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2019 MOCA-Peds Featured Readings and Learning Objectives

Featured Readings

Each year, select peer-reviewed journal articles or guidelines are featured. These readings were selected by a group of practicing pediatricians  serving on a subboard or question writing committee as being important for every pediatrician certified in the given discipline to read. Questions on these readings will be featured within the MOCA-Peds platform. Those engaged in MOCA-Peds will have access to these articles, at no additional charge, during the year they are featured. Up to two questions for each featured reading will appear within MOCA-Peds, however, other questions may list the featured readings as references.

For General Pediatrics

Cheung AH, Zuckerbrot RA, Jensen PS, et al.  Guidelines for adolescent depression in primary care (GLAD-PC): Part ll. Treatment and ongoing management. Pediatrics. 2018;141(3):e20174082.

Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3):e20171904.

Greenhawt M, Turner PJ, Kelso JM. Administration of influenza vaccines to egg allergic recipients: A practice parameter update 2017. Ann Allergy Asthma Immunol. 2018;120(1):49-52.

For Child Abuse Pediatrics

Adams JA, Farst KJ, Kellogg ND. Interpretation of medical findings in suspected child sexual abuse: an update for 2018. J Pediatr Adolesc Gynecol. 2017;(17): S1083-3188.

Access 1/1/19-12/31/19 (Elsevier): This article will be open to all as of 1/1/2019
Mulder TM, Kuiper KC, van der Put CE, et al. Risk factors for child neglect: a meta-analytic review. Child Abuse & Neglect 2018;77: 198-210.

Paine CW, Fakeye O, Christian CW, Wood JN. Prevalence of Abuse Among Young Children With Rib Fractures: A Systematic Review. Pediatr Emerg Care. 2019 Feb;35(2):96-103.


For Pediatric Gastroenterology

Fawaz R, Baumann U, Ekong U, et al. Guideline for the evaluation of cholestatic jaundice in infants: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2017;154-168.

Rosen R, Vandenplas Y, Singendonk M, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 66:3; 516-554

Turck D, Braegger CP, Colombo C, et al. ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016;557-577.

Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children: Recommendations from the expert committee on NAFLD (ECON) and the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). J Pediatr Gastroenterol Nutr. 2017;319-334.

For Pediatric Infectious Diseases

Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control and Prevention clinical practice guidelines: diagnosis of tuberculosis in adults and children. Clin Infect Dis. 2017; 64:111-115.

McCrindle BW, Rowley AH, Newburger JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation. 2017;135:e927-e999.

Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65:1963-1973.

Tunkel AR, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s clinical practice guidelines for healthcare-associated ventriculitis and meningitis. Clin Infect Dis. 2017;64:e34-e65.


Learning Objectives for 2019

MOCA-Peds questions will be based on 45 learning objectives drawn from the content outline that reflects the breadth of knowledge required for practice. These learning objectives will also be available in each participants’ personal MOCA-Peds account at the beginning of the year.

