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DRAFT
Pre-Service Committee
Liaquat University of Medical & Health Sciences
Jamshoro
Pre-Service Curriculum Committee ;Professor Salma Shaikh, Professor Akbar
Nizamani, Dr.Yasmeen Memon, Dr.Shazia Memon,Dr.Akram Shaikh,
Dr.Rehman Siyal, Dr.Farzana Shaikh,Dr.Chetan Das
This document is a formal publication of the Liaquat University of Medical &
Health Sciences, Jamshoro & all rights are reserved. Acknowledgement for
Technical Support in preparation of Document of Dr.Abdul Rehman Pirzado CAH
Officer World Health Organization (WHO) Sindh
TEACHING SCHEDULE FOR 4
TH
YEAR
MBBS STUDENTS
Lec.
#
Topics Teacher
1 Introduction of Paediatrics course content
Dr. Yasmeen / Dr. Shazia Memon
2 History and Examination of Paediatrics
3
Common Paediatrics Problems in Pakistani
Children
4 State of worlds and Pakistani Childrens
Dr. M. Akram Shaikh / Dr. Farzana
5 EPI and update on vaccines
6 Introduction to IMNCI
7 Essential Newborn care
8 Breast Feeding and IYCF
TIME TABLE FOR 4
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ACADEMIC CALENDAR
EIGHTH SEMESTER [FOURTH YEAR MBBS]
BATCH 2007-08
Classes will start from 01
st
July 2011
Classes will end on 29
th
October 2011
Preparation leaves (+Eid-ul-Azha) 30
th
Oct to 20
th
Nov 2011
Theory + OSPE Examination (+Ashura) 21
st
to Nov to 17
th
Dec 2011
Semester Break / Winter Vacation 18
th
to 31
st
December 2011
8
th
Semester [4
th
Year] MBBS Batch 2007-08
DATE
EYE ORT
HO
UROLOGY
PLASTIC
SURGERY
I II III
03 July to 19 July 2011 B1 B2 B3 B4 B5 B6
20 July to 06 Aug 2011 B2 B1 B4 B5 B6 B3
08 Aug to 06 Sep 2011 B5 B6 B1 B2 B3 B4
07 Sep to 24 Sep 2011 B6 B5 B2 B3 B4 B1
26 Sep to 11 Oct 2011 B3 B4 B5 B6 B1 B2
12 Oct to 29 Oct 2011 B4 B3 B6 B1 B2 B5
ENT
PAEDS
DER
MA
NEURO
SURGERY
CARDIO
LOGY
I II
03 July to 19 July 2011 A1 A2 A3 A4 A5 A6
20 July to 06 Aug 2011 A2 A3 A1 A5 A6 A4
08 Aug to 06 Sep 2011 A3 A1 A2 A6 A4 A5
07 Sep to 24 Sep 2011 A4 A5 A6 A1 A2 A3
26 Sep to 11 Oct 2011 A5 A6 A4 A2 A3 A1
12 Oct to 29 Oct 2011 A6 A4 A5 A3 A1 A2
THE NINTH SEMESTER CLASSES WILL START FROM: 2
nd
JANUARY 2012
SCHEDULE OF HOPITAL POSTING
TEACHING SCHEDULE FOR
FINAL YEAR MBBS STUDENTS
Department of Pediatrics
Liaquat University of Medical and Health Sciences, Jamshoro
List of Lectures
No Topic Unit Signature
1 Introduction to the Paediatrics subject I
2 Staus of Children in Pakistan / Sindh II
3
Introduction to Infectious Diseases in Children in Pakistan and
National Guidelines
I
4 Introduction to Integrated Management of a Sick Child II
5 Introduction to Standard Operating Procedures / National Guidelines I
6 Disease Surveillance II
7 Integrated Case Management (Introduction to Case Management Form) I
8 Emergency Triage II
9 Check for general danger signs I
10 Facility Based management of general danger signs II
11 Septic Meningitis / Encephalitis / Cereberal Malaria TMB I
12 Cough or Difficult Breathing II
13 Facility Based management of cough and dificult breathing I
14 Approach to child with wheeze / Asthma II
15 Diarrheas, causes and classification I
16 Facility based management of diarrhoea II
17 Persistant diarrhoea I
18 Fever IMNCI Classification II
19 Facility based management of childhood fever I
20 Malaria and measles II
21 UTI I
22 Dengue fever II
23 Case definitions and Immunization Schedule in EPI I
24 Polio and AFP surveilance II
25 Childhood Tuberculosis I
26 Diphtheria, Tetanus, Pertussis II
27 Hepatitis B I
28 Updates on Vaccine preventable diseases II
29 Hepatitis A, Rota Virus Diarrhea I
30 Typhoid II
31 Mumps, Rubella I
32 Approach to child with palmar pallor II
33 Anemias I
34 Newborn feeding (breast feeding) IYCF / ENCC II
35 Young infant feeding IYCF I
36 Check for malnutrition II
37 CMAM I
38 Severe malnutrition SAM/ CC pathway II
39 Micronutrient deficiencies Vitamin A deficiency/ Rickets/ Zinc I
40 Essential newborn care II
41 Birth asphyxia & resuscitation I
42
Small baby (LBW & Preterm) problems & management/
Kangaroo care
II
43 Neonatal jaundice I
44 IMNCI less than 2 months II
45 Facility based management of danger signs in newborn I
46 Neonatal Sepsis / Meningitis II
47 Approach to neonate with seizures I
48 Birth trauma / common congenital malformations II
49 Approach to a child with edema / nephrotic syndrome I
50 Approach to a child with haematuria / AGN II
51 Management of renal failure (ARF / CRF) I
52 Bleeding disorders II
53 Leukemia I
54 Thalassemia II
55 Approach to a child with short stature / hypothyroidism I
56 Down syndrome II
57 Acyanotic Heart Diseases VSD, ASD, PDA I
58 Cyanotic Heart Diseases TOF, TGA II
59 Rheumatic fever / RHD I
60 Afebrile seizures (Epilepsy) II
61 Cerebral palsy I
62 Approach to a child with haematemesis / CLD II
63 Approach to a child with behavioral problems I
64 Convention of child rights / child abuse II
65 Poisoning I
66 Practical procedures II
67 MCQ Test I + II
FINAL PROFESSIONAL MBBS
NEW COURSE 2010-2011
----------------------------------------------------------
PAEDIATRICS MCQ PAPER TOTAL MARKS 100
----------------------------------------------------------
FIFTY TRUE OR FALSE QUESTIONS
TABLE OF SPECIFICATION (TOS)
Table of specification (TOS)
