 77 6,"V %%
"
9. %,"7G ,"+'/
1'+7
7YH ! 
10. %,"7G+'/
$!
!
)*G%"6
11. 
]H '! )$ $!% wheezing

<=
3.4.7 4H26C? $$%"!$Z$
1' 
]
)
! ! ,%"
>43?@
1.  !
 ! ! ,%"7 6, "V        
$ 7, , %"
humoral, cellular, phagocytes, complement %61  7,  #! 6 7*G%

"1  !
2. % % "%"+'/
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!$G" AIDS / HIV
3.   $ %$  7  !%V     '! 
 !  !  , % " 
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immunoglobulin subclass %%,"7G % %"$ %6,7
4. %# 
#)
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5. %# 
# immunization $'5 ,+'/

! ! ,%"  "
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<=
3.4.8 6H $$%"!$Z$
1' 
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>43?@
1. %# )L$"  %"H %$!%
2. !I%# %66,"
,"% 'c   %$1!,1  
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3. %# %,"7G%"$$ %+
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4.  )'.%" H %$!%
124

<=
3.4.9 6H= 
#
] )+'/
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>43?@
1. %# %% "%" 
!$G"+* %
! 16%  anaphylaxis
2. 
]H +*  +*  exanthems
3. %# 1 
]H
4.  )+* %,"!' $#  7, urticaria, serum sickness, anaphylaxis
 Stevens Johnson syndrome
5.  '()   !  +'/
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! Y%"",
" 6,%$Z+)

<=
3.4.10 Urticaria, Angioedema  Anaphylaxis $$%"!$Z
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1' 
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>43?@
1. 
]H %# # 
$%"! ) angioedema  anaphylaxis
2. )H %,"'5 G 6% 1 %,"!!
3. %# 
#
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%! " "6
4. %G 6% %") anaphylaxis, 
!$G"  +'/
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7 
6 %"!*% % 7, ] epinephrine
5. %#  L , 7  Medi-AlertŽ
<=
3.4.11 <? $$%"!$Z     
'.%" H !  H $"! !
>43?@
1. !I '()  , !  +'/
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1.1  !!,% $*%'.%" H ! 
1.2
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1.3 " "$+'/
 
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%!
1.4 $$%"%" Z ,!  
125

3.5 _CHC 2ou


(ENDOCRINE AND METABOLIC DISEASES) ICD 10, IV; E00-E35
<=
3.5.1 H?=w3@6} !
!
!
$36Z*G \ %"
6,%!1$,% !I 1''6Z 'c 6 " 1 
>43?@
1. %# 
 , embryology 
$ %"6,%!1$,%6,%1' G
1.1 Pituitary  hypothalamus
1.2 Thyroid
1.3 Adrenal
1.4 Pancreas  insulin
1.5 6,%!1$,%$
 calcium homeostasis
1.6 Gonad and sexual development
2. %# " Z " %%d$# “%"œ%ZH! 6,"V %","

<=
3.5.2  _ 1$$
!+ '6 6,"V %"6,%!1$,%
!I 1''6Z 
7'c 6 1 
>43?@
1. %# 1 H /
!
!+ '6 %"6,%!1$,%!6% [(!  1'
'6Z 
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1'
1 %,"!!   6,%1' G
1.1 6%"H
1.2 Pathogenesis, pathophysiology
1.3 Clinical course
1.4 Complication
1.5 Psychosocial •cultural factors

<=
3.5.3  
$" 
!'6 
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+ '6 %"H 6,%!1$,%!6% [(!1 %,"!!
>43?@
1. %# )L Y6 H6  !%" G 
!"$'6 6!
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'6Z '!  Y6 H6
126

2. %#  )L Y6 H6" *%,+ '6


3. %#  )L'  '"$" 
$%"  ,
  ,! 
7 Tanner
staging  !I 
'6 
'5  ,!
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,
%

4.
]
 premature thelarche  adrenarche 
 true precocious puberty

<=
3.5.4 
62 3 gHH= ? 
] ) /

+ '6 $"6,%!1$,%!6% [(! "6,%1' G1  
6 %" H 1!,6%","6,%1'"
+7
7Y
>43?@
1. %# +6
*%  %"
!,%"%"6,%!1$% Z (thyroid screening)  $
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,!*%
6
[G !I%# ,+'/

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1 +'6 *%+ '6
2. %# # 
$%"H 
] )H / 
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2.1 
'5  ,!
7  *%"H *G%" *%
 anorexia nervosa
2.2 
 Y6 H6  *%"H7  (exogenous obesity)
2.3 
 benign premature adrenarche  benign premature thelarche
2.4  *G%"6 6 6!*%
!+ '6 %" puberty, 
 normal
variation
2.5 
6
! #Z (familial short statures, constitutional delay of growth
and puberty)
2.6 Gynecomastia 
, 7
3. 
] )$  L6,%1' G
3.1 $$ ! '5 gestational diabetes
3.2 Transient hypoglycemia
3.3 Transient hypercalcemia
3.4 Transient hypocalcemia
4. 6 6! $! Y6 H67  *G%"6 *%
]
!+ '6 %"
6,%!1$,% !I6  ,"6,%!*%!%,"7G  L$'5 ! #Z (family short
stature) '5  ,!
7 (constitutional delay of growth and puberty)
127

<=
3.5.5 F1 v
H?3C?C $$%"!$Z 
]
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7Y
>43?@
1. !I
] )*G%"6 ,% $,"6,%1'$Z]
6,%!1$,% "6,%1' G
1.1 Adrenal insufficiency
1.2 Ambiguous genitalia, micropenis, hypogonadism
1.3 Diabetes insipidus (central & nephrogenic)  psychogenic polydipsia
1.4 Congenital adrenal hyperplasia
1.5 Delayed or precocious puberty
1.6 Diabetes mellitus (diabetic ketoacidosis, DKA)  )"_`a 
DKA
1.7 
%
$!6%"6,%!1$,%+ '6 7, Cushing syndrome,
hyperthyroidism, growth hormone deficiency, panhypopituitarism '5 6
1.8 Hypoglycemia   
, 
 persistent hypoglycemia in infancy
1.9 Metabolic bone disease 
!$G" rickets  skeletal dysplasias
1.10
!+ '6 %" calcium, phosphorus  magnesium metabolism
1.11 ,!%6
6G   [("% œ%ZH!  Y6 H6 (growth hormone)
,%"
1.12 
,
"+ '6  growth hormone !
1.13
!+ '6 %"6,%!6!%" (pituitary) $'5 + congenital anomaly 
intracranial lesion
1.14
!+ '6 %" thyroid hormone  %%
1.15 ,!% Turner  genetic syndrome %* V $!'KY  6,%!1$,%,
! 

1.16 Undescended testes
1.17 Metabolic disorders 7,
!+ '6 %" amino acid metabolism, carbohydrate
metabolism (hypoglycemia, glycogen storage disease), lipid metabolism '5 6
128

<=
3.5.6 _ 2 
] )H 

>43?@
1. % "*G%"6 %"H 
 !I$6
$"%"'c 6 *%

] )%$[% $"
2. *%76
$"%"'c 6 *G%"6 '+%,"I6%"
!$G" 6
*%
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$[% 1 
3. ) DKA 
  G$"% *% $"'  insulin %!
6
6 6!+$"%"'c 6 
4. $6
 G6 *% H ' G
(home kit) '  %"% [
1 %,"!!
5. ‹.
" %$[% (retinopathy, nephropathy  neuropathy)
6.  '()  +'/
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<=
3.5.7 <? $$%"!$Z '.%" # $ 
6,%!1$,%$" + '6   
>43?@
1.  '()   !   
' '"$ (G  7,
" ,!

2.    



 [ '.%" H '5  3)  $!
!+ '6 %"6,%!1$,%
"%," 7,  influenza vaccine hypoadrenalism, diabetes mellitus, hypopituitarism,
 Cushing syndrome
3.  '()  , !   

!"$ adrenal insufficiency
  $1 ) 
 corticosteroid  V 7, H %* nephrotic syndrome
'5 6
4.  "
!  

6!   ! $$G" 
 !!, '7
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$1 
6!   [! _%_% %1!,"%

3.6  
=231  7_=@4-C?
(DISORDERS OF FLUID, ELECTROLYTE AND ACID-BASE BALANCE) ICD 10, IV;
E86-E87
129

<=
3.6.1 H?=w3@6} 
$
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H$$Z   - ," ,"
>43?@
1. %# 1
 !%"," *%"6,%1' G
1.1 Body volume
1.2 Osmolarity
1.3 Electrolytes: Na, K, Cl, Ca, P, Mg
1.4 Acid-base balance
2. %# 
!6%"%" G%H$$Z 6,
 Y%" G$"
+
 " $"'% (insensible loss) $"'K
 (sensible loss)
3. %# 
*%6,"V $!+6,% fluid, electrolytes  acid-base homeostasis

<=
3.6.2  _ 1
!+ '6 %" G %H$
$Z   - ,"7 6,"V
>43?@
1. %# 1$"#
$ 6 %% "
$[% %"
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+ '6 $" G %H$$Z   - ," %"," 
6,%1' G
1.1 Volume deficit, volume excess
1.2 Hypo / hypernatremia
1.3 Hypo / hyperkalemia
1.4 Acidosis / alkalosis (acute, chronic)
1.5 Hypo / hypercalcemia
1.6 Hypo / hypermagnesemia
1.7 Hypo / hyperphosphatemia

<=
3.6.3 Fx= !I
]
!+ '6 %" G %H$$Z   - ,"
1 
>43?@
1. !I
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6I'" Z% 1 '.! 3.6.2 H 
1.1 

!'
6 6
,"
130

1.2 ,"6
'+6
$"%"'c 6 
1.3
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1.4 
]H /
!+ '6 $'5 1'1 !$

