Download MGR MBBS Final Year Paediatrics Syllabus

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PAEDIATRICS UG CURRICULUM
Goal
GOAL
The broad goal of the teaching of undergraduate students in Pediatrics is to acquire
adequate knowledge and appropriate skills for optimally dealing with major health

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problems of children to ensure their optimal growth and development.
ii) SPECIFIC LEARNING OBJECTIVES
a. KNOWLEDGE
At the end of the course, the student should be able to:
(1)describe the normal growth and development during foetal life, neonatal period,

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childhood and adolescence and outline deviations thereof.
(2) describe the common paediatric disorders and emergencies in terms of
epidemiology, etiopathogenesis, clinical manifestations, diagnosis, rational therapy and
rehabilitation.
(3) state age related requirements of calories, nutrients, fluids, drugs etc. in health and

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disease.
(4) describe preventive strategies for common infectious disor
ders, malnutrition, genetic and metabolic disorders, poisonings, accidents and child
abuse.
(5) outline national programmes relating to child health including immunisation

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programmes.
(6) Recognize a critically ill child based on the pediatric assessment triangle and
effectively intervene to stabilize the child before transporting to a higher centre.
b. SKILLS
At the end of the course, the student should be able to:

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Obtain a proper relevant history and perform a humane and thorough clinical
examination of all organs/systems in children including neonates
Arrive at a logical working diagnosis after clinical examination
Order appropriate investigations keeping in mind their need,relevance and cost
effectiveness

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Plan and institute a line of treatment which is need based,cost effective and
appropriate for common ailments taking into consideration
a.Patient
b.Disease
c.Socio economic status

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d.Instituitional / governmental guidelines
5. Recognize situations which call for urgent or early treatment at secondary and
tertiary centres and make prompt referral of such patients after giving first aid or
emergency treatment

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6. Monitor growth and development of children and differentiate normal and abnormal

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7..Manage diarrhea /dysentery: assess dehydration; prepare and administer oral
rehydration therapy
8. Participate in research activities like ICMR/UNICEF
9. Detect and institute corrective measures for nutritional deficiency
10.Write a complete case record with all necessary details

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11.Write a proper discharge summary with all relevant information
12.Write a proper referral note to secondary or tertiary centres or to other physicians
with all necessary details
13.Organise and give training in first aid
14. Adopt universal precautions for self protection against HIV and hepatitis and

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counsel patients
15.Maintain cold chain for vaccines
16.Perform and read mantoux test
17.Start i.v line and infusion in children and neonates
18.Give intradermal/s.c/i.m/i.v injection

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19.Pass a nasogastirc tube
20. Manage hyperpyrexia
21.Permom CPR and first aid in all new born and children
22..Demostarte empathy and humane approach towards patients,relatives and
attendants

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23.Develop a proper attitude towards patients,colleaguesand other staff
24.Maintain an ethical behavior in all aspects of medical practice
25.Organise antenatal,postnatal,newborn and other clinics
26 .Motivate colleagues,community and patients to effectively participate in national
health programmes

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27. Blood Grouping and typing
C. INTEGRATION
The training in pediatrics should prepare the student to deliver preventive, promotive,
curative and rehabilitative services for care of children both in the community and at
hospital as part of a team in an integrated form with other disciplines, e.g. Anatomy,

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Physiolog,y, Biochemistry, Microbiology, Pathology, Pharmacology, Forensic Medicine,

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Community Medicine and Physical Medicine and Rehabilitation.
TEACHING HOURS -100
6th and 7th sem
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30 hours
8th and 9th sem
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70 hours (including integrated teaching 10 hours)
6th and 7th sem

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Didactic Lecture ? ( 1/3 of the schedule )
- 10 hours
Demonstration / case scenarios
- 10 hours
Seminars/ Symposium with pre and post

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Test questionnaires
- 5 hours
Group Discussion with floor participation and
Faculty as moderators
- 5 hours

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TOTAL
30 hours
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One lecture Communication Skill is mandatory

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8th and 9th sem
Didactic Lecture ? ( 1/3 of the schedule )
- 20 hours
Demonstration / case scenarios/general clinics
- 20 hours