A. Neonatology 10
1. Neonatal mortality rate in Pakistan and its causes
2. Small baby ( preterm / low birth weight / small for dates )
3. Sepsis
4. Birth asphyxia, resuscitation
5. Essential care of newborn (ENC)
6. Neonatal jaundice
7. Convulsion
8. Bleeding / hematological problems
9. Congenital malformations
10. Young infant IMNCI
B. National Programs 10
1. Under 5 mortality rate and infant mortality rate in Pakistan , causes and achieving MDG
4
2. MNCH (IMNCI)
3. EPI & NON EPI Vaccines
4. CMAM / SAM
4. Micronutrient Initiative
5. Malaria
6. Tuberculosis
7. National guidelines on child rights
C. Emergency Peadiatrics 2
1. B.L.S
2. Shock
3. Coma
3. Emergency triage
D. Respiratory System 3
1. Cough or difficult breathing
a. Pneumonia
b. Asthma
c. Croup
d. Throat problem
2. Pleural effusion
3. Pneumo-thorax
4. Reparatory failure
E. Gastro Intestinal System 3
1. Diarrhea
a. Acute diarrhea
b. Persistent diarrhea
c. Dysenteries
d. WHO management plans A, B and C
2. Abdominal pain
5. Constipation
6. Celiac disease
F. Liver 2
1. Infectious Hepatitis A, B, C, D, E
2. Hepatic Encephalopathy
3. Chronic liver disease
4. Liver abscess
5. Wilson Disease
G. CNS lethargic or unconscious child D/D and management 3
1. Convulsions and coma
2. Meningitis / encephalitis / cerebral malaria.
3. Cerebral palsy
4. Developmental delay
5. Space occupying lesion (brain abscess and brain tumor)
6. Epilepsy
H. Cardio vascular system 2
1. A cyanotic heart diseases ( VSD, ASD, PDA)
2. Cyanotic congenital heart disease ( TGA, TOF)
3. Management of cardiac failure
4. Myocarditis
5. Infective endocarditis
6. Rheumatic fever
I. Infectious diseases 4
Approach to child with fever
1. EPI Target Disease
a. Poliomyelitis
b. Childhood Tuberculosis
c. Diphtheria
d. Pertusis( whooping cough )
e. Tetanus and Neonatal Tetanus
f.. HIB ( Pneumonia and Meningitis)
g.. Measles
h. Hepatitis B
2. Non EPI target Diseases
a. Pneumonia and meningitis ( Pneumococcal Vaccine)
b. Enteric fever
c.. Chicken pox
d. Rota virus diarrhea
e. Influenza Virus
f.. Measles, Mumps and Rubella ( MMR)
g. Hepatitis A
h. Cervical cancer
3. Vaccine Research
a. Malaria
b. HIV
c. Hepatitis C
J. Renal Disease / Nephrology 3
Approach to child with edema and haematuria
1. Urinary infections
2. Nephrotic syndrome
3. Acute Glomerulonephritis
4. Acute Renal failure
5. Chronic kidney disease
5. Hyper tension
K. Hematological Diseases and Oncology 3
1. Anemia iron deficiency and others
2. Hemolytic especially thallasemia
3. I.T.P and bleeding disorder
4. Coagulation disorders Hemophilia
5. Leukemia / lymphoma
6. Aplastic Anemia
L. Nutrition 2
1. Breast feeding ( ENC/ IYCF), infant nutrition(IYCF), growth monitoring
2. Classification of malnutrition according to CMAM
3. SAM, Underweight, Marasmus , Kwashiorkor
4. Chronic malnutrition ,short stature
5. Micronutrients
a. Rickets
b. Vitamin A deficiency,
c. Zinc
M. Chromosomal Disorders 1
1. Downs Syndrome
2. Turners syndrome
N. Endocrines and Connective Tissues Disorders 1
1. Diabetes mellitus
2. Hypothyroidism
3. Rheumatoid arthritis
4. Systemic lupus erythmatosis
5. Kawasaki disease
O. Miscellaneous 1
1. Common behavioral problems in children.
2. Poisoning
a. Kerosene oil
b. Organophosphorus
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Lesson Plan
Day 1
Topic : Paediatric History (Indoor)
Introduction to Case Recording Form and chart booklet.
Time : 2 hours & 30 minutes
Facilitator introduces the topic and assign practical /clinical task. 30 min
Student: Each Student takes the history and fills Case Recording Form. 1 hour
Group discussion, on history taking according to form filled by student. 1 hour
Learning objectives:
Students should able to:
Take a Paediatric history.
Knows components of history and how to elaborate each component
To integrate IMNCI assessment and classification with Paediatric history and examination.
Fill the case recording form and classify the illness according to IMNCI.
Ask the questions required to assess the childs feeding.
Do a systemic enquiry.
Make a provisional diagnosis and differential diagnosis on the basis of history.
Clinical Skill Learnt:
Use basic Communication skills to take a relevant history of a child according to disease.
Able to fill the case recording form for general danger signs.
Able to enquire about each main-symptom individually
Facilitator/Instructor Procedure for Clinical work:
Demonstration of taking history on a patient
Facilitator/Instructor Procedure for Practical work:
Wall chart Demonstration
Introduction of recording form
MATERIAL REQUIRED
Paediatric history journal/ form with format /outline of Paediatric history.
IMNCI Wall chart
IMNCI Chart booklet
Case recording form
Pencil
Eraser
Lesson Plan
Day 2
Topic: General .physical examination (Indoor)
Time: 2 hours & 30 minutes
Student: Each Student perform general physical examination on child under supervision of
co-facilitator. 1hour
and discuss the findings in subgroups. 1 hour
Learning objectives: Student should be able to:
Describe the general look of patient .
Identify general danger signs.
Assess childs Nutrional status.
Pick up congenital anomalies/any dysmorphism.
Do a head to toe examination includes vitals, anthropometric measures, identify/ anemia,
cyanosis, edema, clubbing, dehydration
Able to perform the lymph node, back and ENT examination.
Clinical skill learnt
Is able to take the informed consent and perform general physical examination.
Assessment of General look, method to take vitals i-e Respiration, Pulse rate
Temperature, anthropometric measurement, Jaundice, cyanosis, & clubbing,
Able to identify nutritional status, and check for nutritional edema.
Assess the dehydration and can advice plan of rehydration according to status.
Check for anemia and classify the anemia accordingly.
o Demonstrate the assessment a child with general danger sign
o Demonstration on performing general physical examination
o Show students how to use the information on childs history written in recording
form
MATERIAL REQUIRED
Printed proforma or format of general physical examination.
Wall chart & Chart booklet
Case recording form
Torch, Pencil, Measuring Tape
SD chart & MUAC tape.
Weighing scale &Height /length scale
Lesson Plan
Day 3 Approach to a child with convulsion or Coma (Indoor)
Students take the history and performs examination on a patient. 1 hour
Case presentation/ Group discussion 1hour
Learning objectives: Student should be able to:
Take relevant history of a child with convulsion or coma and fill the recording forms
and perform a relevant examination.
Identify general danger signs.
Assess the level of consciousness by AVPU scale.
Know the differential diagnosis of child with convulsion/ coma
To give the pre-referral treatment.
Know how to investigate him
Treat the child with convulsion or coma.
o Demonstrate the assessment of a child with general danger sign
o Communication skills to take a relevant history of child with convulsion or coma
o Check signs of meningeal irritation, and to perform motor
examination of central nervous system.
o Knows pre-referral treatment of very severe disease
Show students how to use the information on childs history which is already
written on recording form.
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
N/G Tube No. 5,6 & 8
D/Syringe 5 &10ml
Normal saline ampoule
Stethoscope
CNS examination kit.
Pre-referral drug tray
Lesson Plan
Final year MBBS Small Group Teaching
Day-4: Meningitis/Encephalitis and Cerebral Malaria (Indoor)
Time: 2 hours and 30 minutes.
Facilitator Introduces the topic and assigns clinical task 45 minutes
Student takes the history and performs examination of patient with possible CNS infection
1 hour
Case presentation 45 min
Learning Objectives: Students should be able to:
Take a relevant history and perform relevant clinical examination.
Describe different causes of CNS infection in children.
Knows the investigation required to conform clinical diagnosis
Knows the treatment of common CNS infection.
Describe the complication of Meningitis / Encephalitis and Cerebral Malaria.
Take the history and performs CNS examination e.g able to check for neck stiffness,
GCS, cranial nerves, signs of meningeal irritation, motor system.
Knows the pre-referral treatment.
Treat the patient with Meningitis / Encephalitis and Cerebral Malaria in health facility.
Wall chart demonstration
MATERIAL REQUIRED
IMNCI Wall chart
IMNCI Chart booklet
IMNCI Case recording form
CNS Examination kit.
Measuring tape, Hammer, Torch.
Disposable tongue depressor
Thermometer
Kit for lumber puncture procedure.
Lesson Plan
Day-5: Approach to child with cough or Difficult Breathing (OPD)
Time: 2 hours and 30 minutes
Facilitator Introduces the topic and assigns practical /Clinical task 30 minutes
Student takes the history and performs examination of a patient with cough or difficulty in
breathing. 1 hour
Case Presentation 1 hour
Learning Objectives:
Student should be able to
Assess and classify a child with cough and difficult breathing.
Take a relevant history, fills the recording form and perform respiratory examination.
Identify general dangers signs, is able to count respiratory rate and lower chest indrawning
and to recognize wheeze and stridor.
Classify the child with cough and difficult breathing.
Describe how to investigate child with cough and difficult breathing.
Treat the child in primary health facility and referral center.
Clinical skills learnt:
Communication skills to take a relevant history of a child with cough and difficult breathing,
counting of respiratory rate in one minute and to define fast breathing.
Differentiates normal breathing from chest indrawing
Differentiates between wheeze and stridor.
Performs Respiratory system examination.
Use nebulizer or inhaler to treat the wheeze
Demonstrate the assessment of a child with cough or difficult breathing, Stridor and fast
breathing
Supervise closely first time students count childs breathing, look for chest indrawing and
listen for stridor
Show how to use information in child history on recording form
Assign the patient, observe and assist as needed while students assess and classify
Facilitator Procedure:
MATERIAL REQUIRED
IMNCI Wall chart
IMNCI Chart booklet
IMNCI Case recording form
Stethoscope.
Measuring tape.
Tongue depressor.