<=
3.6.4 g  )
!+ '6 %" G %H$
$Z   - ,"
>43?@
1.  )   G %H$$Z   - ," 'KY] *%
," ,
(acute or emergency) 1 ,
1.1 Newborn: 7, severe birth asphyxia, idiopathic respiratory distress syndrome
'5 6
1.2 Central nervous system: 7, increased intracranial pressure
1.3 Cardiovascular system: 7, congestive heart failure
1.4 Respiratory system: 7, acute respiratory failure
1.5 Gastrointestinal and hepatobiliary system: 7, severe diarrhea, gut obstruction,
cirrhosis
1.6 Urinary system: 7, acute renal failure
1.7 Endocrine and metabolic system: 7, diabetic ketoacidosis, adrenal
insufficiency '5 6
1.8 Hematology and oncology: 7, tumor lysis syndrome, uric acid nephropathy,
acute hemolysis '5 6
1.9 Infectious diseases: 7, DHF, septic shock, malaria '5 6
1.10 Miscellaneous : 7, burns, near-drowning, salicylate poisoning, SIADH '5 6

3.7 ?_
(NUTRITIONAL DISORDERS) ICD 10, IV; E00-E68
<=
3.7.1 H6} !I    $"H7 *%," !
)%"  !'c  #  I("
, 1 
>43?@
1. %# 
!*G \  H7 %"  
'6 "6,%1' G
1.1 Nutritional requirement for age
131

1.2 Nutrient digestion, absorption and metabolism in health state


1.3 Developmental changes of systems relating to feeding
1.4 Nutrition in lactation
1.5 Breast milk and breast-feeding
1.6 Infant formula and other milk formula
1.7 Complementary feeding

2.      6,%1' G *% 6 H66!


1 
2.1 %6!

2.2 Feeding problems and eating habits
2.3 Food safety

<=
3.7.2 ID__32 
?F_ !
!  H7 
*%'.%" )'KY$"H7 H $* *%"H7 
>43?@
1. %# 1 H 
] )    *%'.%" H *%

6,%1' G
1.1 Protein-energy malnutrition
1.2 Vitamin deficiencies
1.3 Mineral deficiencies
1.4 Obesity
1.5 Nutrient deficiencies in vegetarianism
1.6 Food faddish
1.7 Hyperlipidemia
1.8 Hypervitaminosis
2. %# 1 H 
] ") _`a _%!$G"$,"6,%+'/

"+7
7Y1 %,"!!%"
]] 6,%1' G
2.1 Severe protein-energy malnutrition
2.2 Cardiac beri-beri
2.3 Xerophthalmia
132

3. %# 1 H 
] )*%   *G%"6 %!$G","6,%
+'/
1'"+7
7Y1 %,"!!  H /
6,%1' G
3.1 Morbid obesity
3.2 Lipoprotein disorders
3.3 Eating disorders
4. %# 1 H %!$G"    $"H7 *%'.%" 'KY$
 6!!!*%'5 +Y, "6,%1' G
4.1 Coronary heart disease
4.2 Diabetes mellitus
4.3 Hypertension
4.4 Malignancies
4.5 Osteoporosis

<=
3.7.3 _A F72k= !I)$"H7 , 

'/
1 
>43?@
1. %# 
!*G \ %" $"H7 ,  
'/
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1.1 Nutrient digestion, absorption and metabolism in diseases
1.2 Nutrition assessment : Nutrition history taking, physical examination,
anthropometric measurement, laboratory investigation
1.3 Enteral nutrition : Principles, special formula
1.4 Parenteral nutrition : Principles
2.  )'KY$"H7  H / 
6,%1' G
2.1 AIDS
2.2 Burns
2.3 Critically ill
2.4 Heart disease
2.5 Malignancy
2.6 GI disease: Malabsorption, liver and biliary disease, pancreatic disorders, diarrhea,
constipation
2.7 Pulmonary disease
2.8 Renal disease
133

2.9 Diabetes mellitus


2.10 Food allergy

3.8 _?F 5?6j


(MENTAL AND BEHAVIORAL DISORDERS) ICD 10, V; F00-F99
<=
3.8.1 H?=w3@6} 
! 
$36Z$Z
*G \ "%$'6Z  ) $!
!+ '6 $"d6 ! 6
71 
\ !$Z
>43?@
1. %# J '6     6,"V 6,%1' G
1.1
! 7
Z'KYY (Cognitive development)
1.2 %!LZ (Emotional development)
1.3 " ! (Social development)
1.4  #! (Moral development)
1.5  *% 1
$"6
(Motor development)
1.6 )*% (Speech and language development)
1.7 3 (Gender identity development)
1.8    (Personality development)
2. G 6%
!+ 
,"!, (Bonding and attachment)
3. %# *G %!LZ  %"  (Temperament)
4. G 6% J  % 
(Family development)
5. %# 
! *G \ $"
$36Z$
 %" H $" 6 
7d6 ! 7,
neuropharmacology, neurochemistry, neurophysiology
6. ,"7G
#6
$" 6
$ !I%,"6
1 %,"!! 7, IQ, Bender-
Gestalt test '5 6
<=
3.8..2 ID
62 3 6%"H *%'KY$" 6
7$,%
>43?@
1. %# 6%" mental disorder 6,%1' G
1.1 Mental retardation
1.2 'KYJ  7, autistic disorder, speech and language disorder, motor
incoordination disorder, learning disabilities, attention deficit hyperactivity
134

disorder (ADHD)
1.3 Tics disorder
1.4 Elimination disorder: Enuresis, encopresis
1.5 Eating disorder: Food refusal, pica, anorexia nervosa, bulimia nervosa
1.6 Disruptive behavior 7, conduct disorder, oppositional defiant disorder
1.7 Gender identity disorder
2. 6%" reactive attachment disorder
3. %# 
!!
! Y%" psychological aspect of illness, hospitalization
handicaps  dying
4. %# 6%"H *%
$","$!6!'KY 6-%!LZ1 ,
4.1 Hyperventilation
4.2 Headache
4.3 Abdominal pain
4.4 Cyclic vomiting
5. %# 6%"organic mental disorder 7, acute organic mental disorder, chronic
organic mental disorder, HIV / AIDS   
6. %# 6%" conversion disorder  somatoform disorder
7. %# 6%" anxiety disorder "6,%1' G
7.1 Separation anxiety disorder
7.2 Post traumatic stress disorder
7.3 Phobic disorder
7.4 Panic disorder
7.5 Generalized anxiety disorder
7.6 Obsessive-compulsive disorder
7.7 Mood disorder 1 , depressive disorder
7.8 Substance use disorder
7.9 %* V 7, 'KY %  G
  trichotillomania  Munchausen
syndrome
135

<=
3.8.3 IDx4 x !I )'KY]] 

," ,
$" 6
7$!%H 1!,6%","6,%
>43?@
1. 
] )]] 
," ,
$" 6
7 1 ,
1.1 Drug intoxication
1.2 Attempted suicide
1.3 Hyperventilation
1.4 Acute organic mental disorder
1.5 Aggressive and violent behavior

<=
3.8.4 IDHF  6jh@
62 3 
!I )'KY$" 6
7 'KY$"d6 !%!LZ$ !% !
7
'c 6 1!,'5 6%"
,"6,%+7
7Y
>43?@
1. 
] 'KYd6 !%!LZ$,% 7, temper tantrums,
breath holding spell, feeding problem, sleeping problem, masturbation, stuttering, thumb
sucking
2. 
]  )*G%"6 'KY substance abuse
3. %#  psychosocial care of chronic illness and handicaps
4. 
]  )*G%"6  'KY6,%1' G
4.1 Mental retardation
4.2 Autistic disorder
4.3 Speech and language disorder
4.4 Motor incoordination disorder
4.5 Learning disabilities
4.6 Attention deficit hyperactivity disorder (ADHD)
4.7 Tic disorder
4.8 Elimination disorder: enuresis, encopresis
4.9 Eating disorder 1 , food refusal, pica
136

4.10 Disruptive behavior 7, conduct disorder, oppositional defiant disorder


4.11 Adjustment disorder
4.12 Psychophysiologic disorder
4.13 Separation anxiety disorder
4.14 Reactive attachment disorder
4.15 Chronic headache and chronic abdominal pain

<=
3.8.5 ID
H?3C?C=?H 
=D !I
,"6,%+'/
1'"+7
7Y
'KY$" 6
7 d6 !%!LZ  
>43?@
1.   
 ]       )*G % "6 , "6, % +'/
1'" +  7 
7Y 
 'K Y 
6,%1' G
1.1 Schizophrenia
1.2 Depressive illness
1.3 Repeated suicidal attempt
1.4 Anorexia nervosa
1.5 Bulimia nervosa
1.6 Aggression and violence $1!,6% %")*G%"6
1.7 Autistic disorder $1!,6% %")*G%"6
1.8 Substance abuse
1.9 Cyclic vomiting
1.10 Severe disorganized family
1.11 Obsessive compulsive disorder
1.12 Post traumatic stress disorder
1.13 Phobic disorder
1.14 Panic disorder
1.15 Generalized anxiety disorder
1.16 Gender identity disorder
1.17 Separation anxiety disorder $1!,6% %")*G%"6
1.18 ADHD and LD $1!,6% %")*G%"6
137

<=
3.8.6 <? !
!!I '() 
 ! 
% 
 '.%" 'KY$" 6
7 d6 !%!LZ
>43?@
1. !I "
!  
 parenting, discipline, adoption/foster care, family life
education, impact of mass media, play and game, electronic media, child mental health
2.    '(  ) 
,  !  * % +       
  parenting, discipline,
adoption/foster care, family life education, impact of mass media, play and game,
electronic media, child mental health 1 %,"!!

