Learning Objectives for 2021
Most questions will be based on 45 learning objectives drawn from the content outline that reflects the breadth of knowledge required for practice.
After you answer each question, we ask you how confident you are in your answer and how relevant the question was to you. Taking the time to answer these questions will help improve your MOCA-Peds experience. Your answers determine which questions you will see again as repeats and, over time, will help the ABP select questions more relevant to you. You can review your ratings and see how you did at any time on the My Performance page. You will want to pay special attention to questions you answered confidently but missed; there's a good chance you’ll see a repeat version of them in another quarter.
- Characterize alcohol use in an adolescent.
- Counsel parents regarding circumcision.
- Counsel the caregiver of an abused child on the long-term psychological consequences of maltreatment.
- Differentiate between normal and abnormal variations in head growth and manage appropriately.
- Evaluate a child with hyperpigmentation.
- Evaluate a patient with nephrolithiasis.
- Evaluate a patient with tics.
- Evaluate an internationally adopted child for infectious diseases and appropriate immunizations.
- Evaluate and manage a child with an inguinal mass.
- Evaluate and manage a child with unexplained persistent fever.
- Evaluate and manage a patient with papilledema.
- Evaluate and manage a patient with the new onset of thrombocytopenia.
- Evaluate and manage drug eruptions.
- Evaluate and manage ear trauma.
- Evaluate and manage the adolescent with syncope.
- Identify and manage blood grouping incompatibilities as a cause of hyperbilirubinemia.
- Identify contraindications for sports participation.
- Know the indications and appropriate testing for parasitic disorders.
- Know the indications for prescribing an epinephrine auto-injector.
- Manage acute illness in a patient receiving long-term corticosteroid therapy.
- Manage foreign body ingestion.
- Prevent and manage the complications and risks associated with late pre-term birth.
- Provide anticipatory guidance about sleep hygiene and sleep habits.
- Provide guidance regarding family stressors (eg, birth of a sibling, death, divorce, job loss, relocation).
- Recognize and apply ethical principles involved in end-of-life care.
- Recognize and evaluate a child with chorea.
- Recognize and manage breast disorders in adolescents.
- Recognize and manage delayed hypersensitivity reaction.
- Recognize and manage paradoxical vocal cord dysfunction.
- Recognize and plan initial evaluation of a child with a pituitary disorder.
- Recognize and plan the initial management of cardiogenic shock.
- Recognize common causes of joint pain in children and adolescents.
- Recognize features of stroke in children.
- Recognize genetic causes of congenital heart disease.
- Recognize the child with spinal cord compression from a mass.
- Recognize the clinical features of acute abdomen.
- Recognize the clinical features of dermatomyositis.
- Recognize the effect of parental chronic illness or disability on child health.
- Recognize the features of bipolar disorder.
- Recognize the genetic syndromes that may present with abnormal growth.
- Recognize the risk factors for nutritional insufficiency (eg, food insecurity, restricted diets, etc.).
- Respond appropriately to a child’s disclosure of sexual abuse.
- Screen an adolescent for sexually transmitted diseases and manage appropriately.
- Understand the concept of evidence-based practice.
- Understand the differential diagnosis of an adolescent with difficulty breathing during exercise.
Child Abuse Pediatrics
- Characterize the role of inertial mechanisms in head injuries.
- Describe characteristics of fatalities due to child maltreatment.
- Develop a management plan for a suspected case of medical child abuse.
- Differentiate abusive burns from other conditions.
- Differentiate child-inflicted from adult-inflicted bites.
- Distinguish between SIDS and child maltreatment fatality.
- Distinguish between the clinical presentations of thermal, chemical, radiant, and electrical burns.
- Distinguish birth trauma from abusive head trauma.
- Evaluate caregiver explanations for a child’s cranial injuries.
- Formulate a toxicological evaluation for a newborn infant with neonatal abstinence syndrome.
- Identify evidence models for child abuse prevention.
- Identify long-term mental health complications in a child who has been sexually abused.
- Identify potential harms to children from legalization of marijuana.
- Identify risk factors for child maltreatment.
- Identify tissue layers covering the brain.
- Interpret history and physical examination in a child with anal findings to differentiate traumatic from nontraumatic etiologies.
- Interpret mechanism of injury based on rib fracture location and morphology.
- Interpret patterned cutaneous injury.
- Interpret photo documentation of healed anal injuries.
- Interpret the significance of frenulum injuries in infants and children.
- Know the advantages and disadvantages of various examination techniques for post-pubertal girls.
- Know the common signs and symptoms of children who present with different fracture types.
- Know the differential diagnosis of retinal hemorrhages in children.
- Know the parental risk factors for IPV.
- Manage a conflict of interest in a child abuse evaluation.
- Plan an evaluation for a post-pubertal girl with dysuria.
- Plan the evaluation of pancreatic injury.
- Recognize and evaluate drug-facilitated sexual assault.
- Recognize and manage accidental anogenital trauma.
- Recognize bone diseases that predispose to infant fractures.
- Recognize child manifestations of emotional neglect.
- Recognize clinical indications for sexually transmitted infection testing in prepubertal children.
- Recognize congenital variants of male genital anatomy.
- Recognize features of infectious disease that can be confused with abusive head trauma.
- Recognize findings diagnostic of sexual abuse.
- Recognize normal genital anatomy in post-pubertal children.
- Recognize parent-child interaction therapy (PCIT) as an evidence-based treatment for a child victim of psychological maltreatment.
- Recognize the barriers in detecting and reporting safety concerns.
- Recognize the limitations of interpreting the ages of bruises and burns.
- Recommend optimal parent child interventions to caregivers of children affected by toxic stress.
- Understand differential outcomes for children in kinship versus nonkinship foster care.
- Understand the contributions of social determinants of health on physical neglect.
- Understand the difference between association and causation in child abuse research.
- Understand the differences in the legal definitions of burden of proof.
- Understand the role of cultural practices in diagnosing neglect.