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Seminars/ Symposium with pre and post
Test questionnaires
- 10 hours
Group Discussion with floor participation and
Faculty as moderators

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- 10 hours
Integrated Teaching
- 10 hours
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TOTAL

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70 hours
One lecture on communication skill is mandatory
TEACHING METHODOLOGY
Didactic lectures
Clinical Demonstrations,

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Seminars
Case presentations
General Clinics
Group discussions
Ward rounds

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Communicative Skill assessment ? OSCE/VIVA
Health Informatics
Self assessment
Observation of immunization procedures
Observation of the management of critically ill children in Emergency / Pediatrics

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department
Integrated Teaching
THEORY SYLLABUS
Growth and Development

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Must know

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Normal growth and it's assessment
Normal development
Growth charts
Changes during adolescence(Tanner's staging)
Overview of Intellectual disability (Mental retardation)

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Behavioural disorders (breath holding spells, nocturnal enuresis, temper
tantrums,PICA)
Desirable to know
Failure to thrive
Learning disabilities

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ADHD, Autism
Nice to know
Developmental assessment tools & tests
Fluid and electrolyte disturbances
Must know:

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Composition of body fluids
Clinical assessment of dehydration
Deficit therapy
Normal maintenance requirements
Sodium disturbances

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Potassium disturbances
Desirable to know
Calcium disturbances
Magnesium disturbances
Acid base balance

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Nice to know

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Perioperative fluid therapy
III) Nutrition
Must know
Breast feeding, Weaning, complementary feeding

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Recommended dietary allowances
Nutritive value of common foods
Diet chart
Classifications - IAP, Welcome, WHO
Obesity

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Malnutrition/SAM ? Recognition and management
Vitamins- function and deficiencies
Minerals : iron, zinc, iodine
Desirable to know
National nutrition programs

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Prevention of malnutrition
Hypervitaminosis
Refeeding syndrome
Nice to know
Nutrition Rehabilitation center

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Management of problems related to lactation failure
IV) Immunisation
Must know
National immunisation schedule
Vaccines and vaccine preventable diseases

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Principles of immunisation
Cold chain
AFP surveillance
Pulse polio program

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Adverse events following immunization

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Passive immunization
Rabies vaccination
MMR,typhoid
Desirable to know
Immunization in special circumstances

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Newer vaccines- pneumococcal,meningococcal,varicella,Hepatitis A, Rubella,
influenza vaccine
International ?Polio vaccine switch
Catch up vaccine
Nice to know

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IAP immunization schedule
Rota virus, human papilloma virus
V) Newborn
Must know
Identification of antenatal,intrapartum and immediate postnatal risk factors

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Identification and classification of high risk neonate, gestational age assessment
Neonatal Resuscitation
Normal newborn care
Birth asphyxia, HIE
Care of the preterm /Low birth weight, prevention of complications and

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management
Neonatal jaundice and anemia
Infection
Danger signs in newborn
Thermo regulation in newborn

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Metabolic problems like hypoglycemia, hypocalcemia
Respiratory distress syndrome
Physiological changes in a newborn
Desirable to know
Baby friendly hospital initiative

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Human milk bank
Common surgical problems in newborn
Approach to a bleeding neonate
Meconium aspiration syndrome & Persistent pulmonary hypertension.
Neonatal seizure

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Transport of a sick new born
Nice to know
Infant of diabetic mother
Hemorrhagic disease of newborn
Necrotizing enterocolitis

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VI) Infections
Must know
Natural history, clinical features, investigations, management and prevention of
common bacterial viral and parasitic infections with special reference to vaccine
preventable diseases

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Fever ?definition, pathogenesis, PUO
UTI
Tuberculosis
Enteric fever
Viral hepatitis

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Dengue
Pediatric HIV
Malaria

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Leptospirosis
Scrub typhus

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Amoebiasis, Giardiasis
Pin worm, Ascariasis, Hookworm
Desirable to know
Fungal infections
Current epidemics and pandemics- ex:H1N1

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Zika virus
Scabies
Principles of anti bacterial therapy
Scarlet fever
Nice to know

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Infections in immunocompromised children
Health care associated infection
Ka;a azar,Infectious mononucleosis
VII) Gastrointestinal system & liver
Must know

