Breastfeeding
- Complete Nutrition
- Antibody Protection
- Bonding
- Convenient
- SIDS Risk Reduced
- Possible Enhanced Cognitive Development
- Long-Term Health Benefits
Age 1 Year - Developmental Milestones
- Stands Well
- First Steps
- Throws Ball
- Points to Objects
- Babinski Reflex Disappears
- Two-Finger Pincer Grasp
- "Mama & Dada"
- One-Step Commands with Gesture
Age 2 Months - Developmental Milestones
- Holds Head Up, But Unsteady
- Tracks Objects to the Midline
- Coos
- Social Smile
- Recognizes Parents
Age 18 Months - Developmental Milestones
- Climbs Up Stairs
- Runs
- Stacks Three Blocks
- Eats with Spoon
- Removes Clothing
- 10-25 Word Vocabulary
- “Mine”
- Pretend Play
Age 4 Months - Developmental Milestones
- Sits With Support
- Rooting Reflex Disappears
- Moro Reflex Disappears
- Reaches Across Midline
- Turns to Voice
- Laughs
- Enjoys Looking Around
Age 6 Months - Developmental Milestones
- Palmar Reflex Disappears
- Sits Propped Up On Hands
- Rolls
- Transfers Objects Hands to Hands
- Raking Grasp
- Babbles
- Responds to Name
- Stranger Anxiety Develops
Age 9 Months - Developmental Milestones
- Pulls to Stand
- Starts Cruising
- Three-Finger Pincer Grasp
- Holds Bottle or Cup
- Starts Sounding "Mama" or "Dada"
- Waves Bye
- Separation Anxiety
- Plays Pat-A-Cake
Age 2 Years - Developmental Milestones
- Jumps
- Copies a Line
- Stacks Six Blocks
- Turns Pages
- Two-Word Phrases
- Half of Speech is Understandable
- 200 Words by Age 2
- Parallel Play
- Begins Toilet Training
- Rapprochement
Age 3 Years - Developmental Milestones
- Walks Up/Down Steps with Alternating Feet
- Rides Tricycle
- Stack Nine Block Tower
- Copies Circle
- Uses Utensils
- Three-Word Sentences
- 75% Speech Understood by Stranger
- Knows Gender / Age
Age 4 Years - Developmental Milestones
- Hop on One Foot
- Copies Square
- Uses Fork Well
- 100% Speech Understandable
- Identifies Colors
- Cooperative Play
- Imaginary Friends
Fragile X
- Trinucleotide Repeat
- CGG Repeats
- FMR1 Gene
- X-linked Dominant
- Developmental Delay
- Autism
- Large Ears
- Large Jaw
- Long Face
- Macroorchidism
Norepinephrine (Levophed)
- Alpha Agonist
- Beta-1 Agonist
- Severe Hypotension
- Decreases Renal Blood Flow
- Arrhythmias
- Hypertension
- Tissue Necrosis
- Last Resort Medication
Rubella
- RNA Virus
- Togavirus
- Enveloped
- Icosahedral
- SS Positive Linear
- German Measles or Three-Day Measles
- Fever
- Postauricular Tenderness
- Lymphadenopathy
- Truncal Rash
- Arthritis
- Congenital TORCH Infection
Mumps Virus
- Paramyxovirus
- Parotitis
- Increased Serum Amylase
- Orchitis
- Oophoritis
- Aseptic Meningitis
- Pancreatitis
Rubella TORCH
- Nonspecific TORCH Symptoms
- Patent Ductus Arteriosus
- Pulmonary Artery Hypoplasia
- Cataracts
- Deafness
- Blueberry Muffin Rash
- Glaucoma
Rotavirus
- Reovirus
- Non-enveloped
- Double-Stranded
- RNA Virus
- Linear
- 11 Segments
- Triple Icosahedral Capsid
- Most Common Cause of Diarrhea Worldwide
- Villous Atrophy
- Winter Months
- Day Care Centers
- Oral Rehydration
Influenza
- High Fever
- Cough