- Apply the principles of transition to adulthood planning for youth with ID.
- Counsel families on the risk of recurrence of ASD.
- Counsel regarding normal variation in childhood fears and anxiety.
- Describe the appropriate management for learning disability.
- Describe the natural history of tics and tic disorders.
- Differentiate between acute grief and clinical depression.
- Distinguish statistical significance from clinical importance.
- Evaluate a child with an oral motor feeding problem.
- Evaluate a child with sleep disturbance.
- Evaluate a patient with enuresis.
- Identify risks for suicidal ideation in a teenager.
- Implement appropriate laboratory evaluations for global developmental delay.
- Know the benefits of early intervention on children's development.
- Know the developmental and behavioral characteristics of individuals with myelodysplasia.
- Know the differential diagnosis of language disorders.
- Know the effects of chronic health conditions on child development.
- Know the factors associated with functional outcomes in children with ASD.
- Know the indications and side effects of alpha-agonists.
- Know the management of gender dysphoria
- Know the medical evaluation of a child with ID.
- Know the motor milestones of child development.
- Know the range of treatments for conduct disorder.
- Know the risk factors of obstructive sleep apnea.
- Manage a child who has experienced psychological maltreatment.
- Plan the evaluation of a child with staring spells.
- Plan the management of a child with ADHD and comorbid tics.
- Plan the management of a child with ODD.
- Plan the management of a child with somatic symptoms not fully explained by a medical condition.
- Plan the management of a patient with OCD.
- Provide counseling regarding childhood stuttering.
- Recognize the association between media exposure and adolescent behavior.
- Recognize the cognitive phenotypes of children with Down syndrome.
- Recognize the role of temperament in clinical practice.
- Recognize the side effects of stimulant medication in the treatment of ADHD.
- Understand how timing of nutritional deficiencies can affect development.
- Understand informed consent.
- Understand the association between coercive parenting and externalizing behaviors.
- Understand the consequences of adolescent cannabis use.
- Understand the impact of vision impairment on development.
- Understand the natural history of ADHD.
- Understand the parameters of confidentiality of pediatric patients to physicians.
- Understand the physical findings and the evaluation of a child with hypotonia.
- Understand the processes involved in cortical plasticity.
- Understand the role of DNA methylation in gene-environment interactions.
- Understand the role of joint attention in the evaluation of children with ASD.
- Apply knowledge of the physiologic and metabolic effects of hypothermia to the rationale for and development of infant transport guidelines.
- Compare the epidemiology and prevention strategies of perinatal hepatitis B and C infections.
- Compare the risks for neurodevelopmental impairment between term, late preterm, moderately preterm, and extremely preterm infants (those with and without identified neonatal risk factors).
- Demonstrate an understanding of inheritance patterns and recurrence risks for autosomal recessive disorders.
- Describe changes in the neurologic exam with increasing gestational and postnatal age, and changes that occur after neurologic insults.
- Describe the differences between mother's milk and donor breast milk.
- Describe the rationale for and potential benefits of delayed cord clamping.
- Determine the effects of specific drugs on renal function.
- Develop a management plan for bradyarrhythmias in the newborn infant.
- Develop an evaluation and management plan for a neonate with a condition affecting myocardial performance.
- Develop effective strategies to prevent central line-associated bloodstream infections in the neonatal intensive care unit, and know the rationale for doing so.
- Differentiate maternal drugs associated with neonatal abstinence syndrome by their clinical presentation (including timing).
- Discuss controversies in the evaluation and management of gastroesophageal reflux in neonates.
- Evaluate and manage a preterm infant with a new onset of apnea episodes.
- Evaluate and treat newborn infants with congenital malformations that present in the delivery room (eg, hydrops, congenital diaphragmatic hernia, gastroschisis, meningomyelocele).
- Evaluate and treat the complications of intubation.
- Evaluate the etiology of fetal non-immune hydrops.
- Evaluate the presentation and diagnostic approach to neonatal platelet disorders, both inherited and acquired.
- Evaluate the presentation, differential diagnosis, and diagnostic approach to neonatal respiratory distress.
- Identify and distinguish the clinical characteristics of physiologic versus non-physiologic (pathologic) jaundice.
- Interpret clinical and lab data to determine hydration status.
- Know how to interpret umbilical cord blood gas and pH values.
- Know the clinical manifestations, associated anomalies, and management of gastroschisis.
- Know the definitions of perinatal, neonatal, postneonatal, and infant mortality.
- Know the differential diagnosis for coagulation disorders, both inherited and acquired.
- Know the general mechanisms by which various drugs are metabolized and eliminated in the neonate, and the clinical implications of how this changes with liver or kidney disease.
- Know the maternal and perinatal risk factors for sepsis.
- Know the pathophysiology, risk factors, management, and outcomes of retinopathy of prematurity.
- Know the risk factors for development, proposed mechanisms, diagnosis, and consequences of intra- and extracranial hemorrhage.
- Recognize and manage systemic hypertension.
- Recognize complications of neonatal infections that are unique to the thorax and its contents.
- Recognize complications of parenteral nutrition.
- Recognize the causes and clinical features of large-for-gestational-age (LGA) infants.
- Recognize the clinical and pathologic features of bilirubin encephalopathy and kernicterus.
- Recognize the clinical characteristics, management and outcomes of congenital diaphragmatic hernias.
- Recognize the clinical features and diagnostic characteristics of craniofacial anomalies.
- Recognize the clinical features of a neonate with an arterial vascular abnormality.
- Recognize the clinical features of and formulate a differential diagnosis for a neonate with a suspected immune deficiency.
- Relate essential elements of prenatal care to specific pregnancy outcomes.
- Synthesize the mortality, short-term neonatal morbidity, and long-term outcomes of periviable infants for parent counseling.
- Understand human skin development and the differences in skin between preterm and term newborns; know how this impacts care.
- Understand p values (with and without multiple comparisons) and type I and type II errors.
- Understand the development of thermoregulation and its impact on the management of neonates.