3.9 _223
(DISEASES OF THE NERVOUS SYSTEM) ICD 10, VI; G00-G99
<=
3.9.1 H?=w3@6} 
$36Z*G \ %"H 
'$'6Z 
7'c 6 1 
>43?@
1. %# $"
$36Z*G \ $ Y1!,[[% $
%"'$[("
!I7%# 
!+ '6 $ (G 1 ,
1.1 Neuroanatomy
1.2 Neurophysiology
1.3 Development of nervous system
1.4 Cerebrospinal fluid dynamic
1.5 Neurotransmitters
1.6 Pharmacology of antiepileptic drugs and other drugs used in nervous system
diseases
1.7 Basic principle of neuroimaging
1.8 Basic principle of neurophysiology examination (EEG, EMG, nerve conduction
study)
1.9 Basic principle of neurogenetics
1.10 Molecular and cellular biology of pediatric nervous system disorders
1.11 Environmental epidemiology of pediatric nervous system disorders
138

<=
3.9.2 C1  #  %"H + '6 $"
'$ !'6Z 
7'c 6 1 
>43?@
1. 
]
+ '6 6, %"'$$,%  *G%"6 
,"6,%
6,%1' G
1.1 Neural tube defect 1 , spina bifida, meningocele, meningomyelocele,
encephalocele, syringomyelia '5 6
1.2 Congenital malformation %* V %"'$

<=
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'6 
]H / 

+ '6 $"'$1 
>43?@
1. %# 
!66,"
,"J   6,"V $'6 7, J   *%)
6 'KYY 7! *G%  *% 1
reflex, %!LZ-" !
+ '6
2. !$) ['
6 6
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!+ '6 $6

1 
3.  
!66,"
,"
!+ '6 %"'$",
%* 7,
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4. %# 
!66,"%"
!+ '6 $ "$ (static) 
!+ '6 $'5 !(G *% V
(progressive)
5.  Y $7

7, % ataxia *% lethargy  *%"$1 
7  " 
$!#   '$ 7,   
6 7*G%%,"
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6. %# % " %'$ $  *%"6
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!+ '6  '$
139

<=
3.9.4 
62 3J gHH= ? !I
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6 %"1  H 1!,6%","6,%+'/
1'"
+7
7Y
>43?@
1. %# # 
$ 
]  )H / ,!% / 
6,%1' G
1.1 Absence seizures
1.2 Febrile seizures
1.3 Static encephalopathy
1.4 H '
3), migraine '
3)
!  (tension headache)
1.5 Mild closed head trauma  simple linear skull fractures
1.6
!+ '6 $"'$7

$'5 + 7, benzodiazepine
1.7 Generalized tonic-clonic seizures
1.8 Viral meningitis
1.9 Attention deficit disorder $1!,[[%
1.10 Bacterial meningitis $1!,!' KY[[%

<=
3.9.5 
F3C?C !I
] )*G%"6  H /

 / 'KY$
,"6,%+7
7Y1 %,"!!
>43?@
1. 
] )*G%"6 ,"6,%+'/
H / 
6,%1' G
1.1 Acute encephalopathy 7, metabolic, hypertensive, lead, anoxic, drug / toxin
induced
1.2 Bacterial meningitis
1.3 Brain abscess
1.4 Brain tumor
1.5 Cerebral palsy
1.6 Coma, increased intracranial pressure
1.7 Craniosynostosis
1.8 Encephalitis
1.9 '
3) " $'5 !(G *%1!,6% %"6,%)6!'6 *%!
140

%$,"7G
,% '5  *G%"% !%" 7, %'
$  
7 *%
'

 $6* '5 6
1.10 Hydrocephalus
1.11 Movement disorders (chorea, ataxia, tics)
1.12 'KYY%,% J + '6 , autism
1.13 ! *G%%,% ", hypotonia *% flaccidity 7, anterior horn cell disease,
Guillain-Barre syndrome, muscular dystrophy, myasthenia gravis
1.14 Neurocutaneous syndromes
1.15 %7[("
]1  ) *%! #ZH $"'$$!
%
"*%V *%!%77 6,% *%" (status epilepticus)
1.16   "$3), complicated skull fractures,  %"1 "
1.17 H %"% *% %"!%"
1.18 6 7*G%*%Y $%" ventriculoperitoneal shunt
1.19 Parasitic CNS infestation
1.20 Cryptococcal meningitis
1.21 Tuberculous meningitis
1.22 Spinal cord disorders

<=
3.9.6  !I
] ) ,"6,%+'/
$!
%71 %,"!!
>43?@
1.  %77 6,"V 7, generalized tonic-clonic, atonic, myoclonic, simple partial,
complex partial,  absence
2.   )%7 $ 1 !, [  [ % H !     )'5 G 6%   ! 7  $
!!7 %"%7 *%$ I 6 6!
 !+7
3. %,"7G%","6,%+'/
$!%71'"+7
7Y 1 , +$!%[[%

]*%)1  %7 *G%6,%$) *%!%76,% *%"
4.
"+  )+'/
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5.  " $)  '()  ,+' %"*% ! +'/
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141


71  6,%1' G : 
$ natural history 'K"  %7
'\! *%
#)

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3.9.7 w g !I
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3)1 
>43?@
1.  %'
3) migraine, tension headache, '
3)
!  
H3)"1 ['
6
2. %$"*%%") %'
3) migraine, tension $1!, "  
3. %,"7G "6
 imaging 6,"V  
'
3)   7, CT, MRI

<=
3.9.8 FFx=?223 %,"7G 6
 !6 !$"
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1.1 Electroencephalogram (EEG)
1.2 Head computerized tomography scan (CT)
1.3 Head magnetic resonance scan (MR)
1.4 Lumbar puncture
1.5 Psychometric testing
1.6 Electromyography (EMG) and nerve conduction velocity (NCV)
1.7 IQ test
2. '+6
6,%1' G
2.1 6
 G1 "
2.2 CT scan $!)L+ '6  , 7 7, brain abscess, brain tumor, cerebral
hematoma
2.3 EEG $!)L+ '6 ] 7, absence, localized spike
2.4 IQ test
142

<=
3.9.9 3=5?=?223 %,"7G d$# “" " 1
%%d$# “%"'$$7!%
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1. %#  % , "7G   %  !7 +  "   "
# , "$ %   'c    

," (interaction) 6 6!+7%"6,%1' G
1.1  7$7,% 1 , phenobarbital, phenytoin, carbamazepine, benzodiazepine
1.2 $7,%$!+6,%'$" 7, antihistamine, antidepressants,
stimulants, tranquilizers '5 6

<=
3.9.10 <? $$%"!$Z '.%"
!+ '6 %"
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>43?@
1.  '()  ,+'/
  ! 

1.1 '.%" %6 6,%3)1 " 7, 7!  (seatbelts) $
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143

3.10 _5?3C25?
(DISEASES OF THE EYE AND ADNEXA) ICD 10, VII; H00-H59
<=
3.10.1  
!66,"
,"6 $'6 
+ '6
>43?@

1. %# J $"6 !%"   $'6


2.   
!'6 + '6  %"   Z 6   $    Y 7,
!66, "%" !, 6
(pupil)   6,"V  "66 (ptosis), %" iris )Loptic disc %" 6,


<=
3.10.2 
62 3J 3>gH= ? !I
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>43?@
1. %#  #   
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"6,%1' G
1.1 Conjunctivitis
1.2 Corneal abrasion   
1.3 Periorbital cellulitis
1.4 Hordeolum
1.5 Blocked lacrimal duct
1.6 Simple foreign bodies
<=
3.10.3 
F1 vH?3C?C 
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1.1 Amblyopia
1.2 Cataract
1.3 Chemical burns
1.4 Complicated and intraocular foreign bodies
1.5 Decreased visual acuity
144

1.6 Esotropia, exotropia, ptosis


1.7 Glaucoma
1.8 Herpetic keratitis / chronic conjunctivitis
1.9 Orbital cellulitis
1.10 Retinopathy of prematurity
1.11 Significant eye trauma manifested by hyphema, extraocular muscle palsy, globe
penetration, or orbital fracture
1.12 White pupillary reflex

<=
3.10.4 ? 
?F_22
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$"#   
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1.1 Retinal hemorrhages (child abuse)
1.2 Iritis (collagen vascular disease)
1.3 Cataracts (metabolic disorders)
1.4 Papilledema (increased intracranial pressure)
1.5 Chorioretinitis (congenital infections)

<=
3.10.5 <??Fg4= 6  $$%"!$Z 
'.%"  6
!+ '6 6,"$"  Z6  
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1. !I '()  , % 

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1.1
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  !+" UV  !%* $
1 '.%"
1.2 6
7 6 
!+ '6 %"6'5 V 6G"6, % $
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145

<=
3.10.6 Visual Screening $$%"!$Z 6
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+ '6 $"6%" 6G"6,  I("
,
>43?@
1.  % 7,
"%$ Y 6
*%  %"
!+ '6 $"!%" %" 
2. %#  * %"!* %
#$ %!%"    % 6,  "V 7, Snellen letters,
numbers; Allen figure, LD symbol, Picture test  Tumbling E test
3. ['
6
!+ '6 $"!%" %"  % 
7, '
6 !%" 1!,7
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%!  %, 6%  *%'
6 6G 
% 

4. $6
6 %," I
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4.1 6
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4.2 6
6 (visual acuity) 

#$!!6!%%" 
4.3 $ % *% 1
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4.4 6
 
 ophthalmoscope *% %'$6
5.  "
!!I 6
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!+ '6 $"!%" %"  %
6,"V
5.1 $
5.1.1 Red reflexes, congenital cataract, glaucoma
5.1.2 6
%'$6*% ROP  $ ,%  G 
 1!, 1,500 ! *%% Z1!, 28 ' Z
5.2 % 4-6  *%
5.2.1 6
 *% 1
%"! *G%6 *%  strabismus (visual tropias 
phorias)
5.2.2 Visual acuity
5.2.3 Abnormal red reflex / pupils
5.3 % 1-5 'E
5.3.1 Visual acuity
5.3.2 Visual tropias  phorias
5.3.3 Abnormal red reflexes / pupils
5.4 % 5-11 'E
146