- Headache
- Muscle Aches
- Chills
- Vaccination
- Zanamivir (Relenza)
- Oseltamivir (Tamiflu)
Hepatitis B Virus Disease
- Can turn chronic
- < 10% of adults become chronic carriers
- 90% of newborns become chronic carriers
- Cirrhosis
- Hepatocellular carcinoma
- Membranous Glomerulonephritis
- Polyarteritis nodosa
- Serum sickness like syndrome
Hepatitis B Virus Characteristics
- Hepadnavirus
- Enveloped
- Circular
- Partially Double-stranded DNA
- Has Reverse Transcriptase
- IV Drug Use
- Sex
- Maternal Fetal Routes
- 3 Month Incubation Period
Varicella Zoster Virus (VZV)
- Herpesvirus 3
- Enveloped
- Double Stranded DNA
- Chickenpox
- Pneumonia
- Encephalitis
- Trigeminal and Dorsal Root Ganglia
- Shingles
- Tzanck Test
- Multinucleated Giant Cells
- Cowdry A Inclusion
- Acyclovir
Hepatitis A
- Picornavirus
- 4 Week Incubation Period
- Fecal-oral
- Day Care Centers
- Travel to Developing Countries
- Usually Asymptomatic
- Acute Disease
- Jaundice
- Fever
- Vomiting
Lead Antidotes
- Dimercaprol
- CaEDTA
- Succimer
Sturge Weber Syndrome
- GNAQ Gene
- Port Wine Stain
- Arterial Venous Malformation
- Leptomeningeal Angiomas
- Intellectual Disability
- Seizures
- Pheochromocytoma
- Glaucoma
- Tram-Track Calcifications
Atopic Dermatitis / Eczema
- Pruritic Vesicles
- Inflammatory Skin Rash
- Cheeks in Children
- Skin Flexural Areas
- Associated with Asthma and Allergic Rhinitis
- Tacrolimus
- Moisturizers
- Corticosteroids
- Phototherapy
- Avoid Triggers
- Antihistamines
Moraxella catarrhalis
- Gram-Negative
- Diplococci
- Oxidase-positive
- Catalase-positive
- Otitis Media
- Sinusitis
- Chronic Obstructive Pulmonary Disease (COPD)
- Bronchitis
- Laryngitis
Haemophilus influenzae Characteristics
- Gram-Negative
- Coccobacilli
- PRP Capsule in Type B
- Positive Quellung Reaction
- IgA Protease
- Chocolate Agar
- Factor V is NAD
- Factor X is Hematin
- Staph Aureus Provides Factor V
Haemophilus Influenzae Disease
- Pneumonia
- Cherry Red Epiglottitis
- Meningitis
- Otitis Media
- COPD Exacerbation
- Thumbprint Sign (on X-ray)
- Rifampin Prophylaxis
- Ceftriaxone
Clindamycin
- Bacteriostatic
- Binds 50S Ribosomal Subunit
- Blocks Translocation
- Anaerobic Infections above the Diaphragm
- Aspiration Pneumonia
- Lung Abscess
- Can Cause Pseudomembranous Colitis
Otitis Media Assessment
- Red or Bulging Tympanic Membrane
- Ear Pain
- Pulling at Ear
- Fever
- Upper Respiratory Infection
- More Common in Young Children
- Eustachian Tube Narrower
- Conductive Hearing Loss
- Smoking Increases Risk
Otitis Media Interventions
- Antipyretics
- Analgesics
- Antibiotics
- Irrigation
- Position on Affected Side
- Myringotomy
- Tympanostomy Tube
Ampicillin and Amoxicillin
- Aminopenicillin
- Broad Spectrum Penicillin
- Gram-Positive and Some Gram-Negative Infections
- Rash
- Diarrhea
- No Effect Against Staph Aureus
- Often combined with Beta Lactamase Inhibitor
- Allergic Reaction
Cephalosporins Overview
- Beta lactam drug
- Inhibits cell wall synthesis
- Bactericidal
- Hypersensitivity reactions
- Vitamin K Deficiency