- Understand the risk factors for the development of pulmonary hypoplasia.
- Understand the significance of DNA methylation and epigenetics.
Pediatric Critical Care Medicine
- Describe the clinical findings associated with impending respiratory failure in status asthmaticus.
- Describe the principles of mass casualty and disaster preparedness for the pediatric ICU.
- Determine the changes required in mechanical ventilator settings for worsening hypoxemia.
- Develop a diagnostic plan for children presenting with acute coma.
- Develop a plan for airway control of a child with multiple traumatic injuries.
- Diagnose and manage inborn errors of metabolism.
- Distinguish key differences between spontaneous breathing and positive-pressure ventilation on intrathoracic pressure.
- Distinguish the differences in clinical findings between upper and lower airway obstruction.
- Evaluate the appropriate use of sedatives and analgesics in end-of-life care in the PICU.
- Identify complications of the use of transplant rejection prophylaxis medications.
- Identify mechanisms of pathogen identification and clearance by the immune system.
- Identify the effects of end-organ dysfunction on drug metabolism in critically ill children.
- Identify the role of the kidney in the maintenance of acid-base balance.
- Know the effect of positive pressure ventilation on cardiac preload and afterload.
- Know the management of complications of central venous access placement.
- Know the pathyphysiology and treatment of common overdoses.
- Know the risks associated with interhospital or intrahospital transport of the critically ill or injured patient.
- Know the synthetic functions of the liver.
- Manage complications resulting from hematopoietic stem cell transplantation.
- Manage hyperactive delirium in the critically ill adolescent.
- Manage oxygen delivery for a patient in shock.
- Plan the management of acute liver failure.
- Plan the management of diabetic ketoacidosis.
- Plan the management of toxic shock syndrome.
- Recognize key neurological examination findings in critically ill children with acute neurological disorders, including signs of brain herniation.
- Recognize pericardial tamponade.
- Recognize unique diagnostic characteristics consistent with abusive head trauma in infants and young children.
- Understand factors necessary for spontaneous breathing and assess readiness for extubation in mechanically ventilated patients.
- Understand how to determine cerebral perfusion pressure.
- Understand how to perform a rapid sequence intubation.
- Understand potential complications of endotracheal intubation.
- Understand the complications of hepatic failure.
- Understand the determinants of cerebral flood flow.
- Understand the determinants of oxygen content and delivery.
- Understand the determinants of systemic and pulmonary blood flow in a patient with single ventricle physiology.
- Understand the difference in physiology between SIADH and cerebral salt wasting.
- Understand the effects of altered cardiac physiology, including dysrhythmias, on the central venous waveform.
- Understand the impact of lipid solubility on pharmacokinetics of sedative/analgesic agents.
- Understand the indications for and risks of neuromuscular blocking agents.
- Understand the joint influences of ADH and aldosterone on salt and water balance.
- Understand the principles and applications of study designs.
- Understand the principles of detoxification, including the indications for gastric emptying, toxin binding, enhanced renal excretion, whole bowel irrigation and surface decontamination.
- Understand the role of neuromuscular blocking agents at the time of withdrawal of mechanical ventilation.
- Understand the various pathophysiologies leading to acute kidney injury
- Understand when and why artificial nutrition may be withdrawn in a child.
- Analyze the risk for diabetes in the relatives of a child with type 1 diabetes.
- Construct a differential diagnosis for a patient with an increased upper:lower segment ratio.
- Contrast genotype and phenotype of Turner syndrome versus Noonan syndrome.
- Contrast the treatment of central and nephrogenic diabetes insipidus.
- Define the role of genetic testing for multiple endocrine neoplasia (MEN)1 in families.
- Describe genetic mutations causing peripheral precocious puberty.
- Describe the effect of growth hormone (GH) treatment on adult stature in Turner syndrome.
- Describe the effect of obesity on tests of thyroid function.
- Describe the effects of thyroid hormone on the growth hormone-insulin-like growth factor-1 (GH-IGF-1) axis.
- Describe the factors that affect the response to growth hormone (GH) provocative testing.
- Describe the factors that alter cortisol-binding globulin.
- Describe the hormonal basis of the pubertal growth spurt.
- Differentiate among the different forms of congenital adrenal hyperplasia (CAH).
- Differentiate between disease incidence and prevalence.
- Differentiate Hashitoxicosis from Graves disease.
- Differentiate maturity-onset diabetes of the young (MODY) from other types of childhood diabetes.
- Differentiate nutritional from inherited causes of rickets.
- Distinguish between consent and assent in research with children.
- Distinguish diabetic ketoacidosis from hyperglycemic hyperosmolar state (HHS).
- Distinguish obesity from pathologic causes of tall stature.
- Distinguish thyroxine-binding globulin (TBG) deficiency from hypothyroidism.
- Distinguish type 1 from type 2 diabetes in an adolescent with obesity.
- Evaluate a child with a thyroid nodule.
- Evaluate an infant with midline facial defect.
- Evaluate mineral disturbances in an infant of a diabetic mother.
- Explain the difference between prevalence and incidence.
- Explain the utility of chromogranin A measurement in the evaluation of pheochromocytoma.
- Identify genetic causes of neonatal hyperinsulinemic hypoglycemia.
- Interpret diagnostic imaging for the diagnosis of pituitary hormone deficiency.
- Investigate an infant with microphallus and bilateral cryptorchidism.
- Investigate the impact of adrenal insufficiency on the hypothalamic-pituitary-thyroid (HPT) axis.
- Manage bone health in patients receiving long-term glucocorticoid treatment.
- Manage Cushing disease.
- Manage glucose abnormalities in cystic fibrosis-related diabetes (CFRD).
- Manage patients recovering from chronic hypothalamic-pituitary-adrenal (HPA) axis suppression due to exogenous glucocorticoids.
- Predict the clinical implications of defects in anti-Mullerian hormone (AMH) synthesis or action.
- Predict the impact of circadian variation on the hypothalamic-pituitary-adrenal (HPA) axis.