5.4.1 Visual acuity (Snellen chart)


5.4.2 Visual tropias, phorias
5.4.3 Color blindness (,"'()+7
7Y)
5.4.4 Refractive errors (,"'()+7
7Y)
5.5 Adolescence
5.5.1 Visual screening
5.5.2 Refractive errors
6. "  % 
$I("+$ %!%" %#  /  '()
  ,  % 
 L$!'KY
3.11 _5?4k
(DISEASES OF THE EAR AND MASTOID PROCESS) ICD 10, VIII; H60-H95
<=
3.11.1   
#  '6  $!
!
+ '6 $" % !  "[Z1 
>43?@
1. %# )L$"
 
$%"J $'6 %" 1[  ! % 
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2. 
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1!, " 
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<=
3.11.2 
62 3J gHH= ? !I
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!+ '6 $!%V 
6 %"H 1!,'5 6%","6,%1'"$Z
+7
7Y
>43?@
1.  )+'/
 
 / H /
!+ '6 6,%1' G
1.1 Allergic rhinitis
1.2 Blunt nasal trauma
1.3 Cervical adenitis
1.4 Epistaxis
1.5 Otitis media and externa (uncomplicated)
1.6 Parotitis (mild)
1.7 Pharyngotonsillitis
147

1.8 Routine care for the child with a tracheostomy


1.9 Simple nasal and ear canal foreign bodies
1.10 Acute bacterial sinusitis
1.11 Stridor (mild): 7, croup, tracheomalacia
1.12 Uveitis
1.12 Viral enanthema (herpes, herpangina, measles)
<=
3.11.3 _ /  / 
46=@62 3
3C?C !I

] )*G%"6 ,"6,%*%'()+7


7Y1 %,"!!
>43?@
1. %#  #   
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+7
7Y1 %,"!!  
6,%1' G
1.1 Abscess (retropharyngeal, peritonsillar)
1.2 Airway obstruction (acute, chronic)
1.3 Cholesteatoma, chronic otitis media
1.4 Congenital anomalies of the pinna, lip, palate, jaw
1.5 Complicated otitis media, sinusitis, epistaxis, parotitis
1.6 Epiglottitis
1.7 Chronic hypertrophic tonsillitis, adenoiditis
1.8 Foreign body of the aerodigestive tract
1.9 Head and neck masses
1.10 Nasal polyp
1.11 Significant hearing loss 7, congenital neurosensory hearing loss
1.12 Significant trauma to the middle or external ear, nose, lip, palate, pharynx
1.13 Sleep apnea (obstructive sleep apnea)
1.14 Tympanic membrane perforation (traumatic or persistent)
1.15 Chronic sinusitis acute sinusitis with its complication
<=
3.11.4 _? 32 !I
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7G "
%7 *G%" '5  %"  G 7,%"7G "
>43?@
1. %#  "$6
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$  3$Z$!!% 7G "
148

2. 7 %"7*G%H $'5 6 *%76 7$!! %7 %"$


*G%6,%7*G%$'5 6
3. '! !I1  $6%"$ %%"7G "1 %,"I6%"
4. 
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5. 
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6. 'c 7
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7Y
7. %,"7G 'K" 'H7 Z%", PE (ventilatory) tube

<=
3.11.5 __6?F 32 !I
])H H"!%
1 %,"I6%"!!
>43?@
1. %#  % % " # 
$%"H H"!%
2. %,"7G$""
] 7, X-ray , CT scan  *  H H"!%
3. 7*G%H $'5 6) 
'c 7
$!!
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6 6!+ %,"7G ,"6,%1'$Z+7
7Y

<=
3.11.6 3D 3 =H= (Hearing Loss) !I
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  7,
*%1 6!
!!!
>43?@
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$!! 6
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 audiometry  tympanometry
3. %,"7G $ %1  %# $ %1  6,7 7,
pure tone audiometry, tympanometry, acoustic emission  brainstem evoked potential
4. 
],"6,% $!
Y1  1'"+7
7Y 1 , congenital
syphilis, congenital CMV, hereditary deafness, acoustic neuroma, atresia of the ear,
ototoxicity, noise-induced hearing loss, bacterial meningitis  vestibular disorders
149

5.   I $ $!!


!7,
*% , "6, %  $ Y  1   7,
H" % 
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$7  I $‹  H" $!7G  
  %!$G"
!7,
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<=
3.11.7 <? $$%"!$Z
G 6% 6,"V  
'.%" H  % ! ,%""
>43?@
1. '()  , ! +' %"  
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1  " (noise-related hearing lost)
2. '()   ! +' %" '.%" ,
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$"  
3. '()   ! "  *%1!,  
4. $ %*%  %"1  %"  %6,"V    

3.12 _22  = 


(DISEASES OF THE CIRCULATORY SYSTEM) ICD 10, IX; I00-I99; Q20-Q28
<=
3.12.1 H?=w3@6} !
!
!
$36Z
*G \ %"1
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>43?@
1. %#  embryology %"1
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2. %# 
 
$ %"1
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3. %# # 
$%"H 
+ '6 6, $,%1 
4. H 
% *% $*$% $" #!

<=
3.12.2   !I %% "$'6 %"

% *% %% "$+ '6 1 
>43?@
1. %#  1   "
 murmur  organic %% functional
(innocent)murmur
2. %# %66 %"

!  *% %" $' '"1'6!%% ,
'6  6,7,
"%6G"6,  I("
,
150

3.  
,""
6 %"
$'6 + '6
4. %# 
1
 *%  7,
",%  "  !'6Z
%% "$ (G  $ $!H 
 6,
5. %# %"6
 * 1__.
6
 * "$% 


<=
3.12.3 
62 3 gHH = ? 
#
]
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$!%V 1  
6 %"H 1!,'5 6%","6,%1'"+7
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>43?@
1. %# # 
$
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1.1 Peripheral pulmonic stenosis
1.2 Tachycardia $! #Z1
1.3 Functional heart murmur
1.4 Small VSD
1.5 Small PDA
1.6  %

<=
3.12.4 
H?3C?=?H 
=D 
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$'5 6%"1  )H +7
7Y
>43?@
1. 
]H '!  )*G%"6 ,"6,%+'/
$!%%
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1.1 Cyanosis
1.2 Severe hypertension
1.3 Supraventricular tachycardia
1.4 Bradycardia
1.5 Congestive heart failure
1.6 Cardiovascular collapse
1.7 Syncope
1.8 Pathologic heart murmur
2. %#   "6
 #   
$ 
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LZH %"
6,"V "6,%1' G
151

2.1 Ventricular septal defect (VSD)


2.2 Atrial septal defect (ASD)
2.3 Tetralogy of Fallot (TOF)
2.4 Patent ductus arteriosus (PDA)
2.5 Coarctation of the aorta
2.6 Transposition of great arteries (TGA)
2.7 Atrial stenosis (AS)
2.8 Pulmonic stenosis (PS)
2.9 Mitral valve prolapse
2.10 Total anomalous pulmonary venous return (TAPVR)
2.11 Supraventricular tachycardia
2.12 Myocarditis / cardiomyopathy
2.13 Kawasaki's disease
2.14 Acute rheumatic fever
2.15 Rheumatic heart disease
2.16 Bacterial endocarditis

<=
3.12.5 _5H_AF #  %%
 " 
] )+'/
$'5 H 1!6 ] H 

!6 
>43?@
1. %# #  %"H 1!6 H 
!6 
2. %# %% "%"H 1!6 H 
!6 
3. 
]H 1!6 H 
!6 
4.  )H 1!6 H 
!6 1 %,"!!
5.     *G %"6 + '/
$ '5 H 
 !6 ,"6, %  + 7 
7Y 
$
!!
6. *%7'c 7
$!! '.%"  H 1!6 
152

<=
3.12.6  3? $$%"!$Z$
1' 
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!  *% "
>43?@
1. 
]H *  6  +'/
$!
!  *% " 6,7 %"
!
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2.  )
!  *% "%,"'5 G 6% 
!$G"$$%"% %%"
 76,"V
3. !Y6,"V $7)
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d$# “" "%"6,7

<=
3.12.7 =312_AF  $
%"7
H 
$7!%
>43?@
1. !I%# 7
$ %,"7G%!7H 
$7,% " G
1.1 )

6 + "
 (antiarrhythmic)
1.2 Inotropics
1.3 Diuretics
1.4 Vasodilators
1.5 Vasopressors

<=
3.12.8 <? $$%"!$Z '.%"  H 
1
 *%
>43?@
1.  'K"%" H 
#6
*%  %" atherosclerotic heart 


!  *% "*%'5 
$" '.%" 7, cholesterol screening
2. %,"7G%"'c 7
$!! '.%"  
subacute bacterial
endocarditis 
!$G"
# 
3. %# $$%"%%" Π$G"$!1!,!
+ '6 $"


153

3.13 _22=AF
(DISEASES OF THE RESPIRATORY SYSTEM) ICD 10, X; J00-J99, Q30-Q34
<=
3.13.1 H?=w3@6} !
!
!
$36Z
*G \ %"H   1''6Z$"  1 %,"!!
>43?@
1. %# J 
!+ '6 $"J %"
2. %#  
$%"
2.1 Control of breathing
2.2 Mechanics of breathing
2.3 Gas exchange and gas transport
3. %#  immunology and defense mechanisms %"
4. %# 7
$ %"$7 H 
5. %#  
$ +$ '.%" _`a _!I%"H 
6. %# 1 H 