For General Pediatrics

  1. Diagnose and manage a neonate with an abnormal head size or shape.
  2. Diagnose and manage neonatal abstinence syndrome.
  3. Evaluate a child with hemoptysis.
  4. Evaluate a hypotonic infant.
  5. Evaluate a patient with leukocoria.
  6. Evaluate an adolescent with a testicular mass.
  7. Evaluate and manage a child at risk for type 2 diabetes.
  8. Evaluate and manage a child with gross hematuria.
  9. Evaluate and manage a prepubertal girl with vaginal discharge.
  10. Evaluate and manage back pain in children.
  11. Evaluate and manage neonatal jaundice.
  12. Evaluate suicide risk in an adolescent.
  13. Evaluate the developmental status of infants from 9 to 12 months of age.
  14. Identify factors related to school absenteeism or avoidance.
  15. Interpret tuberculosis screening test results and manage appropriately.
  16. Know the differential diagnosis of lower extremity weakness.
  17. Know the recommended immunization schedule for adolescents.
  18. Manage a child with exposure to a communicable disease.
  19. Manage a patient with poor school performance.
  20. Manage a patient with supraventricular tachycardia.
  21. Manage an adolescent girl with menorrhagia.
  22. Manage local and regional reactions to insect bites or stings.
  23. Manage urticaria.
  24. Plan appropriate antibiotic therapy for a child with lower respiratory tract infection.
  25. Plan appropriate ventilatory support for a child.
  26. Provide advice regarding an infectious disease outbreak in the child care setting.
  27. Provide anticipatory guidance for a child with asplenia.
  28. Provide appropriate health supervision for a child with trisomy 21.
  29. Provide guidance regarding car seats and restraints.
  30. Recognize and apply ethical principles involved in using new technologies in medicine.
  31. Recognize and manage pelvic inflammatory disease.
  32. Recognize and plan evaluation of a child with joint hypermobility.
  33. Recognize causes of gastrointestinal bleeding.
  34. Recognize clinical manifestations of hemolytic-uremic syndrome.
  35. Recognize findings that would suggest an immunodeficiency.
  36. Recognize the barriers in detecting and reporting safety concerns.
  37. Recognize the clinical features of neuroblastoma.
  38. Recognize the clinical manifestations of abusive head trauma in an infant.
  39. Recognize the clinical presentation of leukemia.
  40. Recognize the clinical presentation of lysosomal storage disorder.
  41. Recognize the risk factors for familial hyperlipidemia.
  42. Recognize the risks associated with cannibis use.
  43. Understand etiology and differential diagnosis of elbow pain in the child or adolescent athlete.
  44. Understand the evaluation for developmental dysplasia of the hip.
  45. Understand the extrapulmonary manifestations of cystic fibrosis.

For Child Abuse Pediatrics

  1. Develop an assessment plan for an infant with bruising.
  2. Diagnose cranial nerve injuries based on ocular findings.
  3. Differentiate between normative sexual behaviors and sexual behavior problems in children.
  4. Differentiate between partial and full-thickness burns.
  5. Differentiate bruises from congenital skin conditions.
  6. Distinguish statistical significance from clinical importance.
  7. Evaluate a child with recurrent hypoglycemia in the context of suspected child abuse in the medical setting.
  8. Evaluate and manage a post-pubertal child with a positive urine NAAT.
  9. Evaluate and manage an adolescent with a vaginal discharge.
  10. Evaluate and manage an infant with multiple rib fractures.
  11. Identify contact mechanisms of head injuries.
  12. Identify factors to be considered during clinical evaluation of a case of possible supervisory neglect.
  13. Identify key historical components necessary when evaluating a child with failure to thrive.
  14. Identify metabolic diseases that may be mistaken for abusive head trauma.
  15. Identify risk factors for commercial sexual exploitation of children.
  16. Identify sexual maturation stages for girls.
  17. Identify the pre-test probability of child abuse based on site of fracture.
  18. Interpret a follow-up skeletal survey in the context of suspected child abuse.
  19. Interpret location of bruising in the context of a child’s age/developmental status to distinguish between accidental and abusive etiologies.
  20. Interpret the significance of posterior pharyngeal injury in infants and children.
  21. Know common causes of genital bleeding in a pre-pubertal child.
  22. Know the indications for HIV PEP after child sexual assault.
  23. Know the necessary elements to diagnose a death as SIDS.
  24. Know the newborn risk factors for sudden infant death syndrome.
  25. Know the role and scope of involvement of a child abuse pediatrician within the multidisciplinary team.
  26. Know the role of a guardian ad litem for a child in custody.
  27. Plan collection for forensic evidence from non-genital areas of injury.
  28. Plan the evaluation for hepatic injury.
  29. Recognize adult health consequences of adverse childhood experiences.
  30. Recognize and plan the evaluation of a child with suspected rickets.
  31. Recognize child behaviors that trigger abusive head trauma.
  32. Recognize congenital hymen variations.
  33. Recognize factors necessary for the diagnosis of medical neglect.
  34. Recognize patient barriers to IPV disclosure.
  35. Recognize physician barriers to reporting child maltreatment.
  36. Recognize potential harms to a child living in an environment where drugs are manufactured.
  37. Recognize provider barriers to identifying abusive head trauma.
  38. Recognize that domestic violence is a form of psychological maltreatment.
  39. Recognize the need for consent in specific cases of suspected child sexual assault.
  40. Recognize the pectinate line as a normal finding.
  41. Recognize the various clinical presentations of herpes simplex virus in children.
  42. Understand data sources regarding child maltreatment epidemiology.
  43. Understand how prenatal drug exposure can affect short- and long-term development in children.
  44. Understand the impact of neglect on child development.
  45. Understand the need for differences in the legal definitions of burden of proof.