- Predict the impact of diet modification on low-density lipoprotein (LDL) cholesterol concentrations.
- Predict the pituitary hormone deficiencies associated with POU1F1 mutations.
- Propose evaluation of an infant born to a mother with a history of Graves disease.
- Recognize medications that cause hyperglycemia.
- Recognize the limitations of dual-energy x-ray absorptiometry (DXA) in assessing bone mineral density.
- Recognize various forms of adrenocorticotrophic (ACTH) resistance.
- Recommend management of Graves disease in a child with significant ophthalmopathy.
- Recommend potential uses of aromatase inhibitors in pediatric patients.
- Be able to diagnose and manage acute pancreatitis, including nutritional support, pain management, and treatment of complications.
- Be able to interpret esophageal motility studies, including normal function, achalasia, esophageal spasm, and impairments of peristalsis.
- Be able to interpret gastrointestinal x-ray imaging, both with and without orally/rectally/intravenously administered contrast agents.
- Be able to recognize and plan the management of Crigler-Najjar syndrome (types I and II) and understand the prognosis, including the possible need for liver transplantation.
- Be familiar with benign and malignant liver tumors of childhood, including hemangiomas, hamartomas, focal nodular hyperplasia, hepatoblastoma, and hepatocellular carcinoma, as well as standard symptoms and their laboratory and imaging characteristics.
- Be familiar with heritability and diagnosis of congenital syndromes affecting the bile ducts and hepatic parenchymal architecture, including biliary atresia, congenital hepatic fibrosis, Caroli disease, Alagille syndrome, choledochal cyst, and polycystic disease.
- Be familiar with magnetic resonance imaging studies and their advantages and limitations in gastrointestinal disease.
- Be familiar with metabolic/genetic disorders causing neonatal cholestasis and the current recommended diagnostic testing, including genetic and biochemical assays.
- Describe the composition and complications of ketogenic diets.
- Describe the ethical principles associated with patient confidentiality in the care of children and teens.
- Diagnose and manage acute pancreatitis.
- Differentiate malabsorption from other causes of diarrhea and plan the diagnostic evaluation of a patient with malabsorption.
- Differentiate the causes of ascites based on laboratory evaluation of peritoneal fluid.
- Formulate a tube-feeding regimen for a child who is unable to take foods orally, including bolus vs pump feedings.
- Identify common causes of protein-losing enteropathy and plan a diagnostic workup.
- Identify common presentations and natural history of non-IgE dietary protein intolerance in children.
- Know the differential diagnosis of hepatomegaly.
- Know the inheritance patterns for chronic polyposis disorders and be able to develop a surveillance strategy.
- Know the long-term complications of nonalcoholic fatty liver disease (NAFLD).
- Know the pathways of hepatic drug metabolism.
- Know the patterns of the migrating motor complex in the small bowel and recognize abnormal patterns of activity in both fasted and fed states on motility studies.
- Know the presentation, predisposing conditions, and management of acute cholecystitis.
- Order appropriate parenteral nutrition for children requiring both short- and long-term support and plan appropriate monitoring.
- Plan the diagnostic evaluation of a child with chronic constipation.
- Plan the diagnostic evaluation of a child with dysphagia.
- Plan the diagnostic evaluation of a child with impaired deglutition.
- Plan the diagnostic evaluation of a child with suspected gastroduodenitis.
- Plan the follow-up of a patient treated for Helicobacter pylori.
- Plan the management of a child with a functional gastrointestinal disorder (FGID).
- Plan the management of recurrent Clostridium difficile infection, including choice of antibiotics and use of fecal microbial transplantation.
- Recognize clinical manifestations of congenital esophageal anomalies.
- Recognize complications of peptic ulcer disease.
- Recognize laboratory and clinical features of suboptimal response to treatment for celiac disease.
- Recognize the clinical presentation and plan the management of duodenal hematoma.
- Recognize the complications of acute and chronic pancreatitis.
- Recognize the typical presentation of a child with intestinal obstruction, including differential diagnosis by age, and plan appropriate evaluation and initial management.
- Understand endoscopic therapies for the management of gastrointestinal bleeding.
- Understand how diet contributes to the pathophysiology of nonalcoholic fatty liver disease (NAFLD).
- Understand how inflammatory bowel disease may present with isolated extraintestinal manifestations.
- Understand how to develop a quality improvement project.
- Understand medical and surgical treatment of esophageal motility disorders.
- Understand the characteristic behaviors of caregivers who impose factitious disorders on their children (Munchausen by proxy).
- Understand the physiology, diagnosis, presentation, and management of disorders of gallbladder function.
- Understand the principles of behavior modification for treatment of disorders of defecation.
- Understand the risk factors and diagnostic evaluation of acute, acute recurrent, and chronic pancreatitis.
Pediatric Hospital Medicine
- Assess the risk of prolonged stay or further intervention in croup.
- Assess withdrawal symptoms in an infant born to a mother with active narcotic use.
- Categorize the risk factors for non-accidental trauma.
- Choose diagnostic testing for an immediate newborn with hyperbilirubinemia.
- Compare and contrast considerations in access to care including unconscious bias and barriers to care (economic, social, cultural, geographic).
- Compare and contrast informed permission, informed consent, assent, capacity to consent, implied consent, leaving against medical advice, abandonment, and duty to refer.
- Compare and contrast the features that distinguish pathologic jaundice from physiologic jaundice.
- Compare and contrast the principles and applications of different research study designs.
- Compare and contrast the six quality aims of the Institute of Medicine: safe, timely, efficient, effective, patient-centered, and equitable care.
- Compose a plan for disclosure of medical error to a family.
- Demonstrate knowledge of the clinical presentation of a child with immunodeficiency.
- Describe the initial management of a pediatric patient in hypertensive emergency.
- Determine treatment for thrombocytopenia.
- Develop a feeding plan for a child with medical complexity.
- Develop systems that promote timely and effective communication between providers during handoffs and transitions of care.