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Acute diarrhea
Persistent diarrhea and chronic diarrhea
Acute hepatic failure
Constipation
Gastroesophageal reflex

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Cirrhosis, portal hypertension, chronic liver disease
Differential diagnosis of hepatosplenomegaly
Desirable to know
GI bleed
Wilson's disease

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Malabsorption syndroms
Acute abdomen including surgical causes like intussusceptions, malrotation,
Hirschsprung's disease
Nice to know
Biliary atresia

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Neonatal cholestasis
VIII) Hematology
Must know
Nutritional anemias
Hemolytic anemias- thalassemia, hereditary spherocytosis and others.

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Hemophilia
ITP
Approach to a bleeding child
Leukemias and lymphomas
Desirable to know

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Hemopoietic stem cell transplantation
Blood components transfusion
DIC
Nice to know
Thrombotic disorders

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IX) Respiratory system
Must know
Upper respiratory infections
Bronchiolitis
Community acquired Pneumonia

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Pleural effusion/pneumothorax/empyema
Bronchial asthma
ARI program

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Suppurative lung diseases
Pulmonary tuberculosis

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Diagnosis and appropriate management of foreign body aspiration
Desirable to know
Stridor/ALTB/ Laryngomalacia
Epiglotitis
Aerosol therapy

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Recurrent pneumonia
Nice to know
Cystic fibrosis
ARDS
X) Cardiovascular system

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Must know
Congestive cardiac failure-diagnosis and management
Acute rheumatic fever
Rheumatic heart disease
Acyanotic congenital heart diseases-VSD, PDA, ASD, coarcation

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Cyanotic congenital heart diseases- TOF, management of cyanotic spell
Infective endocarditis
Desirable to know
Other congenital heart diseases
Pericarditis,Myocarditis

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Hypertension
Nice to know
Cardiomyopathy
Arrythmias

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XI) Renal system

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Must know
Acute glomerulonephritis
Nephrotic syndrome
Urinary tract infection
Acute kidney injury

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Desirable to know
HenochSchonlein Purpura
Hemolytic uremic syndrome
Nice to know
Evaluation of proteinuria, hematuria

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Renal transplatation
XII) ENDOCRINOLOGY
Must know
Hypothyroidism and goiter
Short stature

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Desirable to know
Diabetes mellitus & DKA
Nice to know
Disordersof sex development (Ambiguous genitalia)
XIII) Central Nervous System

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Must know
Febrile seizures
Seizure disorder and treatment
Acute bacterial meningitis & Tuberculous meningitis
Encephalitis

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Cerebral palsy

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Hydrocephalus
Microcephaly
Chorea
Infantile hemiplegia

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Stroke in children
Desirable to know
Acute flaccid paralysis
Duchenne muscular dystrophy
Post meningitic and encephalitic sequelae

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Neural tube defects
Nice to know
Neurodegenerative disorders
Floppy infant
XIV) RHEUMATOLOGY

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Must know
When to suspect collagen vascular disorders
Desirable to know
JRA,SLE
Nice to know

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Kawasaki disease
XV) GENETICS
Must know
Downs syndrome
Genetic counseling

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Desirable to know
Turner syndrome
Karyotyping

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Nice to know
Dermatoglyphics

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Prenatal diagnosis
XVI) INBORN ERRORS OF METABOLISM(IEM)
Must know
When to suspect IEM
Newborn metabolic screening

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Desirable to know
Phenylketonuria
Nice to know
Lysosomal disorders- Hurlers and Hunters disease
XVII) SKIN

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Must know
Impetigo
Urticaria
Pediculosis
Scabies

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Desirable to know
Steven Johnson syndrome
Capillary hemangiomas
Nice to know
Staphylococcal scalded skin syndrome

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XVIII) POISONING AND ENVENOMATION
Must know
When to suspect a poison

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Principles of management of poisoning
Snake bite

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Scorpion sting
Desirable to know
Hydrocarbon poisoning
Organophosphorus poisoning
Nice to know

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Toxidromes
XIX) PEDIATRIC EMERGENCIES AND CRITICAL CARE
Must know
How to recognize a sick child and identify the physiologic status
Pediatric assessment triangle