For Pediatric Gastroenterology

  1. Calculate and interpret sensitivity and specificity.
  2. Differentiate disorders of defecation based on anorectal manometry findings.
  3. Differentiate the pathogenesis, histology, and clinical manifestations of congenital disorders of bilirubin metabolism.
  4. Identify disorders causing dysmotility of the upper gastrointestinal tract.
  5. Identify the clinical signs and symptoms associated with vitamin, trace metal, and micronutrient deficiency.
  6. Interpret the laboratory findings associated with protein-losing enteropathy.
  7. Know how to interpret esophageal pH and impedance studies.
  8. Know how to manage complications associated with parenteral nutrition.
  9. Know the clinical manifestations of pseudomembranous enterocolitis.
  10. Know the clinical presentation, evaluation, and management of congenital anomalies of the esophagus, stomach, and duodenum.
  11. Know the clinical symptoms of parasitic infections in immunodeficiency syndromes.
  12. Know the disorders of the esophagus associated with systemic diseases.
  13. Know the extraintestinal manifestations of inflammatory bowel disease.
  14. Know the mechanism of action and common complications of the drugs most frequently used to treat patients who have undergone liver transplantation.
  15. Know the pathogenesis of gastroesophageal reflux.
  16. Know the pathophysiology and treatment of caustic and medication-related injury of the upper gastrointestinal tract.
  17. Know the short- and long-term complications of necrotizing enterocolitis.
  18. Plan evaluation and management of rectal bleeding.
  19. Plan the management of an infant born to a mother who tests positive for hepatitis B surface antigen (HBsAg).
  20. Plan the management of both symptomatic and asymptomatic gallstones in children, and be able to recognize gallstones on imaging studies.
  21. Plan the nutritional management for a child with malabsorption.
  22. Recognize and manage congenital anomalies of the pancreas.
  23. Recognize endoscopic abnormalities of the gastrointestinal tract.
  24. Recognize systemic disorders that can cause gastroduodenitis.
  25. Recognize the clinical presentation of corrosive gastritis.
  26. Recognize the complications of diagnostic and therapeutic endoscopy.
  27. Recognize the gastrointestinal complications of eating disorders.
  28. Recognize the gastrointestinal manifestations of immunodeficiency disorders.
  29. Recognize the gastrointestinal manifestations of systemic disorders.
  30. Recognize the psychological characteristics of children with functional gastrointestinal disorders.
  31. Understand the absorption of vitamins.
  32. Understand the clinical manifestations and management of hepatitis.
  33. Understand the diagnosis and treatment of eosinophilic esophagitis.
  34. Understand the histologic and laboratory findings associated with liver failure.
  35. Understand the informed-consent process for gastrointestinal procedures.
  36. Understand the management of short-bowel syndrome.
  37. Understand the mechanism of blood supply to the liver and the extrahepatic biliary tree.
  38. Understand the mechanism of immediate and late intestinal adaptation in short-bowel syndrome.
  39. Understand the mechanisms of intestinal fluid and electrolyte transport.
  40. Understand the nutritional requirements of term and preterm infants, children, and adolescents.
  41. Understand the pathogenesis and treatment of parasitic liver disease.
  42. Understand the pathophysiology of chronic diarrhea.
  43. Understand the physiology of gastrointestinal motility, including roles of the enteric and central nervous system.
  44. Understand the risk factors for Helicobacter pylori infection.
  45. Understand the technique and interpretation of breath testing in gastrointestinal disease.