- Diagnose and manage a child with Kawasaki disease.
- Distinguish differences in clinical presentation between orbital and peri-orbital cellulitis.
- Employ measures to prevent pressure sores.
- Escalate care for children with worsening respiratory symptoms.
- Evaluate a child with a headache.
- Evaluate a child with hematuria (glomerulonephritis).
- Evaluate a child with proteinuria (nephrotic syndrome).
- Evaluate a fever of unknown origin.
- Evaluate appropriate treatment options for behavioral disorders in the hospital setting.
- Evaluate the ethical issues involved in caring for a child with medical complexity at the end-of-life.
- Evaluate the findings of testing done to assess for sepsis in an immediate term newborn and recognize early and late neonatal sepsis.
- Formulate a plan for the safe discharge of a child with medical complexity to home.
- Incorporate principles of adult learning into an effective teaching session.
- Incorporate the principles of health literacy into communication with patients and/or their families.
- Interpret radiology findings in patients with lower respiratory tract disease.
- Interpret results of commonly used blood inflammatory markers in patients undergoing treatment for osteomyelitis.
- Know the common dysmorphic features and syndromes seen in newborn infants.
- Manage a child with altered mental status.
- Manage a patient with a suspicious non-accidental injury.
- Manage acute and chronic pain.
- Manage emergency ventilation.
- Manage hyperglycemia in a patient with type 2 diabetes.
- Manage hypoglycemia in a newborn.
- Manage the child hospitalized with appendicitis, including complications of appendicitis such as perforation.
- Manage the different types of shock.
- Plan appropriate management for a patient with anorexia nervosa, bulimia nervosa, and restrictive type eating disorder.
- Recognize contraindications to circumcision in newborns.
- Recognize examples of implicit bias in healthcare decision-makings.
- Recognize the clinical features of JIA.
- Recommend specific treatments for select toxidromes.
Pediatric Infectious Diseases
- Advise parents regarding immunization of a child with a history of Guillain-Barre syndrome.
- Describe the appropriate utilization of molecular testing for C. difficile.
- Describe the clinical implications of specific defects in neutrophil function.
- Describe the mechanism of action of tetanus toxin.
- Describe the pathogenesis of hemolytic-uremic syndrome.
- Describe the pathogenesis of toxic shock syndrome.
- Develop an appropriate antibiotic stewardship policy for carbapenem utilization in children.
- Distinguish pyomyositis from necrotizing fasciitis.
- Evaluate a child with a suspected inherited cause of recurrent fever.
- Evaluate a child with suspected acute rheumatic fever.
- Evaluate a child with suspected arboviral infection.
- Identify an appropriate alternate antimicrobial regimen for a patient with pelvic inflammatory disease who is allergic to one of the first-line agents.
- Identify potential conflicts of interest for investigators participating in a clinical trial.
- Interpret the results of diagnostic tests for urinary tract infection.
- Interpret the results of serum immunoglobulin concentrations based on patient age.
- Manage a child with a gram-negative central catheter infection.
- Manage a child with acyclovir-resistant herpes simplex virus infection.
- Manage a child with suspected bacterial meningitis.
- Manage a neonate born to a mother with varicella.
- Manage a neonate with conjunctivitis.
- Manage a patient with suspected acute HIV infection
- Manage a patient with suspected diskitis.
- Manage a patient with suspected pericarditis.
- Manage an asymptomatic child with a positive screening test for tuberculosis.
- Manage the antimycobacterial medications for a child with pulmonary tuberculosis.
- Plan the evaluation of a patient returning from the tropics with an acute febrile illness.
- Plan the evaluation of a patient who requires beta-lactam therapy and has a poorly documented history of penicillin allergy.
- Plan the treatment of a patient with Candida endophthalmitis.
- Recognize contraindications to MMR vaccine.
- Recognize situations in which culture methods may be preferred over molecular diagnostic techniques.
- Recognize the clinical features of empyema.
- Recognize the clinical features of epiglottitis.
- Recognize the clinical manifestations of disseminated cat scratch disease.
- Recognize the clinical presentation of congenital toxoplasmosis.
- Recognize the clinical presentation of pathogens associated with the Lone Star tick.
- Recognize the clinical presentation of primary antibody deficiency (eg, X-linked agammaglobulinemia).
- Recognize the indications for doxycycline treatment in young children.
- Recognize the mechanisms of resistance to fluconazole.
- Recognize the risk factors for parameningeal infections.
- Recognize the side effects of mefloquine.
- Recognize the subset of patients at risk for infective endocarditis for whom antimicrobial prophylaxis with dental procedures should be considered.
- Recognize vaccines that should be postponed after IGIV administration.
- Select an appropriate antimicrobial regimen for a child with a polymicrobial intra-abdominal infection.
- Select an appropriate antimicrobial regimen for a child with ascending cholangitis.
- Select appropriate statistical tools for a research study in which the data are not expected to be normally distributed.
- Anticipate the negative side effects of treating a patient for cystinuria.
- Apply laboratory tests to planning the management of a patient with increased blood pressure.
- Appropriately prescribe continuous renal replacement therapy (ie, continuous veno-venous hemodialysis).
- Assess the adequacy of chronic hemodialysis.
- Contrast the criteria for diagnosis of urinary tract infection in an intact versus a diverted urinary collecting system.
- Describe factors that may limit donor availability for an individual transplant recipient.
- Develop a systematic plan for treating a patient with oxalosis.
- Estimate free water and sodium deficits and develop plans for rehydration.
- Identify clinical signs and symptoms of hyperkalemia.
- Identify prognostic factors in patients with posterior urethral valves.
- Identify the causes of acute allograft dysfunction in the immediate post-transplant period.
- Identify the pathophysiologic factors in chronic kidney disease that negatively affect linear growth.
- Interpret mean and standard deviation in normally distributed data sets.
- Know and apply the appropriate guidelines for sports participation in a hypertensive athlete.
- Know how to interpret results of voiding cystourethrography.