- Disulfiram like reaction with Alcohol
- Increased Nephrotoxicity of Aminoglycosides
3rd Generation Cephalosporin
- Cefotaxime
- Ceftriaxone
- Cefdinir
- Ceftazidime
- Pseudomonas
- Serious Gram-Negative Bacteria Resistant to Other Beta-Lactams
5th Generation Cephalosporin
- Beta-Lactam
- Resistant Bacteria
- Broad Spectrum Gram-Positive and Gram-Negative
- Ceftobiprole
- Has Pseudomonas Coverage
- Ceftaroline
- No Pseudomonas Coverage
Fluoroquinolones Antibiotics
- -floxacin
- Inhibits Topoisomerase II & IV
- Bactericidal
- Gram-negative Rods
- Pneumonia
- Gastrointestinal Infections
- Urinary Tract Infection
- Genital Infections
- Levofloxacin
- Ciprofloxacin
- Has Pseudomonas Coverage
- Avoid Polyvalent Cations
1st Generation Cephalosporin
- Cefazolin
- Cephalexin
- Proteus mirabilis
- E. coli
- Klebsiella
- Gram-Positive Cocci
2nd Generation Cephalosporin
- Cefoxitin
- Cefaclor
- Cefuroxime
- Proteus mirabilis
- E. coli
- Klebsiella
- Gram-Positive Cocci
- Haemophilus influenzae
- Enterobacter
- Neisseria
- Serratia marcescens
4th Generation Cephalosporin
- Cefepime
- Increased Activity Against Gram-Positive Infections and Pseudomonas
Infectious Mononucleosis
- Herpes-like Viral Infection
- Fatigue
- Fever
- Sore Throat
- Head and Body Aches
- Hepatomegaly and Splenomegaly
- Swollen Lymph Nodes in Neck and Armpits
- Rash
- Suppressed Immune Response
- Positive Monospot
Rubeola Virus
- RNA Virus
- Paramyxovirus
- Measles
- Rash Spreads From Head to Toe
- Koplik Spots First
- Red Spots with Blue-White Center on Buccal Mucosa
- Cough
- Coryza
- Conjunctivitis
- Subacute Sclerosing Panencephalitis
- Giant Cell Pneumonia in Immunosuppressed Patients
- Warthin-Finkeldey Multinucleated Giant Cells
- Vitamin A
Roseola
- Exanthem
- Herpesvirus 6
- Enveloped
- Double Stranded DNA
- Linear
- High Fevers Can Lead to Seizures
- Diffuse Macular Rash After Fever
Kawasaki Disease
- Prevalent in Asian Children
- Necrotizing Vasculitis
- Fever
- Strawberry-Red Tongue and Mucosa
- Lymphadenopathy
- Desquamative Skin Rash
- Erythema and Edema of the Hands and Feet
- Conjunctivitis
- Coronary Aneurysm
- Intravenous Immunoglobulin (IVIG)
- Aspirin
Asthma
- Obstructive lung disease
- Bronchial Hyperresponsiveness
- History of Atopic Disease
- Beta2 agonists
- Corticosteroids
- Curschmann's spirals
- Hypertrophy of smooth muscle
- Reversible
- Charcot Leyden crystals
- Methacholine challenge
- Wheezing
- Cough
- Initially decreased PaCO2
- Pulsus paradoxus
Intermittent Asthma
- Symptoms (Bronchoconstriction) and Rescue Inhaler Use ≤ 2 / Week
- No Interference With ADLs
- Nighttime Awakening < 2 / Month
- > 80 % of Predicted FEV1
Persistent Mild Asthma
- Symptoms (Brochoconstriction) and Rescue Inhaler Use > 2 Days / Week
- Nighttime Awakening 3-4 / Month
- Greater or equal to 80 % of Predicted FEV1
Persistent Moderate Asthma
- Symptoms (Bronchoconstriction) and Rescue Inhaler Use Daily
- Nighttime Awakening > 1 / Week
- 60-80% Predicted FEV1
- FEV1/FVC Decreased 5%
Persistent Severe Asthma
- Symptoms (Bronchoconstriction) and Rescue Inhaler Use: Multiple/ Day