For Pediatric Infectious Diseases

  1. Diagnose and plan the management of a patient with acute osteomyelitis.
  2. Diagnose and plan the management of a patient with intrathoracic infection due to Histoplasma capsulatum.
  3. Identify the pathogens likely to be associated with lung abscess secondary to foreign body aspiration.
  4. Interpret laboratory susceptibility test results in the context of different sites of infection.
  5. Interpret mean and standard deviation in normally distributed data sets.
  6. Know examples of bacterial resistance mediated by enzymatic inactivation of the antibiotic.
  7. Know the appropriate indications for initiating antiviral therapy in an immunocompetent host.
  8. Know the infections for which bactericidal antimicrobial therapy is required.
  9. Know the most common pathogens causing bacteremia in children undergoing hemodialysis.
  10. Know the pathogens associated with colitis in immunocompromised children.
  11. Know the pathogens that cause invasive disease in children with chronic granulomatous disease.
  12. Know the recommended approach to prevention of measles infection in exposed children.
  13. Know the recommended approach to prevention of varicella infection in exposed children.
  14. Know the sensitivity and specificity of methods other than culture used in the diagnosis of fungal infection.
  15. Know the viral infections that can be severe or chronic in children with antibody deficiency.
  16. Plan the management of a patient with invasive Staphylococcus aureus infection.
  17. Plan the management of household contacts of a patient who has pulmonary tuberculosis.
  18. Plan the management of infections caused by pathogens that have developed resistance during therapy.
  19. Recognize anatomic factors that predispose to recurrent bacterial meningitis.
  20. Recognize and plan therapy for a patient with Streptobacillus moniliformis infection.
  21. Recognize clinical manifestations of infections caused by Clostridium species and plan appropriate management.
  22. Recognize indications for administration of Td booster and TIG after injury.
  23. Recognize primary and secondary vaccine failure.
  24. Recognize risk factors associated with Salmonella gastroenteritis.
  25. Recognize risk factors for and epidemiologic features of Yersinia enterocolitica infection.
  26. Recognize situations in which combinations of antibiotics are necessary to prevent emergence of resistance.
  27. Recognize situations in which combinations of antibiotics are necessary to provide synergistic bacterial killing.
  28. Recognize situations in which serologic testing is a preferred laboratory method.
  29. Recognize the clinical features of different infectious causes of malignant otitis externa.
  30. Recognize the clinical features of different infectious causes of polyarthritis.
  31. Recognize the clinical features of different infectious causes of vesiculoulcerative genital lesions.
  32. Recognize the clinical manifestations of Aspergillus infections in immunocompromised hosts.
  33. Recognize the fetal infection risks associated with travel for women of child-bearing age.
  34. Recognize the host defense defects associated with an increased risk of pneumococcal sepsis.
  35. Recognize the important viral pathogens causing infection in children undergoing stem cell transplantation.
  36. Recognize the infections most likely transmitted from adult to child or child to adult in a child care center.
  37. Recognize the respiratory and non-respiratory tract manifestations of infection with Mycoplasma pneumoniae.
  38. Recognize the risk factors for and clinical presentation of different infectious causes of bacterial endocarditis.
  39. Recognize the risk factors for and clinical presentation of different infectious causes of keratitis.
  40. Understand effects of immunizations of siblings on infections in immunocompromised patients.
  41. Understand relative advantages and disadvantages of different formulations of amphotericin B.
  42. Understand the clinical features of enterovirus infections in neonates and plan appropriate diagnostic testing.
  43. Understand the different routes of transmission of zoonotic pathogens.
  44. Understand the epidemiology and clinical features of hookworm infections.
  45. Understand the epidemiology and treatment of infections caused by Eikenella corrodens.