- Know the abnormalities of cardiac function associated with chronic kidney disease and end-stage kidney disease.
- Know the basic concepts of quality improvement science.
- Know the indications for kidney biopsy in a patient with proteinuria.
- Know the long-term implications of intrinsic acute kidney injury.
- Know the normal requirements for fluid and electrolytes in children of different ages.
- Know the renal associations of tuberous sclerosis in the perinatal period.
- Know the risk factors for recurrent disease in a kidney transplant recipient.
- Know the uses and limitations of ambulatory blood pressure monitoring in the evaluation of childhood hypertension.
- Plan the appropriate dialysis prescription to minimize the risk of dialysis disequilibrium syndrome.
- Plan the appropriate modification of a dialysis prescription in a child with severe cramping during hemodialysis.
- Plan the diagnostic approach for a patient with a family history of hematuria.
- Plan the laboratory evaluation and therapeutic approach to a child with membranous nephropathy.
- Plan the management of a metabolic emergency in an infant with an inborn error of metabolism.
- Plan the management of a neonate with multicystic-dysplastic kidney.
- Plan the management of a patient with Alport syndrome.
- Plan the management of post-obstructive diuresis in a neonate.
- Plan the pharmacologic management of a child with hyperparathyroidism secondary to chronic kidney disease.
- Plan the treatment of recurrent bacterial infection related to peritoneal dialysis access.
- Provide counseling for participation in sports for patients with a solitary kidney.
- Recognize drugs that should be avoided in a patient with advanced chronic kidney disease or end-stage renal disease.
- Recognize renal compensation for chronic metabolic alkalosis.
- Recognize risk factors for and the clinical presentation of papillary necrosis.
- Recognize the association between thyroid disease and congenital nephrotic syndrome.
- Recognize the causes of hypertension in a patient with a renal transplant.
- Recognize the manifestations of acute cell-mediated transplant rejection.
- Recognize which clinical factors may indicate increased utility of genetic testing in focal segmental glomerulosclerosis.
- Understand how hypomagnesemia complicates the treatment of hypocalcemia.
- Understand risk factors for post-transplant lymphoproliferative disease.
- Understand the effect of chronic kidney disease on neurocognitive development.
- Understand the pathophysiology of acute kidney injury secondary to tumor lysis syndrome.
- Apply current guidelines for the diagnosis of cystic fibrosis and CFSPID (cystic fibrosis screen positive inconclusive diagnosis).
- Apply the federal regulatory definitions to determine which activities are considered research
- Apply understanding of the effects of gravity on the perfusion of the lung to ventilator management in acute respiratory failure.
- Assess the need for surgical repair in a child with a vascular ring.
- Compare the diagnostic implications of disease-causing mutations to variants of uncertain clinical significance
- Compare the total cross sectional area of airways in the normal conducting zone and respiratory zones.
- Decide whether flexible or rigid bronchoscopy is indicated in suspected foreign body aspiration
- Describe mechanisms by which hepatopulmonary syndrome causes hypoxemia
- Describe the effects of diving on patients with obstructive lung disease
- Describe the feasibility of conducting lung function testing during the preschool years
- Describe the histologic characteristics associated with the embryonic (3 to 6 weeks), pseudoglandular (6 to 16 weeks), canalicular (16 to 26 weeks), saccular (26 to 36 weeks), and alveolar (36 weeks and beyond) stages of lung development.
- Describe the natural history of surfactant protein B deficiency
- Describe the primary indication for surgical treatment of pectus excavatum (cosmesis)
- Describe the risk factors for readmission after initial discharge in infants with bronchopulmonary dysplasia.
- Determine management of pulmonary exacerbations based on current guidelines.
- Determine the diagnosis and management of exercise‐induced asthma.
- Determine the diagnostic work-up for tachypnea during infancy
- Develop a care plan for a preschool child with moderate obstructive sleep apnea
- Diagnose obstructive sleep apnea using polysomnography results
- Differentiate between the indications for a rigid bronchoscopy versus a flexible bronchoscopy
- Differentiate the likelihood of specific tumors by location in the mediastinum
- Distinguish the clinical presentation of a congenital lobar emphysema from a pulmonary sequestration.
- Evaluate a child with neuromuscular disease and daytime sleepiness
- Evaluate and manage preschool age asthma.
- Evaluate and manage smoke and thermal inhalational injury
- Evaluate and manage vocal cord dysfunction.
- Evaluate the effects of pulmonary disorders on diffusion of gases between the alveolar space and the pulmonary circulation.
- Identify contraindications to lung transplantation
- Identify pectus excavatum on a chest radiograph
- Identify pulmonary complications of sickle cell anemia (acute chest syndrome, plastic bronchitis)
- Interpret findings on a saline-contrast echocardiography of a pulmonary arteriovenous malformation
- Interpret risk factors for poorer outcomes in newborn infants with respiratory distress.
- Interpret typical lung biopsy findings in pulmonary interstitial glycogenosis
- Judge whether referral for lung transplant evaluation is appropriate in a patient with cystic fibrosis.
- Know that SQUIRE guidelines provide recommendations for reporting of quality improvement work in publications
- Know the differential diagnosis for a new patient presenting with pulmonary hypertension
- List the differential causes of noisy breathing from infancy through the teenage years.
- Name etiologies leading to non-cystic fibrosis bronchiectasis.
- Predict the natural course of laryngomalacia in the term infant.
- Recognize abnormalities in resistance of blood flow in the pulmonary circulation.
- Recognize that mutations in the surfactant protein C gene may not present with clinical findings until after infancy and that the natural history of the disease is variable
- Recognize the diagnostic findings in primary ciliary dyskinesia.
- Recognize the radiographic and laboratory signs of empyema.
- Relate CFTR mutation classes to disease outcomes.
- Use palivizumab in the care of a child with bronchopulmonary dysplasia.
- Know the clinical characteristics of children with joint hypermobility syndrome.
- Know the clinical characteristics of children with musculoskeletal manifestations of chromosomal disorders.