- With Minimal Activity
- Nighttime Awakening: Nightly
- < 60% Predicted FEV1
- > 5% Decrease FEV1/FVC
Stages of Asthma Treatments
- Short-acting Inhaled Beta-Agonist
- Low-Dose Inhaled Corticosteroid
- Montelukast (Leukotriene Receptor Antagonist)
- Low to Medium-dose Inhaled Corticosteroid
- Zileuton
- High-Dose Inhaled Corticosteroid
- Systemic Corticosteroids
- Omalizumab (Allergies)
Asthma Implementation and Education
- Oxygen
- Corticosteroids
- Ipratropium (Anticholinergic)
- Albuterol
- Inhaler/nebulizer
- Pulse Oximetry
- Pursed Lip Breathing
- Carry Inhaler
- Rinse Mouth after Inhaler
- Identify Trigger (Cold Air, Dander, Dust, Infection, Mold, Pollen, Smoke)
Cromolyn (Mast Cell Stabilizers)
- Mast Cell Stabilizer
- Asthma Prophylaxis
- Bronchial Inflammation
- Allergic Rhinitis
- Cough
- Bronchospasm
- Fixed Schedule Administration
Montelukast (Singulair)
- Leukotriene Receptor Blocker
- Allergic Rhinitis
- Asthma Prophylaxis
- Exercise Induced Bronchospasm
- Fatigue
- Headache
- Mood Changes
- Suicidal Thoughts
- Increased Risk of Churg Strauss
Theophylline
- Asthma
- Inhibits Phosphodiesterase
- Increases cAMP
- Cardiotoxicity
- Neurotoxicity
- Blocks Adenosine Action
Gastroenteritis
- Viruses
- Bacteria
- Food Intolerances
- Flu-Like Symptoms
- GI Distress
- Bloody Stool
- Oral Rehydration
- Self-Limiting
- Prevention
Albuterol (Proventil)
- Short-Acting Beta-2 Agonist
- Bronchospasm
- Asthma
- Angina
- Tachycardia
- Tremor
Kallman Syndrome
- Mutation in KAL-1 or FGFR-1 Gene
- Failure of GnRH Secreting Neurons
- Delayed Puberty
- Anosmia
- Hypogonadism
- Infertility
Ventricular Septal Defect (VSD)
- Opening at Intraventricular Septum
- Most Common Congenital Heart lesion
- High-pitched Holosystolic Murmer (over left sternal border)
- Dyspnea and Respiratory Distress
- Loud Pulmonic S2
- Echocardiogram
- Small VSDs Close Spontaneously
- Large VSDs Require Surgery
- Endocarditis
- Eisenmenger's Syndrome
- CHF
Atrial Septal Defect (ASD)
- Hole in Septum between the Atria
- Often Asymptomatic
- Wide and Fixed Split S2
- Cyanosis and Dyspnea
- Easily Fatigued
- Chest X-ray shows Increased Pulmonary Vascular Markings
- Echocardiogram
- Surgery if CHF as Child
- Antibiotic Prophylaxis
- Most Close Spontaneously
Aortic Stenosis
- Age-related Calcifications
- Bicuspid Aortic Valve
- Crescendo-decrescendo Murmur
- Systolic Murmur
- Ejection Murmur
- Ejection Click
- Radiates to Carotids and Apex
- Pulsus Parvus et Tardus
- Syncope
- Helmet Cells
Patent Ductus Arteriosus
- Continuous
- Machine like murmur
- Often Due to Congenital Rubella
- Prematurity
Sepsis Assessment
- Systemic Infectious Process
- Fever
- Hypotension
- Change in LOC
- Increased WBC
- Shift to the Left
- Tachycardia
- Tachypnea
- Hyperglycemia
- Edema
Ibuprofen (Advil, Motrin)
- NSAID
- COX Inhibitor
- General Pain
- Fever
- Inflammatory Conditions
- GI Ulcers
- Nephrotoxicity
- Rash
- Avoid with Alcohol
- Risk of Thrombotic Event
Common Causes of Meningitis: Children (6 Months - 6 Years)
- Enteroviruses