Nebulizer /inhalers
Lesson Plan
Day-6: Approach to child with chronic cough, asthma &
tuberculosis. Approach to child with Wheeze (OPD)
Facilitator Introduces the topic and assigns practical /Clinical task 45 minutes
Students takes history and perform physical examination form child with chronic
cough/recurrent wheeze, or clinically suspected pulmonary TB 1 hour
Group Discussion on history and positive examination findings in subgroups with co-facilitators.
45 minutes
Learning Objectives: Student should be able to
Takes a relevant history, fills the recording form and perform relevant clinical
examination on the child with chronic cough or recurrent wheeze.
Knows about the different causes of wheezing in children.
Knows how to investigate child with chronic cough/recurrent wheeze or suspected
case of tuberculosis.
Is able to treat the child wheeze in primary health care facility.
Knows about the use Nebulizer machine, Peek flow meter, and inhalers.
Knows the questions and clinical signs to be looked for in asthma according to PPA
asthma guidelines and TB according to Keninth Jhon,s criteria and national TB
guidelines.
Facilitator/Instructor Procedure for Clinical work
Communication skills to take a relevant history of a child with wheeze, can identify
wheeze, knows about different causes of wheeze, Is able to differentiate
between wheeze and stridor.
Performs respiratory system examination.
Facilitator/Instructor Procedure for Practical work
Demonstrate use of Nebulizer, use of peek flow meter and use of
inhaler
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Ventolin solution
Nebulizer
Inhaler
Peek flow meter
Lesson Plan
Day-7: Assess and classify child with Diarrhea and Shock (Indoor)
Facilitator Introduces diarrhea, severe dehydration and shock 30 minutes
Student Performs clinical examination of a patient with diarrhea and assess severe dehydration
and shock.. 1 hour
Group Discussion 45 min
Video 15 min
Student should be able to assess and classify child with diarrhea and shock
Takes a relevant history, fills the recording form and perform relevant clinical examination
shock.
Able to identify general danger sign.
Describe etiology and complication of diarrhea including shock.
Knows how to investigate child with diarrhea
To manage the child in community and health facility by treatment plan C
Communication skills to take a relevant history of a child with diarrhea and shock, able to
assess lethargic or unconsciousness, restlessness, or irritable, sunken eyes
capillary refill time and severity of shock.
Observe child for not able to drink or drink poorly, drink eagerly or Thirsty
To identify skin pinch whether goes very slowly or slowly.
Observe a child receiving Intravenous fluid in severe dehydration
Demonstrate the assessment of a child with diarrhea
Demonstrate how to prepare ORS,
MATERIAL REQUIRED
Wall chart IMNCI
Chart booklet
Case recording form
Pen, Pencil, Eraser, cuter, Board and marker
ORS, water, cup and spoon
Inj. Ringer lactate, N/saline, dopamine, I.V cannula, Drip set, N/G Tube
Oxygen stethoscope, B.P apparatus.
Lesson Plan
Day-8: Case presentation on Diarrhea by students (OPD)
Facilitator Introduces the diarrhea management using plan A & B 30 minutes
Student
Group Discussion on demonstration of feeding schedule for persistent diarrhea and counseling
1 hour
Student will fill the case recording form of diarrhea and discus with co-facilitator
1 hour
Student should be able to assess and classify child with diarrhea
Takes a relevant history, fills the recording form and perform relevant clinical
examination.
Recognize the clinical sign of no dehydration or some dehydration.
Feeding management of child with persistent diarrhea.
To treat child in community and health facility
Communication skills to take a relevant history of a child with diarrhea
Counseling learnt about feeding a child with persistent diarrhea.
Demonstrate technique of doing skin pinch
Treat child with no dehydration (Plan A) and some dehydration with (Plan B) in health
facility.
Demonstrate the assessment of a child with diarrhea
Assign patients to students
Demonstrate how to prepare ORS and calculate amount of ORS in diarrhea at
different age groups and weight.
MATERIAL REQUIRED
Wall chart IMNCI
Chart booklet
Case recording form
Pen, Pencil, Eraser, cuter, Board and marker
ORS, water, cup and spoon.
Lesson Plan
Day-9: Assess and classify fever (OPD)
Facilitator: Introduces to assess child with fever 30 minutes
Student
Take history of a child with fever 1 hour 30 minutes
Group Discussion 30 minutes
Takes a relevant history, fills the recording form and perform relevant clinical examination
of child with fever.
Is able to differentiate between malaria, measles, meningitis, typhoid fever, urinary tract
infection, and septicemia and ear infection.
Knows how to investigate child with fever.
Is able to treat the child in community and at health facility.
Basic communication skills to take a relevant history of a child with fever, take temperature,
check stiff neck, runny nose, signs of measles and its complication i-e Pus
draining from eye, clouding of cornea and mouth ulcers. Give Vitamin A capsule.
Teach the mother to treat local eye infection and oral ulcer at home.
Assign patients to students, observe and assessed as needed while students assess and
classify.
If a child with stiff neck demonstrate sign to all students
Choose children with fever and if possible with general danger signs
Demonstrate how to decide malaria risk
Demonstrate the assessment of a child with fever
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Thermometer
Syp Paracetamol
Tab. Nivaquin
Tab. Artisunate
Cap. Vit-A
B.P apparatus (Sphygmomanometer)
Gentian violet
Sterilize gauze piece
LESSON PLAN VIDEO EXERCISE U (Indoor)
Day 10: Approach to child 2 months up to 5 years.
Facilitator Introduces the topic and assigns practical / clinical task
30 minutes
Student
Performs outdoor / Fill the case recording forms / practical task under supervision in
sub group. 1 hour
Group Discussion / Case Presentation / Video 1 hour
Learning Objectives:-
Asking the mother about the childs problems.
Checking for general danger signs.
Asking the mother about.
Cough or difficult breathing
Diarrhea
Sore throat
Ear problem
Fever
Check for malnutrition.
Check for anemia.
Asses breast feeding.
Filling the case recording form properly.
Circle the general danger signs properly.
Tick ( ) either Yes or No.
Material Required:-
LCD / TV
DVD / USB
Case recording form
Pencil, Pen, Eraser, Cutter.
Summary /Clinical skills learned:-
Now you have learn to:
Ask questions from mother.
Identify the general danger signs.
Asking the mother about cough or difficult breathing, diarrhea, Fever,
Sore throat, ear problem.
Check for malnutrition.
Check for anemia.
Asses breast feeding.
LESSON PLAN FINAL YEAR MBBS SMALL GROUP TEACHING
Day 11 : Assess and classify Ear/Throat Problem (OPD)
Time: - 2 hours and 30 minutes.
Facilitator introduce ear problem and throat problem 30 Minutes.
Student:
1 Students take history of a child with ear or throat problem 1 hour.
2 Group discussion/ case presentation 1 hour
Learning Objectives: Student should be able
Takes a relevant history, fills the recording form and Perform relevant clinical examination.
Classify illness according to IMNCI guidelines
Knows that majority of ARI are viral, but is able to diagnose streptococcal sore throat,
throat abscess, AOM and COM.
Treat the child in OPD and at health facility with Ear/Throat problem.
Rational use of antibiotic.
Clinical Skills Learnt.
Communication skills to take a relevant history of child with Ear/Throat problem, to see and
palpate tender swelling behind the Ear, pus draining from the Ear or any
discharge from Ear.
Detect the severity of Throat problems like sore Throat or not able to drink, tender
enlarged lymph nodes on neck, red enlarged tonsils or white exudates on
Throat and classify accordingly,
Explain the mother to make wick and method of wicking the child Ear for
drying.
Give pre referral treatment write referral note
Assign patients to students, observe and assess as needed while students assess and classify.
If a child with tender enlarged lymph nodes in neck or red enlarged tonsils or white exudate
on throat demonstrate signs to all students.
Choose children with Sore throat / Ear problem
Demonstrate how to assess a sick child with sore throat who has sings suggesting throat
abscess, streptococcal sore throat.
Material Required.
Wall chart,
Chart booklet, Case recording Forms,
Thermometer, Cotton piece for wicking,
Syrup Paracetamol, Benzathine Penicillin or Amoxicillin,
Tongue Depressor, Torch.
Lesson Plan
Day 12 : Day of assessment
Written EXERCISES (Indoor)
Facilitator Introduces the topic and assigns practical /clinical task 30 minutes
Student
Fill the case recording forms 1 hour
Group Discussion 1 hour
To assess the students ability to assess and classify the illness according to IMNC in 2 months to
5 years.