<=
3.13.2 C1  J $+ '6 $'5 +$
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>43?@
1. %# 
!+ '6  H "" $%"%

6,"V    !
'6Z 
]
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1.1 Choanal atresia
1.2 Web of larynx
1.3 Congenital laryngeal stridor, laryngomalacia
1.4 Subglottic stenosis
1.5 Congenital tracheomalacia
1.6 Bronchial stenosis
1.7 Congenital malformation of the lung: cystic, sequestration, agenesis hypoplasia and
dysplasia
1.8 Bronchogenic cyst
1.9 Vascular ring
1.10 Pulmonary AV fistula
154

1.11 Diaphragmatic hernia/ eventration of diaphragm

<=
3.13.3  !I 
'6 + '6 %"H  
1 
>43?@
1. %# )L 
'6 
!$G")L' '"%"
L$
6"
 %%" *%!1
2. %# % "$+ '6 %" 7, %6*%)L$
+ '6 "!$+ '6 '5 6
3.  )LH ""%"$
"%6,"V 7, pectus excavatum $1   '6
%%
!+ '6 %"H %* V
4. '+
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<=
3.13.4 
62 3J gHH= ? !I

] )'KY$!%V %"H $"1  


6 %"
>43?@
1. %# 1$"# 
$ 
]  )H / 
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+ '6 $" "6,%1' G
1.1 6 7*G%%"$" ,

1.1.1 Common cold
1.1.2 Pharyngotonsillitis
1.1.3 Acute otitis media
1.1.4 Acute rhinosinusitis
1.2 6 7*G% $" ,
,"
1.2.1 Acute epiglottitis
1.2.2 Acute laryngotracheobronchitis (croup)
1.2.3 Bacterial tracheitis
1.2.4 
$[% %"6 7*G%  7, retropharyngeal
abscess, pleural effusion, lung abscess
1.2.5 Acute bronchitis
1.2.6 Acute bronchiolitis  wheezing associated respiratory infection
155

(WARI)
1.2.7 Pneumonia (bacterial, viral)
1.2.8 Bronchiectasis
1.3 
%* $ Y 6,%1' G
1.3.1 Chest pain
1.3.2 Apnea of prematurity
1.3.3 Asthma (
Allergy)

<=
3.13.5 
H?3C?C !I )*G%"6 6%  ,"
6,%+'/
$!'KY$"$[[% 1'"+7
7Y1 %,"!!
>43?@
1. 
] )*G%"6 'KY%"7
LYL 
,"6,%+'/
%,"!!  
6,"V "6,%1' G
1.1 Upper / lower air obstruction
1.2 Apnea
1.3 Apparent life threatening event
1.4 Bronchopulmonary dysplasia
1.5 Bronchiectasis
1.6 Foreign body in the airway
1.7 Pneumonia with empyema
1.8 % "
$[% $" +'/
% Z 7,
Pneumocystis carinii infection  lymphoid interstitial pneumonia
1.9 Recurrent / persistent pneumonia
1.10 Refractory *% severe asthma (
Allergy)
1.11 Persistent atelectasis
1.12 Bronchopleural fistula
1.13 Respiratory failure 66,"V 7, pulmonary edema, ARDS near
drowning
1.14 Significant pneumothorax
1.15 Congenital disorders of respiratory system
1.16 Volatile substance abuse
156

1.17 Intrathoracic tumor


1.18 Obstructive sleep apnea
1.19 Pulmonary tuberculosis

<=
3.13.6 <? $$%"!$Z$
1' '.%" H $"
  
>43?@
1. '.%"
 !H ," ! 'KYH $"$,%
  7,  H 
 
!$G"%%,"7G 
!!! 71% )
%
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2.  '()  +'/
 % 
I("% 6%"
  $G"%"6
%"
*%%"!7  % 
%!$G"  I $% 
3.  '()  +'/
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I("% 6%"6,"V $G"$1 
$" *%6 7 6,"V
4. 
 [ $!! +'/
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5.   '( )   , + '/
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I( "!
'5  ) %3$G "   
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6.  '()  +'/
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I(" +'/
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_`a _!I'%   ! , H 7%'LZ6, "V 1 %,"!!

3.14 _22=C=
(DISEASES OF THE DIGESTIVE SYSTEM) ICD 10, XI; K00-K93; Q38-Q45
<=
3.14.1 H?=w3@6} !
!*G \ 
,%%
 1''6Z$"  1 
>43?@
1. %# J  # 
$ 7
 ! 1! ! 7
$%",%
% !I 1''6Z  )+'/

1.1 GI development
1.2 Bilirubin and bile acid metabolism
1.3 Digestion and absorption of nutrients
1.4 Gut immunology
157

1.5 Liver function


1.6 Gut peptide
1.7 Basic GI pharmacology
1.8 Physiologic gastroesophageal reflux

<=
3.14.2 C1  J %",%%$'5 +$

!+ '6 6,
>43?@
1. %# J $ + '6 $"H ""  $%"%

,%%  !
'6Z
 
]H / 
 6,%1' G
1.1 Tongue tie
1.2 Cleft lip, cleft palate
1.3 Trachea-esophageal fistula
1.4 Hiatal hernia
1.5 Congenital pyloric stenosis
1.6 Congenital absence, atresia and stenosis of intestines
1.7 Omphalomesenteric duct
1.8 Meckelˆs diverticulum
1.9 Hirschsprung disease
1.10 Duplication of intestine
1.11 Recto-vaginal, urethrorectal fistula
1.12 Atresia of bile duct
1.13 Choledochal cyst
1.14 Annular pancreas

<=
3.14.3  !I%# 
!66,"
,"
'6 
+ '6 $"
$%",%%6-$,% G 
>43?@
158

1. %# )L %'6 (feeding pattern) + '6 6G"6, I("


, 
*%"  % G 6
(G 
 ! % ! %'  I, %
H  
'6 %%)L+ '6 [("6%"6

]
2.
 ZH / 
 physiologic gastroesophageal reflux, functional abdominal pain 
$
3.  
!+ '6 7

%"6
!+ '6 $ Y

<=
3.14.4 FFx= !I%G 6% 
] 
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$" %6,"V $ Y
>43?@
1. %# G 6% 
]H H %3['
6 6
," ,"6

 %*%
6,%1' G
1.1 Dysphagia, abnormal swallowing
1.2 Vomiting
1.3 Hematemesis
1.4 Hematochezia
1.5 Abdominal pain
1.6 Constipation
1.7 Diarrhea
1.8 Ascites
1.9 Jaundice
1.10 Abdominal mass
2. *%,"6
'+6
$ Y6,%1' G
2.1 Stool examination
2.2 Stool reducing substance
2.3 Liver function test
2.4 Plain film abdomen  
 gut obstruction, gut perforation
2.5 Ascitic fluid examination
2.6 Scotch tape test for pinworm
2.7 Upper GI series, barium enema $!
!+ '6  , 7 7, barium swallowing
in achalasia, barium enema in Hirschsprung ˆs disease
159

3. %# %,"7G%'H7 Z%","6
$ Y6,%1' G
3.1 Esophagogastroduodenoscopy
3.2 Colonoscopy
3.3 Sigmoidoscopy
3.4 pH monitoring
3.5 D-xylose test
3.6 Ultrasonography and CT abdomen
3.7 Liver biopsy

<=
3.14.5 6
2 3J gHH= ? !I%1
 H  )H / 
$",%%6$!%V !I
 )1  
6 %"
>43?@
1. %# 1$"# 
$ H 
] )H 
6 %"
*%
6,%1' G
1.1 Acute diarrhea: bacterial enteritis, viral gastroenteritis
1.2 Lactose intolerance
1.3 Vomiting
1.4 Constipation, encopresis
1.5 Cow milk protein  food intolerance
1.6 Antibiotic associated diarrhea
1.7 Recurrent abdominal pain
1.8 Infantile colic
1.9 Primary peritonitis
1.10 Acute viral hepatitis, uncomplicated
1.11 Anal fissure
1.12 Intestinal parasites
1.13 Jaundice associated with breast feeding
1.14 Gastroesophageal reflux (mild)
160

<=
3.14.6 
H?3C?C=?H 
=D !I
] )
*G%"6 !
LYL ,"6,%1'"+7
7Y1 %,"!!
>43?@
1. %# 1 H 
] )*G%"6  "
LYL ,"
6,%+'/
1'"+7
7Y 1 %,"!!  H / 
 6,%1' G
1.1 
]] $,%
,6%","6,%1'"3$Z *%+7
7Y$",%
% : Appendicitis, bowel obstruction, volvulus, intussusception, pyloric
stenosis, secondary peritonitis, caustic ingestions, massive GI bleeding, blunt
abdominal trauma, esophageal atresia, TE fistula, duodenal atresia, fulminant
hepatitis, hepatic failure
1.2 Hepatobiliary disease: Hepatitis, undiagnosed hyperbilirubinemia, Wilson
disease, choledochal cyst, liver abscess, biliary atresia, pancreatitis,
hepatosplenomegaly, portal hypertension, cholangitis
1.3 Gastrointestinal conditions : Constipation, encopresis, gastroesophageal reflux,
peptic ulcer disease, H. pylori gastritis, intestinal pseudoobstruction, abnormal
swallowing, Hirschsprung disease, cyclic vomiting, inflammatory bowel disease,
short bowel syndrome, malrotation, colitis, significant GI bleeding, inguinal
hernia
1.4 Malabsorption entities : Celiac disease, cystic fibrosis, persistent diarrhea
1.5 %* V 7, H %
, anorexia nervosa, bulimia, severe failure to thrive, Henoch-
Schoenlein purpura

<=
3.14.7  F = !I
])+'/
$!%% 1 
>43?@
1.  %
 ! %  functional gastroesophageal reflux %% $
 H $ "
,
2. 
]H / 
 "!%$$ %% $G"61
7, viral gastroenteritis *% %1 7,  *G%"% !%"
3. *%76
$"%"'c 6  " *%$*  6%"% 1 
%,"!!
161

4.   
]  H / 
$ 6 % ", "6, %1' "3  $Z 7, intestinal obstruction,
intussusception 1 %,"!!$ $,
"$
5. 
]%% "%"
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<=
3.14.8 4FFC? !I
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%,
"1 
>43?@
1. 
]H 
, "%,
"6 7*G% (infectious) 1!,6 7*G % (non-
infectious)
2. %# 
!66,"
," bacterial  viral gastroenteritis
3. *%76
$"%"'c 6 *%6
 3) +'/
$'5 acute, subacute 
chronic diarrhea
4. %*%)+'/
%,
"H   ("I("6%"%,
"
5.  G %H$$Z$!!*%
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<=
3.14.9 H? !I
])%'
$%"  1 %,"
!!
>43?@
1. *  6%"%'
$%"$!%  
2. 
]
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$%"$! # 
3.  "
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)L% '
6 $"%!LZ-" !
4. $*  6%"%'
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5. )%'
$%"6!6 ,"6,%1'"+7
7Y

<=
3.14.10 3C? 33456<? F72k= $$%"!
$Z ," !'.%" H $",%%6  
>43?@
1.  '()  +' %" '  
%
1.2 %$I6%"!!6!