- Neisseria meningitidis
- Haemophilus influenzae Type B
- Streptococcus pneumoniae
Common Causes of Meningitis: Adolescent and Adult (6 - 60 Years Old)
- Enteroviruses
- Herpes Simplex Virus (HSV)
- Neisseria meningitidis (#1 Cause in Teens)
- Streptococcus pneumoniae
Common Causes of Meningitis: Elderly (60+ Years Old)
- Streptococcus pneumoniae
- Gram-Negative Rods
- Listeria Monocytogenes
Aspirin
- Fever
- Pain and Headache
- Cardiovascular Disease (CAD)
- Irreversible inhibition of COX-1 and COX-2
- Suppress Thromboxanes and Prostaglandins
- NSAID
- Reye's Syndrome
- Tinnitus
- Peptic Ulceration
- Mixed Acidosis/Alkalosis
- Nephropathy
Common Causes of Meningitis: Newborn (0-6 Months)
- Group B Streptococci
- E. coli
- Listeria monocytogenes
Aspirin Poisoning (Salicylism) Assessment
- Nausea and Vomiting
- Tinnitus
- Confusion
- Hyperventilation
- Respiratory Alkalosis
- Metabolic Acidosis
- Coma
- Hyperthermia
Meningitis Assessment
- Nausea and Vomiting
- Fever
- Nuchal Rigidity
- Severe Headache
- Purpura
- Seizures
- Photophobia
- Opisthotonus Position
- High-Pitched Cry
- Bulging Fontanel
Meningitis Interventions
- IV Antibiotics
- Dexamethasone
- Analgesics
- Antipyretics
- Closely Monitor for Increased ICP
- Bed Rest
- Preventative Vaccinations
- Droplet-Airborne Precautions
Streptococcus Pneumoniae Characteristics
- Gram-Positive
- Diplococci
- Lancet-Shaped
- Catalase-Negative
- Optochin-Sensitive
- Bile Soluble
- Alpha-Hemolytic
- Polysaccharide Capsule
- Positive Quellung Reaction
- IgA Protease
Common Causes of Pneumonia: Neonates (< 4 Weeks Old)
- Group B Streptococci
- E. coli
Streptococcus Pneumoniae Disease
- Sickle Cell Anemia
- Sepsis in Patients with Splenectomy
- Rusty Sputum
- MOPS
- Meningitis
- Otitis Media
- Pneumonia
- Sinusitis
Common Causes of Pneumonia: Children (4 Weeks - 18 Years)
- Runts May Cough Chunky Sputum
- RSV (Viruses)
- Mycoplasma
- Chlamydia pneumoniae
- Chlamydia trachomatis
- Streptococcus pneumoniae
Common Causes of Pneumonia: Adults (18 - 40 Years Old)
- Mycoplasma
- Streptococcus pneumoniae
- Chlamydia pneumoniae
Common Causes of Pneumonia: Elderly (65+ Years Old)
- Influenza Virus
- Haemophilus influenzae
- Anaerobes
- Streptococcus pneumoniae
- Gram-Negative Rods
Common Causes of Pneumonia: Middle-Aged Adults (40 - 65 Years Old)
- Streptococcus pneumoniae
- Mycoplasma
- Haemophilus influenzae
- Anaerobes
- Viruses
Bordetella pertussis
- Gram-Negative
- Coccobacillus
- Bordet-Gengou Agar
- ADP Ribosylating AB Toxin
- Inhibits Gi to cause Increase in cAMP
- Lymphocytosis
- Increase in Insulin
- Catarrhal Phase is Infectious Period
- Paroxysmal Phase is Symptomatic Period
- Whooping Cough
- Macrolides
Trimethoprim
- Bacteriostatic
- Inhibits Bacterial Dihydrofolate Reductase
- Causes Sequential Block of Folate Synthesis
- Used in Combination with Sulfamethoxazole
- Combination Used For Recurrent Urinary Tract Infections
- Shigella
- Salmonella
- Pneumocystis Jiroveci Pneumonia
- Decrease in Red and White Blood Cells
- Alleviated with Leucovorin Rescue