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Shock- recognition and management of hypovolemic, cardiogenic, septic and
anaphylactic shock.
Status epilepticus
Status asthmaticus
Stridor

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Hypertensive emergencies
Acute pulmonary edema
Pediatric basic life support
Desirable to know
Nosocomial infections

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Oxygen delivery devices
Positive pressure ventilation
Head injury and Polytrauma
Nice to know
Indication and principles of mechanical ventilation

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Inotropes

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XX) PROCEDURES
Must know
Injection techniques-intramuscular, intravenous, subcutaneous
Bag and mask ventilation

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Lumbar puncture
Bone marrow aspiration
Desirable to know
Naso-gastric feeding,
Paracentesis

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Nice to know
Intraosseous access
XXI) Pediatric surgery:
Must know
Tracheo- esophageal fistula,

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Diaphragmatic hernia,
Umbilical hernia,
Hypertrophic pyloric stenosis.
Intusussception
Appendicitis

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Desirable to know
Diagnosis and timing of surgery of cleft lip/palate, phimosis
Anorectal malformation
Malrotation
Hirschsprung disease

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Undescended testes
Nice to know
Cystic hygroma
Tortion testes
XXII) Dosages of common drugs (Must know)

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XXIII) IMNCI (Must know)
XXIV Radiology (Must know)

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Common Pediatric X-ray interpretation
Pneumonia & Consolidation
Miliary tuberculosis

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Pleural effusion
Pneumothorax
Rickets
Scurvy
Diaphragmatic hernia

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Tracheoesophageal fistula
Congenital heart disease with increased or decreased blood flow
XXV) VITAL STATISTICS/NATIONAL HEALTH PROGRAMMES
Must know
ICDS

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RCH,
Vitamin A prophylaxis
ARI
Diarrhea control programme
Desirable to know

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Maternal, perinatal, neonatal, infant and preschool mortality rates. Definition,
causes, present status
Nice to know
FIMNCI
CEMONC

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BEMONC
PRACTICAL SYLLABUS
II M.B.B.S PART -I
Introductory Batch (2 weeks)

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Must Know

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1. History taking :General and system wise .
2.General examination
3. Examination of all systems
4.Anthropometry:Measurement and interpretation of height, weight, head
circumference, chest circumference, mid arm circumference

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5.Measurement of vital signs in pediatrics
6.Writing a pediatric case sheet
7.Over view of difference between child and adult
Desirable to know:
1.Nutrition ?normal protein, calorie, fat requirements

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2. Formulation of diet chart to one year old child
3. Immunisation schedule
4. History taking in newborn
Nice to know:
1.Understanding normal growth and development

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2. Evaluation and management of common OPD conditions
UG CURRICULAM (4 WEEKS)- (III M.B.B.S ? Part I )
Must Know:
1.Taking a detailed Pediatric history
2.Conducting physical examination of children

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3. Normal growth and development
4.Performing anthropometry and its interpretation
5.Developmental assessment of a child
6.Assessment of calorie/ protein intake and advise regarding feeding practice
7.Immunization schedule

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8.Evaluation and management of common OPD conditions like diarrhea,
common cold, upper and lower respiratory infections, asthma.
11.Approach to a child with acute fever (evaluation and management of
common febrile conditions

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including viral fever, enteric fever, malaria, UTI)

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12.Approach to a child with prolonged / persistent fever (evaluation and
management of pulmonary tuberculosis
13. Approach to respiratory distress
14. IMNCI
Desirable to know

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1.Care of normal newborn at birth and in postnatal ward
2.Counseling for breast feeding/ infant feeding
3.All about normal newborn
4. Evaluation and management of common infectious diseases(viral hepatitis, malaria,
typhoid)

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5. Evaluation and management of acute gastroenteritis, persistent diarrhea
6. Evaluation and management of cardiovascular problems like congenital acyanotic
and cyanotic heart diseases and rheumatic heart disease
7. Evaluation and management of common CNS conditions febrile seizures, epilepsy,
cerebral palsy, developmental delay, microcephaly, hydrocephalus

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III M.B.B.S. PART ?II PEDIATRICS (4 weeks)
MUST TO KNOW
Diagnose and appropriately treat common pediatric and neonatal illness.
Identify pediatric and neonatal illnesses and problems that
require secondary and tertiary care and refer them appropriately.