1.3 %"% 7,  !
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162

2.  '( ) 


,  !   ‹ I,  * %'.%" H $ %"+ 

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3.  '() 
, !  *%"'.%" 6 7*G%%,
" 
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4. %# 6+   %,"I6%" 
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hepatitis A
5.      7$",%%$!+6,%%*
6. %#  
$" 
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G" "


3.15 _?  =


AH?
(DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE) ICD 10, XII; L00-L99
<=
3.15.1 H?=w3@6} !
!
!
$36Z
*G \ %"+
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>43?@
1. %# 
!*G \ !I 1''6Z'KY$"   "6,%1' G
1.1 Anatomy of skin
1.2 Physiology of skin of the normal newborn infant and premature infant
1.3 Pharmacology of topical and systemic drugs used in dermatology
1.4 Dermatoimmunology

<=
3.15.2 ?
   
,")L
+
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>43?@
1.
] %H (lesion)   "6
$"+
  "
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' '""7
L *%'5 H +
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$'5 6%"1  %,"6,% *%"*%6%"1 )

<=
3.15.3 <? $$%"!$Z '.%" H $! #Z

!+ '6 %"+
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>43?@
163

1.  '()   ! ,+' %"+'/




1.1
# )
!% % !%"+
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$"+
 "  +!
1.2 !6  H +
 "$ I 6,%H $ 6
1
!  H "6,"V 
!$G"7!"$!!
1.3
#'.%" +
 "% 6"
1.4 %6"%" [G'.%" H +
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<=
3.15.4 31D5?_?  Y 
] 
)
!+ '6 6,"V %"+
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>43?@
1. 
]H %"%H (lesion) $"+
 "7 6,"V 7,
1.1 Scaling lesions
1.2 Macular or papular lesions
1.3 Plaque and nodule
1.4 Vesiculobullous lesions
1.5 Pustular lesions
1.6 Purpuric lesions
1.7 Pruritic rashes
1.8 Hypopigmented and hyperpigmented lesions
2. *%76
$"%"'c 6 $!! 
]H +
 " 1 ,
2.1 KOH preparation
2.2 Gram stain and AFB stain
2.3 Tzanck ˆs smear
2.4 Scrape for scabies
2.5 Scotch tape test for tinea versicolor
2.6 Woodˆs lamp examination
2.7 Skin biopsy
3. *%7+ 6LŠZ$+
 "$!'%,"1 I6%"!!H   ("I("'K
   ' $#  )
!
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3.1 L!6 %" ! H7 G+(G"
3.2
!"  6,"V %"$'$ corticosteroids
164

3.3 ) 

#6,"V 7, '  (compress) wet  dry '5 6

<=
3.15.5 
3>gHH= ? !I
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)
6,"V $"+
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7Y
>43?@
1. %# 1$"# 
$ H ['
6 6
," 
]H

]  H *   $"%"'c 6    ) 
!I("
'()%# , !  % 
+'/

6   H 
LZH 1 %,"I6%"!!  H +
 "6,%1' G
1.1 Infections and infestations
1.1.1 Bacterial infections : Impetigo, ecthyma, folliculitis, furuncle,
carbuncle, erysipelas, cellulitis, staphylococcal scalded skin syndrome,
sexually transmitted diseases (congenital syphilis)
1.1.2 Superficial fungal infections : Candidiasis, dermatophytosis (tinea
capitis, tinea corporis, tinea pedis), tinea versicolor
1.1.3 Viral infections : Molluscum contagiosum, warts, herpes simplex,
herpes zoster, chickenpox, viral exanthems, HIV infection
1.1.4 Insect bites and parasites : Insect bite reaction, scabies, pediculosis,
creeping eruption
1.2 Common dermatitis
1.2.1 Atopic dermatitis (mild to moderate)
1.2.2 Seborrheic dermatitis
1.2.3 Pityriasis alba
1.2.4 Dyshidrotic eczema
1.2.5 Contact dermatitis
1.2.6 Autosensitization dermatitis
1.2.7 Diaper dermatitis
1.3 Urticarial disorders
1.4 Cutaneous drug reactions
1.5 Maculopapular eruption
1.6 Erythema multiform
165

1.7 Fixed drug eruption


1.8 Neonatal skin problem
1.8.1 Transient skin lesions (7, erythema toxicum, milia, miliaria, neonatal
acne)
1.8.2 Birthmarks and developmental defects (vascular and nevi)
1.9 Papulosquamous diseases 7, pityriasis rosea
1.10 Acne
1.11 Cutaneous manifestations of systemic diseases
1.11.1 Gram negative septicemia
1.11.2 Lupus erythematosus and connective tissue diseases
1.12 Genodermatoses
1.12.1 Neurofibromatosis
1.12.2 Tuberous sclerosis
1.13 Alopecia (traction, trichotillomania, tinea or drugs)
1.14 Hemangioma (uncomplicated)

<=
3.15.6 
H?3C?C=?H 
=D 
# )*G%"6
!I,"6,%+'/
L!'KY$"+
 "$6%" )H +7
7Y1 %,"
!!
>43?@
1. 
] )*G%"6 !I,"6,%+'/
1 %,"I6%"!! H
6,%1' G
1.1 Infections
1.1.1 Tuberculosis and other mycobacterial diseases
1.1.2 Leprosy
1.2 Dermatitis
1.2.1 Atopic dermatitis (severe)
1.2.2 Photodermatitis
1.3 Cutaneous drug reactions
1.3.1 Stevens-Johnson syndrome and toxic epidermal necrolysis
1.4 Papulosquamous diseases
166

1.4.1 Psoriasis
1.5 Vesiculobullous diseases
1.5.1 Chronic bullous dermatosis of childhood
1.5.2 Bullous pemphigoid
1.5.3 Dermatitis herpetiformis
1.5.4 Pemphigus
1.6 Acne (severe)
1.7 Cutaneous manifestations of systemic diseases
1.7.1 Histiocytosis X
1.7.2 Malnutrition dermatosis
1.8 Genodermatoses
1.8.1 Incontinentia pigmenti
1.8.2 Congenital ichthyosis
1.8.3 Epidermolysis bullosa
1.9 %* V
1.9.1 Vitiligo
1.9.2 Urticaria pigmentosa
1.9.3 Hemangioma (complicated)

<=
3.15.7 Atopic Dermatitis (_6H?) $$%"!$Z
 ) Atopic dermatitis
>43?@
1. 
]
]H 1 )L$"  
2.  ) atopic dermatitis 7 $1!, "1 %,"I6%" 
!$G"    
+
 " 7 topical corticosteroids
3. 
$[% $,% atopic dermatitis )%,"!!
4.  ! "#$%&'()*+,-&./ 0& 1 2 3!4)562708#.$%

<=
3.15.8 3 $$!$Z 
]H 

, $
)
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>43?@
167

1. 
]H 
]H 
1 I6%"
2. ,"7G'K$$ H 
%," "
3.  
! "%"
7 6,"V
4.  7 %"$
7 6, "V * %7  $  )1  I6% " 7, benzoyl
peroxide, retinoic acid, topical antibiotics
5. %# $$%" systemic antibiotics  )
+" "%"
6. %# 
# )H 
%,"'5 G 6% 
!$G" )+
 " 77
$ 7 
7.  '()    % 
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7,
*%  'KY$" 6$ (G
%,"7G ,"+$'5 
1'"+7
7Y
3.16 _22H C_?C?  =
 
=6
(DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE)
ICD 10, XIII; M00-M99
<=
3.16.1  !I
]
'6 + '6 $"
! *G%H ","  *G%*%
 
+ '6 7


+ '6 $ H
,!!6 1 
>43?@
1. %# )L
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2. %# ' '"$%,  '6 (normal variations) %"J %" 
!*% , $%" 
3.  %'
! *G%*% %  $'5 7

(7, '
%  )

  *%
+ '6 $H $ "1 
4. %# # 
$%"H ! *G% %$,%   7,
4.1 Benign musculoskeletal pain
4.2 '
%*%%%%*  *%"!'c   %""7 (serum sickness)
4.3 '
   "H6 (growing pain *% idiopathic limb pain of
childhood)
4.4 H ! *G%%,% " 7, myotonic dystrophy
4.5 ! *G% '$+ '6 (neuromuscular disorders) 7, H Werdnig•
Hoffman *% spinal muscular atrophy (%D %)
168

4.6 H %% 66,"V 7, septic arthritis, rheumatoid arthritis, juvenile


arthritis
'5 6

<=
3.16.2 _
62 3J ?22H _?C? # 
$

#6
*%  %"
!+ '6 $!%V 6!
  'KY1 %,"!!
>43?@
1. !I6
*%  %"
!+ '6 $"H ","%","$!%6!
 