. Material Required:-
LCD / TV
DVD / USB
Case recording form
Summary /Practical skills learned:-
Assessment and classification of illness according to IMNCI.
EXERCISE A
Case 1: Salina
Salina is 15 months old. She weighs 8.5kg. Her temperature is 38.5C.
The health worker asked, What are the childs problems? The mother said, Salina has
been coughing for 4 days, and she is not eating well. This is Salinas initial visit for this problem.
The health worker checked Salina for general danger signs. He asked, Is Salina able to
drink or breastfeed? The mother said, No Salina does not want to breastfeed. The health worker gave
Salina some water. She was too weak to lift her head. She was not able to drink.
Next he asked the mother, Is she vomiting? The mother said, No. Then he asked. Has
she had convulsions? The mother said, No
The health worker looked to see if Salina was lethargic or unconscious. When the health
worker and the mother were talking, Salina watched them and looked around the room. She was not
lethargic or unconscious. She is not convulsing now.
Now fill the case recording form and classify the illness and identify the treatment .
EXERCISE B.
Case 1: Gul
Gul is 6 months old. He weighs 5.5kg. His temperature is 38C. His mother said he has
cough for 2 days. The health worker checked for general danger signs. The mother said that Gul is able to
breastfeed. He has not vomited during this illness. He has not convulsions and is not convulsing now. Gul
is not lethargic or unconscious.
The health worker said to the mother, I want to check Guls cough. You said he has
cough for 2 days now. I am going to count his breaths. He will need to remain calm while. I do this.
The health worker counted 58 breaths per minute. He did not see chest indrawing. He did
not hear stridor. He did not hear wheeze.
Now fill the case recording form and assess and classify the sick child
EXERCISE E
Case 1: Paro
Paro has diarrhea for five days. He has no blood in the stool. He is irritable his eyes are
sunken. His father and mother also think that paros eyes are sunken. The health worker offers Paro some
water, and the child drinks eagerly. When the health worker pinches the skin on the childs abdomen. It
goes back slowly.
EXERCISE F
Case 4: Heera
Heera is 3 years old. She weighs 10kg. He temperature is 37C. Her mother came today because
Heera has a cough and diarrhea.
She does not have any general danger signs. The health worker assessed her for cough or
difficult breathing. She has cough for 3 days. He counted 36 breaths per minute. She does not have chest
indrawing or stridor or wheeze.
When the health worker asked how long Heera has diarrhea, the mother said, For more than 2
weeks. There is no blood in the stool. Heera is irritable during the visit, but her eyes are not sunken. She
is able to drink, but she is not thirsty. A skin pinch goes back immediately.
EXERCISE H
Case 1: Ghori
Ghori has fever off and on for two days and has complained of a sore throat. He has no
general danger signs, no difficult breathing and he has not been coughing. He did not have diarrheoa. His
mother brought him to you today because he is refusing to eat, although he is still able to drink clear
soup. Ghori is four year old, he weights 16kg.
You feel Ghors neck and find that his glands are swollen and tender. He has red
enlarged tonsils. He has white exudates on his throat. His temperature is 39.7C.
EXERCISE I
Case 1: Hira
Hira is 3 years old. She weighs 13kg. He temperature is 37.5C. Her mother came to the
clinic today because Hera has felt hot for the last 2 days. She was crying last night and complained that
her ear is hurting.
The health worker checked and found no general danger signs.
Hira does not have cough or difficult breathing. Se does not have diarrhea. Her malaria
risk is high. Her fever was classified as Malaria.
Next the health worker asked about Hiras ear problem. The mother said she is sure Hira
has ear pain. The child cried most of the night because her ear hurt. There has been discharge coming
from Hiras ear on and off for about a year, said the mother. The health worker did not see any pus
draining from the childs ear. He felt behind the childs ears and felt tender swelling behind one ear.
EXERCISE M
Case 3: Atika
Atika is 5 months old. She weighs 5kg.Her temperature is 36.5C. Her family brought her to the clinic
because she feels hot and has had cough for 2 days.
She is able to drink. She has not vomited or had convulsions, and is not lethargic or unconscious.
The health worker said, I am going to check her cough now. The health worker counted 43 breaths per
minute. There was no chest indrawing and no stridor or wheeze when Atika was calm.
Atika did not have diarrhea,Sore throat or ear infection.
Now, I will check her fever, said the health worker. Atika lives in an area where many cases of malaria
occur all year long (high malaria endemicity). Her mother said. Atika has felt hot off and on for 2 days.
She has not had measles within the last 3 months. She does not have stiff neck or runny nose.
Atika has a generalized rash. Her eyes are red. She has mouth ulcers. They are not deep and extensive.
She does not have pus draining from the eye. She does not have clouding of the cornea.
Now fill the case recording form and assess and classify the sick child.
Lesson Plan
Day-13: Practical Approach to malnourished child (OPD)
Facilitator introduces the topic and assigns practical /clinical task. 30 min
Student
Practical demonstration anthropometry (MUAC and Z-Score) and growth chart in NSC
/OTP / OPD 1 hour
Students practice and measure anthropometry (MUAC & Z- Score), uses growth chart
and fills recording forms. 1 hour
Student should be able to:
Assess and classify a child with mal-nutrition.
Take a relevant history, fill the case recording form and perform relevant clinical
examination.
measure anthropometric measures like MUAC, length or height and weight, and able to
classify standard deviation score (Z-score) and determine weight according to weight for age
chart of IMNCI protocol
Students should be able to differentiate between severe acute malnutrition and moderate
acute malnutrition.
Knows how to investigate child with SAM and MAM.
Able to treat the child in community and at health facility
Communication skills to take a relevant history of a child with malnutrition, measure
anthropometry (MUAC or Z-score) and weight for age according to IMNCI
protocol.
Able to differentiate between SAM and MAM according to MUAC and Z-score
Demonstrate how to check for malnutrition
Demonstrate the technique of assessing edema of both feet
Demonstrate how to use weight for age chart
Conduct practice for students who do not know how to Zero the scale to get an accurate
reading.
MATERIAL REQUIRED
IMNCI charts and Chart booklets
Z-score charts
MUAC tape
Growth charts
Examination kit for malnutrition.
Weight machine, length measuring infant-meter
Lesson Plan
Day-14: Approach to child with malnutrition and Introduction to
CMAM (Indoor)
Lead Facilitator introduces the topic and assigns practical /clinical task. 30 min
Student
Demonstration of signs of Malnutrition and Vitamin deficiencies 30 min
Lecture and practical demonstration on patient and wall chart 40 min
Video and photographs 30 min
Reassemble in class with lead facilitator and case presentation 20 min
Student should be able to assess and classify a child with mal-nutrition.
Takes a relevant history, fill the recording form and perform relevant clinical examination.
Student should be able to demonstrate visible severe wasting or edema of both feet,
determine weight for age, height/ length and able to measure mid upper arm circumference
(MUAC)
How to use standard deviation reference card
How to approach and investigate the child with malnutrition and to treat the child in the
community at OTP and health facility by using critical care pathway form.
Communication skills to take a relevant history of a child with malnutrition, Examination
of child like able to decide for visible severe wasting
Bilateral pedal edema
Determine weight for age
Able to measure the height / length
Able to use the standard deviation (SD) reference card
Knows the use of critical care pathway form
Demonstrate how to check for malnutrition
Demonstrate the technique of assessing edema of both feet
Demonstrate how to use weight for age chart
Conduct practice for students who do not know how to Zero the scale to get an accurate
reading.
MATERIAL REQUIRED
IMNCI charts and Chart booklets
Case recording form
Examination kit-2
TV. DVD Player for video demonstration
Photographs
Z-score chart
Weighing Scale
Stadio meter, RUTF
Lesson Plan
Day-15: Approach to child with anemia (Indoor / Outdoor)
Facilitator introduces the topic and assigns practical /clinical task 30 minutes
Student- Take history & perform clinical examination of child with anemia
1 hour
Case Presentation Group Discussion 1 hour
Take a relevant history, fills case the recording form and perform relevant clinical
examination.
Differentiate between different causes of anemia in children i.e Iron deficiency, Vitamin
B12 and folate deficiency, Thalasemia, Hemolytic anemia and aplastic anemia.
Describe how to investigate child with anemia, knows the appropriate investigations required
to confirm the cause of anemia
Treat the child in community and at health facility.
Knows the indication of blood transfusion in anemic patient.
Write blood transfusion note.
Communication skills to take a relevant history of a child with anemia, checking for
palmar pallor, & differentiate between some palmar pallor and severe palmar
pallor.