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Provide emergency cardiopulmonary resuscitation to newborns and older
children.
Recognize a critically ill child based on the pediatric assessment triangle and
effectively intervene to stabilize the child before transporting to a higher centre.
Ask for only relevant investigations and interpret it appropriately.

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Perform routine investigations and therapeutic procedures in a child.
Administer vaccines.
Manage and refer children and neonates based on IMNCI
Counsel the parents and relatives of the patient regarding the illness, possible

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complications and the prognosis.

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Participate in National programmes effectively.
Manage patients with empathy, respect and ethically.
Nice to know
1.Adolescent Pediatrics
2.Pediatric emergencies ?status epilepticus, status asthmaticus, recognition of critically

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ill child
3. Medical conduct during patient examination(empathy,privacy, Communication skill
etc)
Recommended reading books
Textbooks for Pediatrics

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1. "Essentials of Pediatrics" by OP Ghai, Vinod K Paul and Piyush Gupta
(latest edition)
2. "Care of the Newborn" by Meharban Singh (latest edition)
Reference Books 1. "Nelson Textbook of Pediatrics" by Richard E.
Behrman, Robert M. Kliegman, Waldo E. Nelson and Victor C. Vaughan

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(latest edition)
2. "Rudolph's Pediatrics" by Abraham M. Rudolph, Julien IE Hoffman,
Colin D. Rudolph and Paul Sagan (latest edition)
3.IAP Text book of Pediatrics (latest edition)
Clinical Methods

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1. "Hutchison's Clinical Methods" by M Swash (latest edition)
2. "Pediatrics Clinical Methods" by Meharban Singh (latest edition
3. "Pediatric Clinical Examination" by Dr. A. Santhosh Kumar (latest
edition)
THEORY EXAMINATIONS

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Question
Marks
1
Essay
1 x 10 marks =

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10 marks
2
Brief Answers
5 x 4 marks =
20 marks

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3
Short Notes
5 x 2 marks =
10 marks
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Total
40 marks
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PRACTICAL EXAMINATIONS
Clincial Examination

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Case
Duration
Maximum
Long Case
1

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35 minutes
13 marks
(5 marks for history, clinical examination and eliciting signs; 3marks for discussion on
differential diagnosis; 5 marks for management)
Short case

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2 (2x3marks)
20 minutes
6 marks
Spotters
2 (2x3 marks)

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20 minutes
6 marks
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Total
25 marks

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OSCE
5 stations x I mark each
5 marks
(demonstration of clinical signs-observed station, Case scenario , IMNCI, counseling,

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recent advances)
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30 marks
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VIVA 10 marks (4 stations- drug and vaccines, radiology, instruments, nutrition 2.5

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marks each)
One Short case may be assigned as per the IMNCI (Integrated Management of
Neonatal and Childhood illness) approach.
Eg. New born
Anemia

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Malnutrition
Pneumonia
Jaundice
Diarrhea
Severe bacterial infection

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.
Formative Assessment
At the end of every clinical posting a practical evaluation should be conducted
and assessment marks with attendance to be submitted to the university at end of
everyclinical posting ? both hard and soft copy

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Theory test should be conducted periodically at end of three / four chapters during
theory classes.
Internal Assessment (20 marks)
The final Internal assessment marks will be the average of all tests conducted from II
MBBS part I to III MBBS part I ? Theory 10, Practical -10.

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For III MBBS part II Theory 10,Practicals 5 and Record 5

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Medical ethics
Human values
Conflicts
Informed consent

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Confidentiality
Conflicts of interest
Cultural concerns
Importance of communication
A theory class on medical ethics is allotted each year.