- Know the clinical characteristics of psychological issues of chronic illnesses in children and families.
- Know the clinical presentation and management of the gastrointestinal manifestations of IIM.
- Know the clinical presentation and management of the pulmonary manifestations of IIM.
- Know the clinical presentation of children with pernio.
- Know the clinical presentation of children with RF-positive polyarticular JIA.
- Know the clinical presentation of children with slipped capital femoral epiphysis.
- Know the clinical presentation of drug-induced lupus in children.
- Know the clinical presentation of pulmonary disease in children with SLE.
- Know the current theories regarding the pathogenesis of RF-positive polyarticular JIA.
- Know the diagnostic evaluation of cardiac disease in children with SLE.
- Know the diagnostic evaluation of children with central nervous system lupus.
- Know the diagnostic evaluation of children with FMF.
- Know the diagnostic evaluation of children with Sjogren syndrome.
- Know the differential diagnosis for children with RF-negative polyarticular JIA.
- Know the differential diagnosis in children with dermatomyositis.
- Know the manifestations of hematologic malignancies that mimic rheumatic illnesses.
- Know the musculoskeletal manifestations of children with cystic fibrosis.
- Know the pathogenesis of hemophagocytic lymphohistiocytosis.
- Know the principles of management for children with localized scleroderma.
- Know the principles of management of children with acute rheumatic fever and post-streptococcal arthritis.
- Know the principles of management of children with granulomatosis with polyangiitis.
- Know the principles of management of children with JIA-associated uveitis.
- Know the principles of management of children with Kawasaki disease.
- Know the principles of management of children with lupus nephritis.
- Know the principles of management of children with oligoarticular JIA.
- Know the principles of management of children with pain amplification syndrome (including primary fibromyalgia syndrome and complex regional pain syndrome).
- Know the principles of management of children with Raynaud phenomenon.
- Know the principles of management of children with RF-negative polyarticular JIA.
- Know the prognosis and outcome of children with enthesitis-related JIA.
- Know the prognosis and outcome of children with Henoch-Schoenlein purpura.
- Know the prognosis and outcome of children with PFAPA.
- Know the prognosis and outcome of children with systemic JIA.
- Know the side effects and toxicity of B-lymphocyte-directed therapy.
- Know the side effects and toxicity of glucocorticoid drugs.
- Know the side effects and toxicity of hydroxychloroquine.
- Recognize normal and abnormal gait patterns in children.
- Understand the concept and relevance of an interferon signature.
- Understand the consequence of single base DNA changes, including synonymous, missense, and nonsense substitutions.
- Understand the indications and contraindications for the use of anti-TNF agents.
- Understand the indications and contraindications for the use of cyclophosphamide.
- Understand the indications and contraindications for the use of NSAIDs.
- Understand the methodology, limitations, and uses of clinical laboratory techniques commonly used in rheumatology and immunology.
- Understand the principles of ethics of research in human subjects.
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. Until then, you might need a subscription to access some of these articles. Up to two questions for each featured reading will appear within MOCA-Peds, however, other questions may list the featured readings as references.
Oskoui M, Pringsheim T, Holler-Managan Y, Potrebic S, Billinghurst L, Gloss D, Hershey AD, Licking N, Sowell M, Victorio MC, Gersz EM, Leininger E, Zanitsch H, Yonker M, Mack K. Practice guideline update summary: Acute treatment of migraine in children and adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019 Sep 10;93(11):487-499. doi: 10.1212/WNL.0000000000008095. Epub 2019 Aug 14. Review. PubMed PMID: 31413171.
Puopolo KM, Lynfield R, Cummings JJ. Management of Infants at Risk for Group B Streptococcal Disease. Pediatrics. 2019 Aug;144(2). doi: 10.1542/peds.2019-1881. Epub 2019 Jul 8. Review. PubMed PMID: 31285392.
Wolraich ML, Hagan JF Jr, Allan C, Chan E, Davison D, Earls M, Evans SW, Flinn SK, Froehlich T, Frost J, Holbrook JR, Lehmann CU, Lessin HR, Okechukwu K, Pierce KL, Winner JD, Zurhellen W. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019 Oct;144(4). doi: 10.1542/peds.2019-2528. PubMed PMID: 31570648.
Zuckerbrot RA, Cheung A, Jensen PS, Stein REK, Laraque D. Guidelines for Adolescent Depression in Primary Care (GLAD-PC): Part I. Practice Preparation, Identification, Assessment, and Initial Management. Pediatrics. 2018 Mar;141(3). doi: 10.1542/peds.2017-4081. PubMed PMID: 29483200.