Check signs of heart failure due to severe anemia such as gallop rhythm, edema, liver
enlargement and fine basal crackles on auscultation
Treat the child with anemia in community & at health facility.
Demonstrate how to check for anemia
Demonstrate how to differentiate between some and severe palmer pallor
Interpret blood complete picture report.
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Different blood complete picture reports
Blood transfusion set
Syp. Iron
Inj. Furesomide
Lesson Plan
Day-16: EPI and Non EPI Vaccines. Method of notifying to EDO
Health for Communicable diseases/ AFP (OPD)
Facilitator introduces the topic 30 minutes
Facilitator give demonstration of Vaccine Vials, Vaccine Syringes, Polio surveillance, Checking
Immunization status 30 minutes
Student
Performs outdoor practical task under supervision in sub group& fill the case
recording form of a child for immunization status & need of 1 hour
Vaccination on that day & thereafter.
know about EPI and non EPI vaccines
Take a relevant history, fills the recording form
Knows about indications and contra-indications of different vaccines
EPI Schedule of Immunization
Checking the status of immunization
Know about Polio surveillance
Describe the method of notifying to EDO health for communicable diseases/ AFP
Importance of vaccination card
Basic communication skills to take a relevant history, identify vaccine vials and give
vaccines, checking Immunization status
Demonstrate how to assess Immunization status of a child
Method of notifying to EDO Health for communicable diseases/AFP
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Vaccine vials
Syringes
Vaccination cards
EDO information form
Lesson Plan
Final year Small group Teaching
Day 17: Photograph Exercise D, J, K, L, O, P (Indoor)
Facilitator Introduces the example of photograph related to IMNCI photo guideline
30 minutes
Student
Student should be able to identify clinical signs from the photographs/ practical task
under supervision in sub group. 1 hour
Group Discussion 1 hour
To assess the students ability to identify different clinical signs taught in IMNCI
Summary / Practical work:-
Knows & identify different clinical signs to properly classify the illness according to
IMNCI : like
Signs of dehydration
Identify the skin rashes
Identify Sign of malnutrition
Identify pus discharge from eyes and other signs of Vitamin A deficiency
Identify edema on both feet
Identify palmer pallor
Material Required:-
Case recording form/Plan paper
Photograph book
Lesson Plan
Day 18 Topic: Neonatal History and Examination (Indoor)
Time : 2 hours & 30 minutes
Facilitator introduced the topic and assign practical /clinical task. 30 min
Student takes history & perform indoor clinical task/ practical task under
Supervision in subgroups. 1 hour
Case presentation / Group discussion, 1 hour
Take a relevant history and knows components of antenatal, natal and postnatal history
and how to elaborate each component.
Knows how to fill the case recording form of 0-2 months
Do a head to toe examination includes vitals, anthropometric measures; identify anemia,
cyanosis, edema, dehydration.
Pick up congenital anomalies
Counsel parents regarding problem of neonate and follow up visits.
Basic communication skills to take neonatal history.
Identify general danger sign
Inquire about each main-symptom individually
Identify General look, take vitals i-e Respiration, Pulse rate, Temperature,
anthropometric measurement, assess anemia, Jaundice, cyanosis, edema,
dehydration & congenital malformations.
Demonstrate young infant with as many signs of very severe disease as available; severe
chest indrawing, grunting, fast breathing, convulsion, not feeding well, fever or low body
temerature
Demonstrate assessment of a young infant for very severe disease
Assign patients to students, observe and assess as needed while students assess and classify
MATERIAL REQUIRED
Wall chart
Chart booklet
Case recording form
Pencil
Eraser
Thermometer
Measuring Tape
Weighing scale
Lesson Plan
Final year MBBS Group Teaching
Day-19: WHO, Essential Newborn Care (Indoor)
Facilitator Introduces the topic assign practical /clinical task 30 minutes
Student:
Performs indoor/clinical/ practical task under supervision in sub group. 1 hour
Topic from ENCC to be covered in this session
1. Introduction to PCPNC guide
2. Immediate care at the time of Birth
3. Routine newborn care includes keeping the baby warm
Student should be able to
Use PCPNC guide session related to ENCC
Perform the routine newborn care
Give immediate care to newborn at the time of delivery
Counsel the mother for the routine newborn care in the neonatal ward or
postnatal ward.
Give immediate care to newborn at the time of delivery
Use the PCPNC guide sessions and following the commands of cross reference.
MATERIAL REQUIRED
PCPNC Guideline
Neonatal examination forms of ENCC.
Nursery/Labour Room
Hand washing facility
D/Gloves
Gown
Mask
Cap
Mother/Dummy
Lesson Plan
Final year MBBS Small group Teaching
Day 20: Approach to a neonate with birth asphyxia (Indoor)
Facilitator introduces the topic and assigns practical
and clinical tasks. 30 minutes
Students:
Take history and perform examination of neonate with birth asphyxia
1 hour
case presentation and demonstration on neonatal resuscitation
1 hour
Learning objectives: Students should be able to
Define and recognize birth asphyxia.
Takes history, fill recording form and
perform neonatal examination.
Relate and interpret Apgar score.
Knows the importance of initiation of breathing at the time of birth.
Knows the importance of resuscitation by delivering personnel.
Knows and able to count respiratory rate, counts heart rate.
Recognizes cyanosis, pallorness and differentiate b/w lethargy, unconsciousness and
normal movements and decreased movements.
Knows and able to interpret staging of HIE.
Is able to recognize and identify various effects of asphyxia on body systems i.e. CNS,
renal, GIT, CVS.
Resuscitate when needed.
Knows to investigate various effects of birth asphyxia.
Able to give supportive care and treat neonates with birth asphyxia and its complications.
Basic communication skills to take history and perform examination.
Count respiratory rate in one minute
Recognize cyanosis, pallorness.
Asses a newborn with lethargy and unconsciousness.
Differentiate normal movements from those of convulsions and decreased
movements.
Check tone in a new born.
Knows about complications of asphyxia on individual system of body and their
management
Interpret Apgar score.
Knows about HIE staging.
Knows Bag and Mask and method of using them during resuscitation.
Material Required:
Resuscitation Trolley, Dummy, AMBU Bag and Masks of different size
Lesson plan
Day 21: Practical approach to small baby (Indoor)
Students:
Students take history and perform examination of preterm or low birth
Weight baby 1 hour
Case presentation and Group discussion 1 hour.
Recognize small babies (LBW) and classify them as IUGR and preterm.
Takes relevant history, fill recording form and perform relevant examination.
Knows, interpret and apply Ballard scoring system to asses gestational age.
Knows to plot small babies on percentile charts and classify them as SGA, AGA, LBW,
and VLBW.
Recognize risks for small babies like IRDS, hypothermia, sepsis, feeding difficulties.
Knows to investigate small babies for their problems.
Knows and give supportive care and treat small babies for possible problems in
community and health facility.
Basic communication skills to take relevant history
Perform examination and apply ballard scoring for assessment of gestational age
Differentiates b/w premature and IUGR small babies.
Knows how to take care of small babies in community
Interpret t percentile charts and plot small babies on them.
Knows about the relevant equipments for small babies like incubators and
warmers.
Lesson plan
Day 22: Check for Possible Infection in Young Infant (OPD)
Students:
Take history fills recording form and performs relevant examination of a Young
Infant with susceptible neonatal sepsis 1 hour
Case presentation and Group discussion /video 1 hour
Learning objectives: Students should be able to:
Asses and classify the young infant for possible infections.
Takes history, fill recording form and perform examination of young infant
Recognize lethargy/ unconsciousness and bulging fontanel and knows to take
temperature.
Knows and able to count respiratory rate, recognizes severe chest in drawings, nasal
flaring and grunting.
Identify umbilical redness and pus draining and identify skin pustules.
Knows to investigate young infant for possible infection.
Treat young infant for possible infection in community and health facility.
Knows the importance of universal precautions and clean cutting of umbilical cord
Communication skills to take history and perform examination.
Take one minute respiratory rate and repeat if fast breathing.
Differentiates b/w mild chest in drawings from severe one, lethargy,
unconsciousness.
Accurate method to look for bulging fontanel and differentiate normal
movements from those of convulsions and decreased movements.