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Integrated teaching
Theory classes should include integrated teaching.
Vertical integration with involvement of Anatomy, Physiology, Biochemistry,
Microbiology, Pathology, Pharmacology
Horizontal integration with involvement of General Medicine, Surgery, Orthopediatrics,

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Community Medicine , Physical Medicine and Rehabilitation.
Vertical integration- Horizontal Integration
1.Rheumatic heart disease
1. Cerebral Palsy
2,Bronchiectasis

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2. Nephritic/nephritic syndrome
3.Rickets
3. Downs syndrome
4.Portal hypertension
4. Immunization in children

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5.Anemia
5. Pediatric HIV
6.Thalassemia
6. Acute CNS infections
7.Infective endocarditis

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7. Hypothyroidism/short stature
8.Urinary tract infection
8. .Cyanotic heart diseases
9.Diarrheal diseases
9. Chronic liver disease

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10.Pneumonia
10.Stroke in children
11. Immunization Schedule
11.Common
Poisoning

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in
children
Record/ Log book
Record should be submitted at the end of the postings during the internal assessment
practical test.

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The record should contain a detailed case sheet of ten cases admitted in the ward
along with the investigations done for those patients and treatment given.
The cases should include atleast one newborn, one emergency, and one from IMNCI.

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LOG BOOK:
Log Book should be followed as recommended by the University.

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CRRI orientation in Pediatrics
Skills
1. Diagnose and appropriately treat common pediatric and neonatal illness.
2. Should know to write a pediatric and newborn case sheet.
3. Identify pediatric and neonatal illnesses and problems that require secondary

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and tertiary care and refer them appropriately.
4. Provide emergency cardiopulmonary resuscitation to newborns and older
children.
5. Recognize a critically ill child based on the pediatric assessment triangle and
effectively intervene to stabilize the child before transporting to a higher centre.

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6. Do only relevant investigations and interpret it appropriately.
7. Administer all vaccines in national immunization schedule
8. Manage and refer children and neonates based on IMNCI
9. Counsel the parents and relatives of the patient regarding the illness, possible
complications and the prognosis.

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10.Participate in National programmes effectively.
11.Manage patients with empathy, respect and ethically.
12.Should know to manage the following Pediatric emergencies ?
status epilepticus, status asthmaticus, stridor, various types of shock,
snake bite, scorpion sting.

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13.Should know to identify manage the following neonatal emergencies- neonatal
seizures, Hypoglycemia, hypocalcemia, sepsis,life threatening surgical
emergencies
14.Should identify a child with poisoning and manage appropriately.
15.Should know basics of fluid therapy in children including preparation and dose of

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ORS.
16.Should know about oxygen delivery devices.
17.Should have knowledge of the drug dosage in relation to body weight
(commonly used drugs)

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Therapeutic and diagnostic procedures

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1. Start an intra venous line
2. Lumbar puncture
3. Bone marrow aspiration
4. Pleural tap
5. Ascitic tap

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6. Urinary catheterization
7. Collection of blood sample for investigations
8. Intramuscular injections
9. Bag mask ventilation
Should have completed PEMC module for CRRI and BLS

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Assessment
A test will be conducted at the end of the posting.
Log book should be maintained
UNIT TEST I
1.Normal growth and its disorders

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2.Development
3. Adolescent health and development
4.Fluid and electrolyte disorders
Unit TEST II
1.Nutrition

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2.Micronutrients in health and disease
3 Newborn infants
UNIT TEST III
1.Infections and infestations
2.Immunization and Immunodeficiency

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UNIT TEST IV
1.Diseases of gastrointestinal system and liver
2.Haematological disorder
3.Otolaryngology
UNIT TEST V

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1.Disorders of respiratory system
2.Disorders of cardiovascular system
3.Disorders of kidney and urinary tract
UNIT TEST VI
1.Endocrine and metabolic disorders

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2.Central nervous system
3.Neuromuscular disorders
UNIT TEST VII
1.Childhood malignancies
2.Rheumatological disorders

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3.Genetic disorders
UNIT TEST VIII
1.Inborn errors of metabolism
2.Eye disorders
3.Skin disorders

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UNIT TEST IX
1.Poisoning ,injuries and accidents
2.Paediatric critical care

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UNIT TEST X
1.Rational drug therapy

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2.Integrated management of neonatal and childhood illness
3.Rights of children
Mock clinical exam / Theory test will be conducted unit-wise and evaluated accordingly for
Internal Assessment.

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