Child Abuse Pediatrics
Adamsbaum C, De Boissieu P, Teglas JP, Rey-Salmon C. Classic Metaphyseal Lesions among Victims of Abuse. J Pediatr. 2019;209:154‐159.e2. doi:10.1016/j.jpeds.2019.02.013
Lindberg DM, Stence NV, Grubenhoff JA, et al. Feasibility and Accuracy of Fast MRI Versus CT for Traumatic Brain Injury in Young Children. Pediatrics. 2019;144(4):e20190419. doi:10.1542/peds.2019-0419
Paine CW, Wood JN. Skeletal surveys in young, injured children: A systematic review. Child Abuse Negl. 2018;76:237‐249. doi:10.1016/j.chiabu.2017.11.004
Hyman SL, Levy SE, Myers SM; Council on Children with Disabilities, Section on Developmental and Behavioral Pediatrics. Executive Summary: Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics. 2020;145(1):e20193448. doi:10.1542/peds.2019-3448
Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents [published correction appears in Pediatrics. 2020 Mar;145(3):]. Pediatrics. 2019;144(4):e20192528. doi:10.1542/peds.2019-2528
Fierson WM. American Academy of Pediatrics Section on Ophthalmology; American Academy of Opthamology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity [published correction appears in Pediatrics. 2019 Mar;143(3):]. Pediatrics. 2018;142(6):e20183061. doi:10.1542/peds.2018-3061
Pediatric Critical Care Medicine
Kochanek PM, Tasker RC, Bell MJ, et al. Management of pediatric severe traumatic brain injury: 2019 consensus and guidelines-based algorithm for first and second tier therapies. Pediatr Crit Care Med. 2019;20(3):269-279. PMID: 30830015
Topjian AA, de Caen A, Wainwright MS, et al. Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association. Circulation. 2019;140(6):e194-e233. PMID: 31242751
Zhao Y, Wu Y, Xiang B. Tight glycemic control in critically ill pediatric patients: A meta-analysis and systematic review of randomized controlled trials. Pediatr Res. 2018; 84:22-27. PMID: 29795449
Bangalore Krishna K, Fuqua JS, Rogol AD, et al. Use of Gonadotropin-Releasing Hormone Analogs in Children: Update by an International Consortium. Horm Res Paediatr. 2019;91(6):357-372. doi:10.1159/000501336
Mantovani G, Bastepe M, Monk D, et al. Diagnosis and management of pseudohypoparathyroidism and related disorders: first international Consensus Statement. Nat Rev Endocrinol. 2018;14(8):476-500. doi:10.1038/s41574-018-0042-0
Sklar CA, Antal Z, Chemaitilly W, et al. Hypothalamic-Pituitary and Growth Disorders in Survivors of Childhood Cancer: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(8):2761-2784. doi:10.1210/jc.2018-01175
Hyams JS, Davis Thomas S, Gotman N, et al. Clinical and biological predictors of response to standardised paediatric colitis therapy (PROTECT): a multicentre inception cohort study. Lancet. 2019 Apr 27;393(10182):1708-1720. doi: 10.1016/S0140-6e736(18)32592-3. Epub 2019 Mar 29. PubMed PMID: 30935734; PubMed Central PMCID: PMC6501846.
Lightdale JR, Liu QY, Sahn B, et al. Pediatric endoscopy and high-risk patients: a clinical report from the NASPGHAN Endoscopy Committee. J Pediatr Gastroenterol Nutr. 2019 Apr;68(4):595-606. PubMed PMID: 30664560.
Schwimmer JB, Ugalde-Nicalo P, Welsh JA, et al. Effect of a low free sugar diet vs usual diet on nonalcoholic fatty liver disease in adolescent boys: a randomized clinical trial. JAMA. 2019 Jan 22;321(3):256-265. PubMed PMID: 30667502; PubMed Central PMCID: PMC6440226.
Pediatric Hospital Medicine
Abu-El-Haija M, Kumar S, et al. The management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition pancreas committee. J Pediatr Gastroenterol Nutr. 2018;66(1):159-176
Hamline MY, Speier RL, Vu PD, et al. Hospital-to-Home Interventions, Use, and Satisfaction: A Meta-analysis. Pediatrics. 2018;142(5):e20180442
Merritt J Lawrence, Quinonez RA, Bonkowsky JL, et al. A Framework for Evaluation of the Higher-Risk Infant After a Brief Resolved Unexplained Event. Pediatrics. 2019;144(2):e20184101
Mueller BU et al. Policy Statement: Principles of Pediatric Patient Safety: reducing harm due to medical care. Pediatrics. 2019;143(2):e20183649
Pediatric Infectious Diseases
McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. PMID: 29462280
Nicolle LE, Gupta K, Bradley SF, et al. Clinical practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2019;68:e83-e110. PMID: 31506700
Slack MA, Thomsen IP. Prevention of infectious complications in patients with chronic granulomatous disease. J Ped Infect Dis Soc. 2018;7:S25-S30
Alobaidi R, Morgan C, Basu RK, et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr. 2018;172:257-268. PMID: 29356810
Basu B, Sander A, Roy B, et al. Efficacy of rituximab vs tacrolimus in pediatric corticosteroid-dependent nephrotic syndrome: a randomized clinical trial. JAMA Pediatr. 2018;172:757-764. PMID: 29913001
Gimpel C, Bergman C, Bockenhauer D, et al. International consensus statement on the diagnosis and management of autosomal dominant polycystic kidney disease in children and young people. Nat Rev Nephrol. 2019;15:713-726. PMID: 31118499
McAlister L, Pugh P, Greenbaum L, et al. The dietary management of calcium and phosphate in children with CKD stages 2-5 and on dialysis – clinical practice recommendation from the Pediatric Renal Nutrition Taskforce. Pediatr Nephrol. 2019 doi: 10. 1007/s00467-019-04370-z. (Epub ahead of print) PMID: 31667620
Chang AB, Oppenheimer JJ, Weinberger MM, et al. Use of Management Pathways or Algorithms in Children with Chronic Cough: CHEST Guideline and Expert Panel Report. Chest. 2017;151(4):875-883. doi:10.1016/j.chest.2016.12.025
Mercuri E, Darras BT, Chiriboga CA, et al. Nusinersen versus Sham Control in Later-Onset Spinal Muscular Atrophy. N Engl J Med. 2018;378(7):625-635. doi:10.1056/NEJMoa1710504
Middleton PG, Mall MA, Dřevínek P, et al. Elexacaftor-Tezacaftor-Ivacaftor for Cystic Fibrosis with a Single Phe508del Allele. N Engl J Med. 2019;381(19):1809-1819. doi:10.1056/NEJMoa1908639
Angeles-Han ST, Ringold S, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis–associated uveitis. Arthritis Care Res. 2019;71:703–716. PMID: 31021540
Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Arthritis Rheumatol. 2019;71:1400-1412. PMID: 31385462
Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the treatment of juvenile idiopathic arthritis: therapeutic approaches for non-systemic polyarthritis, sacroiliitis, and enthesitis. Arthritis Care Res. 2019;71:717-734. PMID: 31021516
Schulert GS, Yasin S, Carey B, et al. Systemic juvenile idiopathic arthritis-associated lung disease: characterization and risk factors. Arthritis Rheumatol. 2019;71:1943-1954. PMID 31379071