Demonstrate young infant with as many signs of very severe disease as available;
severe chest indrawing, grunting, fast breathing, convulsion, not feeding well, fever
or low body temperature
Demonstrate assessment of a young infant for very severe disease
Material Required:
IMNCI Chart booklet
Recording form
Photograph/ Video
Multimedia
Lesson plan
Day 23: Approach to young infant with jaundice (Indoor)
Students:
Take history and perform examination of baby with jaundice and fill recording
forms under supervision in sub groups. I hour
Case presentation and Group discussion: 1 hour
Asses and classify the young infant for jaundice according to IMNCI guideline
Knows the importance of blood groups of mother, and baby.
Differentiate clinically between physiological & pathological jaundice.
Knows to investigate the child for jaundice.
Knows the indications of phototherapy and exchange transfusion.
Knows the method of exchange transfusion
Communication skills to takes relevant history and perform relevant examination.
Recognizes and classify severity of jaundice on clinical examination.
Observes phototherapy unit.
Demonstrate assessment of a young infant for Jaundice
Recognizes three way cannula set.
Observe exchange transfusion procedure
Material Required
Examination Kit
Recording form
Exchange transfusion Kit (Three way cannula, N/G tube or catheter, surgical blade. Gloves,
dressing material)
LESSON PLAN
Final Year MBBS Small group Teaching
Day 24: Check the young Infant for feeding problem, Assessment
of Breast Feeding (OPD)
Facilitator introduces the topic & assigns practical/ clinical task 30min
STUDENT: take history and examination of young infant with feeding problems and
assessment of breast feeding under supervision in subgroup 1hr
Group discussion/ / video 1hr
LEARNING OBJECTIVES: Students should be able to:
Assess young infant for feeding problem & able to assess how infant breast feeds.
Take a relevant history, fill recording form & perform relevant clinical examination.
Explain advantages of exclusive breast feeding, and knows how breast feeding works
Explain 4 key points of good attachment & position recognize signs of good & poor
attachment & positioning.
Demonstrate & teach correct position & attachment & different positions of mother to
hold the baby.
Communication skills to take relevant history about feeding problem and asses breast
feeding.
Demonstrate a normal young infant feeding well, emphasizing the signs of attachment and
suckling
Supervise students closely to be sure they assess breastfeeding and counsel the mother
correctly
Skill to demonstrate the mother correct positioning and attachment
Counseling skills to tell mother the importance of breast feeding
Demonstrate how to counsel mother about correct positioning and attachment according to
steps on young infant chart
Material Required
Multimedia, video on breast feeding recording forms
Lesson plan
Day 25: Check for feeding problem or low weight. And methods of
Breast Feeding Replacement (Cup feeding) (Indoor)
Facilitator introduces the topic and assigns practical/clinical task.
30 minutes
Students:
Take history and perform relevant examination of baby with feeding problems or
low weight under supervision in sub groups. 1 hour
Group discussion / Video 1 hour
Assess child for feeding problems or low weight.
Weigh the child, and determine weight for age on growth chart
Advise on replacement or supplement feeding
List conditions in which cup feeding needed and its importance in small babies
List the advantages of cup feeding, estimate volume of milk to give to a baby according
to weight
Demonstrate how to cup feed safely, demonstrate how to prepare a cup hygienically for
feeding, explain the requirements for clean & safe feeding.
Know the disadvantages of bottle feeding and how to express mother milk
Communication skills to take relevant history and perform relevant examination.
Weigh the child
Demonstrate a normal young infant feeding well, emphasizing the signs of
attachment and suckling
Supervise students closely to be sure they assess breastfeeding and counsell the
mother correctly
Hand washing
Determine weight for age on a growth chart
Calculation of amount of milk to give to babies, hand washing, method of cup
feeding.
Demonstrate how to counsel mother about correct positioning and attachment according to
steps on young infant chart
Materials required:
IMNCI wall chart, Weight machine & weight for age chart, cup, spoon and Model of breast
Lesson plan
FINAL YEAR MBBS SMALL GROUP TEACHING
Day 26:
Identify treatment for all classification. And Identify pre- referral
treatment and treatment for those where referral Is not possible
(OPD)
Facilitator introduces the topic and assigns practical/clinical task.
30 minutes
Students:
Chart wall demonstration on identification and pre-referral treatment by hnay7co-
facilitator in sub groups. 1 hour
Practical work by filling recording form 1 hour
Identify treatment for all the classifications from the chart booklet.
Identify & record the treatment according to classification
List the drugs for relevant classification.
Select appropriate form of drug i.e. tablet or syp.and its doses
Identify pre referral treatment
Give per rectal diazepam in a convulsing child.
Give I/M antibiotic
Pass I/V line.
Write referral note
Treat the child to prevent low blood sugar
Treat the child in community & health facility where referral is not possible
Identify & give drugs used in IMNCI.
Identify and differentiate emergency and home treatment
Treatment of local infection
Writing prescription.
Write referral note
Materials required:
IMNCI WALL CHART, Drug Tray and Recording form
LESSON PLAN
DAY 27
Communication &counseling skills need for when to return immediately,
counsel the mother about her own health. And follow up care of sick
child and young infant (OPD)
TIME 2 hours and 30 minutes
Lead Facilitator introduces the topic and assign practical/clinical task.
30 minutes
STUDENTS
Wall chart demonstration and practical task under supervision in subgroup
1 hour
Group discussion and role play 1 hour
LEARNING OBJECTIVES: Students should be able to
Identify those who need follow up care in OPD / IPD
Assess any new problems on follow up
Classify the problems according to chart booklet.
Assess the previous problem and classify it according to follow up modules and treat them
as per need.
Assess the response of drugs
Select the appropriate drug for that classification
Counsel the mother to give oral drug and to treat local infection at home
Counsel the mother when to return immediately by using mother card
Skill to identify those patients who need follow up care
Communication skills to ask about new problems
Counseling skills to tell mothers when to return immediately
Classify the problems according to chart booklet.
Assess the previous problem and classify it according to follow up modules and treat them
as per need.
Know the list of drugs for relevant classification
Know how to check mother understanding
Counsel the mother about her own health
MATERIAL REQUIRED:
IMNCI Chart Booklet, Drug Tray & Mother Card
LESSON PLAN
DAY 28
APPROACH TO CHILD WITH MICRONUTRIENT
DEFICIENCY (Indoor)
TIME 2 hours and 30 minutes
Lead Facilitator introduces the topic and assign practical/clinical task.
30 minutes
STUDENTS
Take history of child with micronutrient deficiency and perform general physical
and relevant examination 1 hour
Case presentation and group discussion/ 1 hour
LEARNING OBJECTIVES: students should able to
Know the definition and importance of micronutrients
Know the name , daily requirement of common micronutrient
Take relevant history and general physical examination and investigate the micronutrient
deficiency
Identify the signs of vitamin A and D deficiency (Rickets)
Prevention and treatment of micronutrient deficiency
CLINICAL SKILL LEARNT
Communication skills to take relevant history
Identify the signs of micronutrient deficiency (Vitamin A and D)
Prevent and treat the micronutrient deficiency.
MATERIAL REQUIRED
WHO guidelines
Patient or Photograph booklet to assess the signs of micronutrient deficiency.
LESSON PLAN
Final Year MBBS Small group Teaching.
DAY -29 Approach to a child with rashes, Purpura and bleeding
disorder (Indoor)
TIME: 2 Hour 30 minutes
Facilitator introduces the topic and assist practical and clinical task in 30 minutes
STUDENT: take history of patient with bleeding disorders and perform general physical and
relevant examination 1 hour
Case presentation and group discussion 1 hour.
LEARNING OBJECTIVE Student should be able
To take relevant history of bleeding disorders.
To identify and differentiate rashes of bleeding diathesis like petechiae, bruises and
purpuras
To do general physical examination including distribution and extent of rashes
To investigate and interpret different Laboratory investigation including Bleeding time,
PT, APTT, and Blood CP
To take relevant history of bleeding disorders.
To do general physical examination including distribution and extent of rashes
Examination skills to differentiate different type of rashes
Interpretation of data regarding bleeding diathesis
Material Required:
Photographs of different common rashes.
Different lab reports for interpretation.
Examination kit
Lesson plan
Final year MBBS Small group teaching.
DAY-30 Approach to a child with Oedema and Ascites (OPD)
TIME 2 Hour 30 min
Facilitator introduces the topic and assist clinical / practical task.
30 min.
STUDENT. Takes history of a child with edema or ascots and performs general physical and
clinical examination. Individually and under supervision in sub group 1hour
Group discussion case presentation (Nephrotic syndrome) 1 hour
Learning Objective:
Student should able to take relevant history, including age at presentation, mode of
onset, specific system and organ involved.