)'()$Z3!  1 %,"!! 'KY6,%1' G
1.1  : Hip dislocation (Ortolani  Barlow maneuvers), fracture of clavicle,
congenital club foot
1.2 $ : Tibia torsion, metatarsus adductus
1.3 1-5 'E : In-toeing, out-toeing, metatarsus adductus, interior and external tibia
torsion, femoral anteversion and retroversion bow-legs, knock-knees, external
rotary contraction infancy
1.4 5-11 'E : Scoliosis, muscle strain, flat feet, low back pain
1.5
, : Osgood-Schlatter disease, scoliosis, sport fitness
<=
3.16.3 
!+ '6 $"! *G%  %6,%  *G%*%
 $
!%!I 'KY1   \ !$Z
>43?@
1. 6
   %# # 
$  )'KY6,%1' G
1.1 Musculoskeletal pain 7 1!, "
1.2 '
%%%'c   %""7 7, serum sickness
1.3 Growing pain (idiopathic limb pain in childhood)
1.4 Henoch-Schoenlein purpura
1.5 Hypermotility syndrome
1.6 Patellofemoral syndrome
1.7 Transient synovitis
1.8 Acute rheumatic arthritis (%!E#&$ )
1.9 Juvenile idiopathic arthritis 7 1!,[[%
169

<=
3.16.4 
F1 vH?3C?C 
#
])*G%"6
H $"! *G%%6,%   *G%*%
 ,"6,%1'"+7
7Y1 %,"!!
>43?@
1. 
]  )*G%"6 'KY! *G%   %  *G%*%
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LYL ,"6,%+'/
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7Y' "   ) L
6,%1' G
1.1 Rheumatic fever (!E#&$ )
1.2 Arthritis associated with malignancy, viral infection, bleeding diathesis
1.3 Dermatomyositis
1.4 Juvenile rheumatoid arthritis
1.5 Fibromyalgia
1.6 Kawasaki syndrome (!E#&$ )
1.7 Mixed connective tissue disease
1.8 Takayasu ˆs arteritis
1.9 Pain and somatization syndrome
1.10 Reflex sympathetic dystrophy
1.11 Scleroderma
1.12 Spondyloarthropathies
1.13 Systemic lupus erythematosus including neonatal lupus syndrome
1.14 Polyarteritis nodosa
1.15 Systemic vasculitides
1.16 Avascular necrosis of femoral head (Perthesˆ disease)
1.17 Compartment syndrome
1.18 Osteochondritis dessican
1.19 Slipped capital femoral epiphysis
1.20 Osteomyelitis
1.21 Septic arthritis
1.22 Kyphosis
1.23 Cerebral palsy
1.24 Poliomyelitis
170

1.25 Arthrogryposis congenita


1.26 TB hip, TB spine

<=
3.16.5 Limping Child 
#
] ) $!%
+
>43?@
'!  6

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1.1   +
1.2 %
!  / *%
1.3 1!,%!
1.4 1!,%!7 " " ("

<=
3.16.6 FFx=?H?~2 'c   ! !  H 

#6
$"%"'c 6 6
" $7,
 
]H ,!!6 
>43?@
1. *%7'+6
$"%"'c 6 *%7,
 
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!! 1 ,
1.1 6
 joint fluid
1.2 Complement component, 7, C3, C4, C50
1.3 Serologic tests, 7, rheumatoid factor, ANA, anti-ds DNA, ANCA '5 6
1.4 Anti phase reactions, 7, ESR, CRP
2. *%7'+6
" 6,%1' G
2.1 Plain X-ray %" %
2.2 Bone scan
2.4 Angiograms

<=
3.16.7 <? 6  $$%"!$Z '.%" H *%

!+ '6 %"! *G%  #") (health maintenance)
>43?@
1.    ,   ! *%+' %" 
!"6,% 
171

2. 6

!+ '6 $"J %"%H (development dysphasia of hip)
%# 
#% 
6
*%  %"
"H" (scoliosis) %" $
H" $  
3. %# )$" _`a _ (physical therapy and rehabilitation)
,   ! *%+' %" $!'KY

3.17 _5?22326K4@CI33
(DISEASES OF THE GENITOURINARY SYSTEM) ICD 10, XIV; N00-N39,N99
<=
3.17.1 H?=w3@6} !
!
!
$36Z
*G \ %"* #Z,
!'K
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>43?@
1. %#  embryonic formation %" GU system
2. %#  anatomy and physiology %" GU system
3. %# 7  $%"œ%ZH! 6,"V 6,%16
4. %#  1 H %"H 16
5. %# 1%%d$# “%"6,"V $!+6,%16

<=
3.17.2 C1  J $+ '6 [("'5 +
!
+ '6 6, %"'K
* #Z
>43?@
1. %# J $"
 
$%"'K 
 [("'5 +
!
+ '6 %"'K
  )*G%"6 ,"6,%1'"+7
7Y1 %,"
!!
1.1 Renal agenesis, absence; Potter syndrome
1.2 Cystic kidney disease: Polycystic kidney renal dysplasia, sponge kidney
1.3 Congenital obstructive defects: Congenital hydronephrosis, megaloureter,
malposition of ureters, vesico-ureteral reflux, duplication of ureters
Other congenital malformation: Horseshoe kidney, ectopic kidney, posterior urethral
valves
2. %# 
!+ '6 %"J $"
 
$%"* #Z 

]*G%"6 ,"6,%1'"+7
7Y1 %,"!!
172

2.1 Imperforate hymen


2.2 Congenital malformation of uterus, cervix, genitalia
2.3 Undescended testicle
2.4 Hypospadias, epispadias
2.5 Hydrocele
2.6 Indeterminate sex and pseudohermaphroditism

<=
3.17.3 5?22326K4@CI33 !
!
!I
+ '6 %%
'6 %"* #Z,
!'K

>43?@
1. %# J $"
$$'6 %"16 'K
  
6,"V 6G"6,
  I("
, 7, renal concentrating ability, glomerular filtration and sodium
handling, normal voiding pattern, urine output and attainment of bladder control '5 6

!$G"% ,'6 $"%"'c 6 $! #Z $ ",

2.   transient proteinuria  persistent proteinuria *% intermittent proteinuria 1  H 


%3)L$ Y$"  
3.   transient hematuria  persistent hematuria 1 H %3)L Y$"  
4. %1 
,7  !+6,%$" %"167  $'5 6%"'  
+'/
$!
!,%" $" %"16

<=
3.17.4  / _
62H 3 CH?3C?C=? H 
=D 
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!'K
1 H 1!,6%","
6,%1'"+7
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1. %# # 
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!'K
 
6 %"6,%1' G
1.1 Urinary tract infection (pyelonephritis and cystitis)
1.2 Orthostatic proteinuria
1.3 Balanitis
1.4 Nonspecific urethritis
1.5 Prepubertal vaginitis
173

1.6 Labia minora adhesions


1.7 Scrotal pain of swelling, mild
1.8 Genital trauma
1.9 Mild hypertension
1.10 Steroid responsive nephritic syndrome
1.11 Acute postinfectious glomerulonephritis

<=
3.17.5  / _ / 4C?22326K4@CI33
H?3C?C 

] )*G%"6 
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!'K
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1'

,"6,%+7
7Y
>43?@
1. !I
]1 %,"!! 
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1.1 Acute and chronic renal failure
1.2 Hemolytic uremic syndrome
1.3 Hypertension
1.4 Renal mass or cyst
1.5 Obstructive uropathy 7, posterior urethral valve, neurogenic bladder
1.6 Nephrogenic diabetes insipidus
1.7 Urolithiasis
1.8 Tubular defect: 7, renal tubular acidosis. Fanconiˆs syndrome, Bartterˆs
syndrome, tubulointerstitial disease
1.9 Nephrotic syndrome; steroid non-responsive, resistant
1.10 IgA nephropathy
1.11 Congenital nephritic syndrome
1.12 Derangements of renal function in the acutely ill child 7, acute tubular necrosis
1.13 Toxic nephropathy
1.14 Vesicoureteric reflux
1.15 Voiding dysfunction
1.16 Phimosis and paraphimosis
1.17 Orthostatic proteinuria
1.18 Wilms tumor
174

1.19 Scrotal pain or swelling (moderate and severe)


1.20 Ambiguous genitalia
1.21 Sexual abuse

<=
3.17.6 ?22C?=
 
 ?CH= 
# 
$!I )
 / H / ,!%$1 ,%[("!%$"
16'5 % [("%6%","6,%1'"+7
7Y
>43?@
1. !I
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$"16,
! 
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+7
7Y!*%!%,"7G 1 ,
1.1 Henoch-Schoenlein purpura
1.2 Systemic lupus erythematosus
1.3 Bacteremia (shunt nephritis, endocarditis)
1.4 Systemic infection, bacteremia

<=
3.17.7  ?22I33 !I7
#$!! 
]
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1 %,"I6%"!!
>43?@
1. 
]  )*%6

]$"I," (imaging) 
7
36Z
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2. *%7'c 7
1 %,"I6%" !! H   ("I("6 ,"%"6 7*G% (upper,
lower tract infection) '%" *G%6,%'c 7
  I $ G
3. %#  # 
$ LZH %"+'/
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UTI 1 
4. 6 6! +'/
$!6 7*G%'K