Is able to perform GPE and relevant systemic examination and clinical signs like fluid
thrill and shifting dullness.
Should know the common renal, hepatic, nutritional and cardiac causes of oedema and
ascites.
Student should investigate and interpret ate different type of lab investigation including
urine/ DR, ascetic/ DR, blood CP, Ultrasound abdomen, total protein AG ratio,24 hour
urinary protein.
Is able to know the management of nephritic syndrome.
Student communicates properly and take history and be able to differentiate new case
from relapse.
Able to do GPE, abdominal examination; especially relevant systemic
examination like fluid thrill and shifting dullness.
Should be able to assess & classify different grades of edema and as cites.
Is able to counsel parents about course of disease and long term management of
nephrotic syndrome.
Student should investigate and interpret ate different type of lab investigation including
urine/ DR, ascetic/ DR, blood CP, Ultrasound abdomen, total protein AG ratio,24 hour
urinary protein.
Should know the common renal, hepatic, nutritional and cardiac causes of oedema and
ascites.
Reads and interprets the laboratory data
Material Required:
Photograph of oedema and ascites
Laboratory reports
Examination kit
LESSON PLAN
DAY 31: Approach to child with Jaundice (OPD)
Facilitator introduces topic and assigns clinical tasks. 30 minutes
Student:
Assess a child with jaundice under supervision in sub group and individually.
1 hour
Group Discussion / Case Presentation. 1 hour
Students should be able to:
- Take relevant history of a child with jaundice.
- Do general physical & relevant systemic examination like examination of
sclera, liver, GIT & CNS.
- Know the associated clinical features of jaundice Like anemia, hematemesis,
behavioral changes etc.
- Know the causes of jaundice, like viral hepatitis A,B & C, Drug induced &
autoimmune hepatitis or hemolytic anemia.
- Know how to investigate the child for jaundice & interpret LFT (prothrombin
time, S. albumin level), bilirubin levels, viral profile, serology, CBC, retic
count.
- Know the management of acute viral hepatitis, hepatic encephalopathy &
chronic hepatitis.
- Know the importance of relevant history & examination.
- Take relevant history of a child with jaundice.
- Do general physical & relevant systemic examination like examination of
sclera, liver, GIT & CNS.
- Know the associated clinical features of jaundice Like anemia, hematemesis,
behavioral changes etc.
- Know the mode of spread/route of infection of different hepatitis.
- Know the ways to prevent hepatitis
- Know how to investigate the child for jaundice & interpret LFT (prothrombin
time, S. albumin level), bilirubin levels, viral profile, serology, CBC, retic
count.
LESSON PLAN
Final Year MBBS Small group Teaching
Day 32: Pediatric Radiology (Indoor)
Time: 2hours
Venue: Ward Class room
Know the importance of view, exposure ,translucency, density, normal organs and
mediastinum on x-ray chest
Is able to recognize abnormal chest x ray findings of common problems like: Pneumonic
consolidation, Tuberculosis, Effusion, collapse, Pneumothorax, Cardiomegaly and
abnormal shape of Heart
To make a differential diagnosis on radiological findings
SKILLS
To hold the x-ray in proper position
Correlate the abnormalities with clinical findings
To operate the illuminators
MATERIAL REQUIRED
X-ray films & illuminator
LESSON PLAN
Day 33: Approach to child with cerebral palsy (OPD /
Physiotherapy Department)
Facilitator introduces topic & assigns clinical tasks 30 min
Student:
Perform clinical tasks under supervision in sub-group 1hr
Group discussion/ case presentation 1hr
Students should be able to know the definition, incidence and prevalence of cerebral
palsy.
Students should be able to identify the causes of cerebral palsy.
Students are able to understand the importance of preventable causes of cerebral palsy
like birth asphyxia and know the importance of timely and correct resuscitation of
newborn.
Should be able to understand the importance of fetal hypoxia and immediate perinatal
problems at the time of birth
They should be able to know the different types of cerebral palsy.
They should be able to identify acute & chronic problems related to C.P & their
management.
Ability to take a proper relevant antenatal, peri natal and immediate post partum details
of history.
Ability to examine CNS and development of a child with cerebral palsy.
Ability to differentiate between various grades and severity of mental retardation and
physical handicap of a child with cerebral palsy
Counseling with parents to discuss acute, recurrent and long-term problems like
spasticity, seizures, aspiration pneumonia and their management.
Ability to understand the importance of multidisciplinary approach and parental
understanding of the concept of long term management.
Lesson plan
Final Year MBBS Small group Teaching.
Day 34: Approach to child with congenital heart disease (Indoor)
Time : 2 hours and 30 minutes
Facilitator introduces the topic and assign practical /clinical task
30 minutes
Students take history of patient with congenital heart disease and perform related and
Cardiovascular system examination 1 hour
Case presentation and group discussion 1 hour
Learning Objective : Student should be able
To perform the examination of a child with congenital heart disease, like, counting heart rate,
take B.P, character of pulse, recognize cyanosis, sign of heart failure, in older children JVP,
recognize 1st and 2nd heart sound, and recognize murmur.
To differentiate cardiac & respiratory distress.
To investigate child with congenital heart disease.
To know the supportive management of congenital heart disease
To know the management of CCF
To take history of a child with congenital heart disease
Cardiovascular system Examination
Examination of pericardium of infant/ child with cong: heart disease.
To differentiate cyanotic and a cyanotic heart diseases, and identify general danger signs
To investigate child with congenital heart disease.
Material Required
Recording forms, Examination Kit
LESSON PLAN
Dysmorphic Features (Down Syndrome)
Final Year MBBS Small Group Teaching
Day 35: Approach to a child with Dysmorphic feature/Down
Syndrome (Indoor / Outdoor)
Clinical demonstration on: Patients / Photograph.
Facilitator Introduces topic & assigns practical / clinical task 30 minute.
Student take history and perform examination of child with dysmorphic features
1 hour
Group discussion / case presentation / photographs 1 hour.
LEARNING OBJECTIVES: Student should be able to
Define that what the Dysmorphic feature are.
Take relevant history, and relevant general and systemic physical examination.
Know about terms and glossary about Dysmorphic feature.
Know about clinical features of Down syndrome.
Student should be able to counsel about chronic problem related the Down syndrome.
Student should be able to counsel about genetic problem.
Student should know that what the investigations to perform for Down syndrome are.
Communication and counseling skills to take relevant history to do physical examination
and genetic counseling.
Recognize features of Down syndrome on a patient.
Knows common stigmas of odd facies suspect and understand the importance of early
recognition of newborn features of common problems presenting with dysmorphism like
Down syndrome and cretininism.
Communication skills to counseling about problems with Down syndrome.
Counseling for families to understand the risk in next pregnancy and prevent birth of next
baby with similar problems
Lesson Plan
Final year MBBS small group teaching.
Day 36 Approach to diabetic child (Indoor)
Time: 2 hours & 30 minutes.
Facilitator: Introduce the topic & assign practical work. 30 minutes.
Student:
Perform outdoor / indoor clinical/ practical task under supervision in subgroup 1 hour.
Clinical demonstration on patient
Case presentation and Group discussion 1 hour.
Student should know the incidence and prevalence of Diabetes Mellitus in children and
understand its different etiology, pathophysiology and management
Student should be able to define Diabetes and know the common presentation of a child
with diabetes mellitus and diabetic keto acidosis.
Student should know danger signs, electrolyte imbalance, complications of diabetes and
diabetic ketoacidosis.
Student should know what is the management of diabetic ketoacidosis.
Fluid (maintenance + deficit)
Insulin infusion
Potassium replacement
Bicarbonate
Student should know the long term management of diabetes mellitus.
To take relevant history, identify signs of diabetes and diabetic ketoacidosis and observe
the vitals, conscious level, dehydration cerebral edema and other complications.
Recognizes types of fluids to be given and how to correct dehydration
How to correct electrolyte imbalance.
How to monitor the child with diabetic Ketoacidosis, level of consciousness, vitals,
dehydration, and urine output.
Recognizes types of insulin used, insulin syringes and how to give insulin.
Demonstrate the amount and type of fluids given in diabetic Ketoacidosis
Material Required
Examination kit, Recording Forms, Insulin Syringe & I/V drips
GROUP CHECKLIST OF CLINICAL SIGNS
Sick Child Age 2 Months Up To 5 Years
Not able to drink or
breastfeed
Vomits everything History of convulsions
(with this illness)
Lethargic or
Unconscious
Convulsions (in the Clinic) Fast breathing Chest indrawing Wheezing
Stridor in calm child Restless and Irritable Sunken eyes Drinking poorly
Drinking eagerly, thirsty Very slow skin pinch Slow skin pinch Stiff neck
Runny nose Enlarge tender,
lymph nodes in neck
Red enlarged Tonsills White exudate on
Throat
Generalize rashes of
measles
Red eyes Mouth Ulcers Deep and Extensive
Mouth ulcers
Pus draining from eyes Clouding of Cornea Pus draining from ear Tender swelling behind
the ear
Visible severe wasting Severe Palmer pallor Some Palmer Pallor Edema of both feet
GROUP CHECKLIST OF CLINICAL SIGNS
Age 0 to 2 Months
Mild chest indrawing in
young infant (normal)
Fast breathing in
young infant
Severe chest indrawing
in young infant
Nasal flaring
Grunting Bulging fontenelle Umblical redness
extending to the skin
Red umblicus or
draining Pus
Many or severe skin
pustules
skin pustules Lethargic or
unconscious
Less than normal
movement
No attachment at all Not well attached
to breast
Good attachment Not sucking at all
Not sucking effectively Sucking effectively Thrush
CLINICAL SESSION & PRACTICAL PROCEDURES
ACTIVITIES TEACHER SIGNATURE
Presentation of seminar on IMNCI topic
Role play
Practical skills / practical session on IMNCI
Video / Photograph
Given I/M Injection / Observe
Positioning and attachment of baby for
breastfeeding
Plotting on growth chart and use of Z-score chart
Technique of measuring MUAC
Prepare ORS and use of different treatment plans
Prepare First dose of antibiotic
Perform skin pinch
Dry ear by wicking
Treat local infection
Measure the temperature
Fill in EPI card in under 5 OPD / Well baby clinic
Use of nebulizer
Counsel the mother for nutrition IYCF / OTP
Use of mother card
FORMATIVE EVALUATION FORM FOR FINAL YEAR STUDENTS
SUMMATIVE EVALUATION FORM FOR FINAL YEAR STUDENTS
Theory
(MCQs)
100
Practical / OSPE (A+B) 100
(A) Internal Evaluation
20%
(B) OSPE
80%
Attendance
Marks in
MCQ
Marks in
OSPE
Marks in
Clinical
Evaluation
General / Recording
Form
5% 20% 50% 15% 10%
(B) OSPE will include 15 to 20
stations:
50% clinical stations
50% static stations
Weight age of OSPE
Stations:
IMNCI 30%
Neonatology 20%
Other topics 50%
OSPE station will include:
1. Case Scenario
2. X-ray and Instruments
3. Counselling
4. Communication Skills
5. Procedures
LEAD FACILITATORS GROUP SUMMARY
Group :
Dates:
Unit:
Number of Students in Group:
Number of facilitators:
Names of Lead Facilitators:
Total Working days:
Total Teaching hours:
Hours of IMNCI teaching:
Indoor Hours :
Outdoor Hours:
Theory sessions number and hours:
Practical Sessions number and hours:
Clinical Sessions number and hours:
Maximum number of patients assessed by students
Average number of patients assessed by students
Seminars
Projects:
Maximum number of classifications seen:
Average number of classifications seen:
Maximum number of signs seen by students:
Average number of signs seen by students:
Did each student have?
Recording forms: 2M- 5Years Young infant
Chart Booklets:
History forms and Journal
Maximum attendance :
Average attendance of group:
Total Marks In group assessment:
Written
Clinical Skills Observed
IMNCI Marks:
Written
Clinical Skills Observed
Average Marks MCQ
Maximum Marks
MCQ
OSPE
Average grades of group:
Comments and observations of lead facilitator:
Material Required for Final Year M.B.B.S Class Teaching Purpose
1. IMNCI Facilitators Guide for all modules
2. IMNCI Facilitators Inpatient Guide
3. IMNCI Facilitators Outpatient Guide
4. IMNCI Chart 2 months to 5 years (Wall chart)
5. IMNCI Chart 0 - 2 months (Wall chart)
6. IMNCI Chart Booklets and Photograph Books
7. IMNCI case record forms 2 months to 5 years and 0 - 2 months
8. PCPNC guide and neonatal examination forms of ENCC
9. Multimedia, Video, CDs, USB, Computer, Soft copy of IMNCI Photographs, Video
on Breastfeeding, Artificial Breast.
10. Blood CP reports, Urine DR reports, CSF reports, LFT reports and Serum Electrolyte
reports etc for data interpretation assessment.
11. Examination Kit-1: Equipments for General Physical Examination including
Thermometer, Torch, Tongue depressor, Measuring Tap, B.P apparatus, Stethoscope
and stop watch
12. Examination Kit-2 comprising of Equipment for CNS Examination measuring Tape,
Hammer, Fundoscope, Disposable tongue depressor, Torch, B.P Apparatus, Tuning
fork, Thermometer, color Tags, different swabs for sense of smell.
13. Examination Kit-3 Nebulizer, Peak flow meter, Inhaler, Stethoscope, Ventoline
Solution, N/saline Ampoules and stop watch
14. Examination kit-4 for plan A& B of rehydration: ORS Packets, Measuring
containers, Spoon, and Cups, water 1 liter for preparing ORS
15. Examination Kit-5: Z-Score chart, Growth chart, MUAC Tap, Torch, Thermometer,
Glucometer, Sugar water, and plummpy nuts for appetite test.
16. Examination Kit-6: Dummy, Resuscitation Trolley, Ambu Bag for neonatal
resuscitation
17. Examination Kit-7 for plan C of rehydration: Ringer Lactate Intravenous solution,
I.V Cannula, Drip set, N.G tube, liquid paraffin (Lubricant) and Sticking Plaster
18. Vaccine Vial, Syringes, Vaccination Card, EDO Information forms, Recording forms,
Mother Card.
19. National Malaria Guideline
20. Tuberculosis National Guideline
21. National Guideline for CMAM.
22. X-Ray and Illuminator
23. Drug Tray : IMNCI oral medicines consisting of Syp. Paracetamol, Ventoline,
Amoxil, Nivaquine, Metronidazole, Zinc Sulphate, Ciproflaxaciline, Cephradine,
Albendazole, Mebendazole, Multivitamine, Iron.
Tab. Paracetomol, Chloroquine, Ciproflaxaciline, Metronidazole
Cap. Vit-A
Poly fax eye ointment
Chloramphenicol eye ointment
Gentian violet
N/Saline Ampoul
24. Drug Tray for IMNCI pre-referral treatment
Inj Diazepam
Inj. Ampiciline
Inj. Gentamycin
Inj. Quinine
Inj. Chloramphenicol
Inj. Benzathin pencilline
Syringes
N/G Tube
D/Saline
References:
WHO/PAK/00-2, A
1. Integrated Management of childhood illness
INTRODUCTION AUGUST 2010
WHO/PAK/00-2, B
ASSESS AND CLASIFY THE SICK CHILD 2 MONTHS UPTO 5 YEARS - AUGUST
2010
WHO/PAK/00-2, C
IDENTIFY TREATMENT AUGUST 2010
WHO/PAK/00-2, D
TREAT THE CHILD - AUGUST 2010
WHO/PAK/00-2, E
COUNSEL THE MOTHER - AUGUST 2010
WHO/PAK/00-2, F
MANAGEMENT OF SICK YOUNG INFANT AGE LESS THAN 2 MONTHS -
AUGUST 2010
WHO/PAK/00-2, G
FOLLOW-UP - AUGUST 2010
8. NATIONAL GUIDELINE 2010
Community based management of acute malnutrition (CMAM)
SEPTEMBER 2010.
WHO/NHD/02/-4(P)-1
9. Training Course For The Management Of Severe Malnutrition
WHO/PAKISTAN/2010
10. Pregnancy, child birth, postpartum and newborn care (A guide for essential practice )
11. Malaria case management (Training manual)
Directorate of Malaria Control Ministry of Health Pakistan
12. WHO Pocket Hand book of Hospital Care for Children
13. National Tuberculosis Guidelines (Revised addition 2007)
14. WHO (DEWS) Case Definition, Management, Prevention of Infectious Diseases (November
2007)NIH/Ministry of Health
15. National IYCF Guidelines
ALL REFERENCE BOOKS ARE AVAILABLE IN PRE-SERVICE LIBRARY
FOR READING BUT WILL NOT BE ISSUED.
PHOTOGRAPHS AND VIDEOS ARE ALSO AVAILABLE

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