%,"6,% *% "
5. %#   6

]     )+'/
$ ! recurrent UTI 
LŠZ ,"6,%1'"+7
7Y

<=
3.17.8 Nephrotic Syndrome # 
$! ! # 
$

]),!% Nephrotic Syndrome 1 
>43?@
175

1. %# # 
$%",!% nephrotic syndrome
2. *%76
$"%"'c 6  6
 3)1 %,"!!
3.  #
$ % % " +6
$"%"'c 6    H
%" minimal change (primary) nephrotic syndrome  nephrotic syndrome 7 steroid
resistant *% non-responsive 1 
4. 
]) nephrotic syndrome 7 idiopathic 
 corticosteroids 
6 6!+)
5. 
] *G%"6 ,+'/
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,"6,%1'"+7
7Y1 %,"!!
6.  '()  ,+'/
 nephrotic syndrome  ! $6%"1 )'5

   'c 6 6   %"H

<=
3.17.9 3? $$%"!$Z 
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<=
3.17.11 <? $$%"!$Z '.%" 
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!'K
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>43?@
    '.%" H , ! +' %" +'/
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1.  $
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2. )L'6 %"I,'K
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%"'K

3. )L6
$'6 !*% %% vagina *%!6 !H6 $ [("'5
% $# œ%ZH! %"! 
4. J 6!'6 %"%

3 J $"3 33()

3.18 2?=C?
A=1  
(CERTAIN CONDITIONS ORIGINATING IN THE PERINAL AND NEONATAL
PERIOD) ICD 10, XVI; P00-P96
(
Neonatal Intensive Care Unit)
176

3.19 6C1  C?___o


(CONGENITAL MALFORMATIONS, DEFORMATIONS AND CHROMOSOMAL
ABNORMALITIES) ICD 10, XVII; Q00-Q99
<=
3.19.1 H?=w3@6}26C? !I
%#  H $!6
%"'K$" #!*%H $" #!

'6 
!+ '6 $ (G "1 
>43?@
1. %# J %"6
%,% '6 $6,"V  Z!  H ]%," " 
"%

 (organogenesis) %# 
 Y
H ""$" %"
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2.1 H H!H[!+ '6 (chromosomal disorders) 1 ,
!+ '6 $"H ""

7 G ,
H H!H[!$ 1'
2.2   
+ '6 (single gene disorders) 4  *%
2.2.1 Autosomal dominant 7, achondroplasia, neurofibromatosis, Noonan
syndrome, Apert syndrome  Marfan syndrome
2.2.2 Autosomal recessive 7, thalassemia, phenylketonuria, maple syrup
urine disease, urea cycle defects, mucopolysaccharidosis (Hurler,
Hunter, Sanfilippo, Morquio)
2.2.3 X-linked dominant 7, incontinentia pigmenti, hypophosphatemic
rickets
2.2.4 X-linked recessive 7, hemophilia A, B, G-6-PD deficiency, Duchenne
muscular dystrophy, Fragile-X
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(INJURY, POISONING AND CERTAIN OTHER
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ICD 10, XIX; T00-T07, T15-T32, T36-T79, T90-T98, XX; V01-V99, W00-Y89
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3.1 Mechanism and diagnosis of injury : Fall, animal bites (snake bites, dog bites),
road accident, thermal injuries (burn, scald, heat stroke), submersion, sharp and
blunt injuries, electrical injury, foreign body, insect sting, radiation injury, sport
injuries, child abuse (physical , sexual, mental)
3.2 Mechanism and diagnosis of poisoning
3.2.1 Drugs : Analgesics and antipyretics (salicylate, acetaminophen
181

ibuprofen) opiates compound (morphine, heroine), narcotics (cocaine,


LSD, amphetamines, ecstacy, marijuana), sedative and hypnotics
(barbiturate, benzodiazepine), antidepressants (tricyclic anti-depressant),
major tranquilizers (chlorpromazine, haloperidol), anticonvulsants
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iodide), antidiarrheal drugs and antispasmodic drugs (loperamide,
atropine), inotropic and antihypertensive drugs (digitalis, clonidine,
beta-blocker, calcium channel blocker), bronchodilators (theophylline,
beta-agonists) , antibiotics (penicillin, co-trimoxazole, aminoglycosides)
3.2.2 Heavy metal : Lead, arsenic, mercury, cadmium
3.2.3 Household product poisoning : Hydrocarbon (benzene, gasoline,
thinner), methanol and ethanoil, corrosive agents, detergents, nail
remover and supernail remover, cyanide, bleaching agents, hair spray
3.2.4 Pesticides : organophosphate, organochlorine, carbamate, pyrethrum,
diethyl toluamide (DEET), paraquat, 2-4 D, 2-4-5 T, warfarin, zinc
phosphide
3.2.5 Environment hazards : carbon monoxide, sulfur dioxide, nitrogen
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weed (H"), cfc ( hair spray, foam, G6 vv)
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1.1 Prehospital management
1.2 Emergency management
1.2.1 First aid treatment
1.2.2 Shock (hypovolemic, cardiogenic, anaphylactic)
1.2.3 Respiratory failure
1.2.4 Renal failure
1.2.5 Hepatic failure
182

1.3 Specific management


1.3.1 Proper transportations
1.3.2 Decontamination: gastric lavage, hemodialysis
1.3.3 Increase excretion
1.3.4 Specific antidotes
1.4 Ethical, legal, social issues
1.5 Rehabilitation
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2.3.1 Predisposing factors
- Developmental factors: correlation of age and type of accident and
poisoning
- Environmental factors
- Temperamental factors
2.3.2 Health and health maintenance
- Pharmacology and pharmacokinetic
- Principles of management
- Health supervision
2.3.3 Epidemiology (morbidity and mortality) of poisoning
2.3.4 Impact and prevention of all poisoning
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1. THERAPEUTIC AND TECHNICAL PROCEDURES


Abscess (simple), I & D
Abdominal paracentesis
Airway management : laryngoscopy, endotracheal intubation
Arterial puncture
Bladder catheterization, transurethral
Bleeding time
Blood and blood component transfusion
Cardiopulmonary resuscitation, basic and advanced life support (newborn & pediatric)
Central line : use/care
Chest physiotherapy
Electrocardiogram, perform and interpret
Endotracheal intubation
Exchange transfusion
Gastric suction/lavage
Gastric tube placement (NG)
Gynecologic examination (pre-pubertal)
Heimlich maneuver
Immunization administration (IM, SC, PO)
Inhalation equipment :
- dry powder inhaler (DPI)
- metered dose inhaler (MDI)
- nebulizer
Injection/medication delivery, IM, SC, ID, IV, rectal, aerosol
Intraosseous line placement
Intravenous line placement
Lumbar puncture : spinal fluid collection & examination
Newborn procedures :
- Bilirubin measurement
- Gavage feeding (gastric & transpyloric)
- Phototherapy
- Silver nitrate cauterization
- Umbilical vessel catheterization
Oxygen delivery systems: select and use
Pericardial tapping
Peritoneal dialysis
Physiologic monitoring:
- Blood pressure ; automated, Doppler, sphygmomanometer
- Body temperature
- Cardiac
- Respiratory
Pneumatic otoscopy
186

Proctoscopy
Pulmonary function tests : Peak flow meter, spirometry
Pulse oximetry
Sexual abuse : Examination / evaluation
Sterile technique
Skin biopsy
Suctioning of : Nares, trachea, tracheostomy
Subdural tapping
Suprapubic aspiration of urine
Thoracentesis, needle, intercostals drainage for air/fluid
Tourniquet test
Tuberculin test (place & read) : Mantoux, PPD, Tine
Universal precautions
Venepuncture
Ventilation : Bag-valve-mask, CPAP
Ventilation support, initiation
Venous cut down and CVP placement
Wound care (simple)
X-ray interpretation (initial or emergency reading) :
- Abdomen
- Cervical spine
- Chest
- CT of head
- Fractures in extremities
- Lateral neck
- Skeletal surveys for suspected abuse
2. DIAGNOSTIC AND SCREENING PROCEDURES
Antropometric measurement : Weight, height, chest/head circumference, U/L ratio, span
Apt test for maternal blood swallowing
Blood gases determination : Arterial and capillary
Developmental screening : DDST II, Gasell figure, drawing test, DAP test, Bender • Gestalt Test
Growth chart : Recording & interpretation
Growth velocity determination
Intellectual screening in mental retardation
Skin fold thickness, mid-arm circumference measurement
Visual screening : Acuity , strabismus
Pubertal staging : Tanner
Testicular volume measurement
Transillumination test
3. LABORATORY PROCEDURES AND SPECIMEN COLLECTION
3.1 Collection techniques & proper handling for :
Abscess fluid, pus
Blood culture
CBC with differential count
Conjunctival swab : Bacteria, chlamydia
187

Hair collection (tinea)


Nasal smear for PMNs
Newborn blood screening : Hypothyroid, PKU
Pleural fluid
Skin scraping : Scabiasis, fungal
Scotch tape for pinworms
Spinal fluid
Throat swab
Tracheal aspirate (include child with tracheostomy)
Urine culture
Urethral culture
Vaginal culture
3.2 Perform and interpret :
Bedside glucose determination
Bone marrow : Aspiration, biopsy, smear & stain
Capillary blood gases
CBC : - Wright stain smear for RBC morphology, WBC and platelets
- Staining for reticulocytes, inclusion body, Heinzˆs body
- Buffy coat smear & Wright stain
- Interpret RBC indices read out on automated CBC
Coagulogram (screening), venous clotting time, clot retraction, clot lysis, and
platelet function test
CSF cell count
ESR
Gram stain and AFB stain
Hematocrit
KOH preparation : Hair, skin, vaginal
Lymph node imprint
Nasal smear for PMNs
Rapid test : Cold agglutinin, mononucleosis agglutination test
Stool : Occult blood, reducing substances, pH, parasites
Throat swab culture : Selective media for group A presumptive diagnosis
Tzanck smear
Urinalysis : Dip and microscopic
Urine culture & colony count
Urine ferric chloride test
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