Kathryn Shared "Test 1: 450" - 43 Picmonics
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Test 1: 450
Diagnosis of Autism Spectrum Disorder
- Deficit of 3 Social Communication Skills
- Deficit of Social/Emotional Reciprocity
- Deficit of Nonverbal Communication
- Deficit of Social Relationships
- Presence of Repetitive Behaviors
- Repetitive Motions, Speech
- Excessive Adherence to Routine
- Fixed Interests
- Hypo/Hypereaction to Sensory Input
- Hereditary
- No Eye Contact
- Failure to develop a social smile
- Use of Parent's Hand
- IQ - predictor
Delirium
- Mechanism
- Rapid Onset
- Reversible
- Assessment
- Hallucinations
- Decline in Cognition
- Short Attention Span
- Rapid Speech
- Change in Activity Level
- Mood Swings
2 mins
Delirium Management
- Etiology
- Medications
- Abuse Withdrawal
- Metabolic
- Infections
- Investigations
- Complete Blood Count (CBC)
- Electrolyte Abnormalities
- Glucose
- Renal Disorders
- Thyroid
- Urine Analysis
- Toxicology
- AST/ALT Ratio
- Chest X-Ray
- Management
- Treat Underlying Cause
- Safe Environment
- Reassure Patient with Anxiety
- Antipsychotics
- Avoid Benzo
Delerium and Dementia
- Delerium
- Waxing and waning consciousness
- Hallucinations (often visual)
- Cognitive Dysfunction
- Disturbance in sleep-wake cycle
- Secondary to other illness
- Abnormal EEG
- Dementia: Impairment in one or more cognitive domains
- Normal LOC
- Normal EEG
- Dementia can be secondary to hypothyroidism, B12 deficiency
- 1) Complex attention
- 2) Executive Function (planning, decision making)
- 3) Learning/Memory
- 4) Language
- 5) Perceptual-motor ability
- 6) Social cognition
Alcohol and benzodiazepines withdrawl
- examination
- Seizures
- Tachycardia
- Palpitations
- symptoms
- benzodiazepines
- Tremors
- Anxiety
- Perceptual Distortion
- Psychosis
- Insomnia
- alcohol
- Delirium
Delirium Risks and Causes
- Older Adult
- Malnutrition
- Sleep Deprivation
- Dementia
- Anticholinergics
- Opioids
- Benzodiazepines
- Constipation
- Haloperidol (Haldol)
- Atypical Antipsychotics
- Reverse Weekdays Test
- Active Infection
Signs of Inflammation
- Heat
- Redness
- Swelling
- Pain
- Loss of Function
- Chronic Inflammation
- Neutrophils in Acute Inflammation
- Macrophages, lymphocyes, plasma cells - chronic phase
- Tissue Injury
- Return To Normal: 2-3 Days
- Edema
Triggers of Acute Inflammation
- Infection
- Trauma
- Tissue Necrosis
- Immune Reactions
- Foreign Body
Acute Pancreatitis Assessment
- Mechanism
- Heavy Alcohol Use and Gallstones
- Signs and Symptoms
- Abdominal Pain
- Nausea/Vomiting/Anorexia
- Abdominal Rigidity/Guarding
- Decreased or Absent Bowel Sounds
- Hypotension and Tachycardia
- Jaundice
- Increased White Blood Cells
2 mins
Acute Pancreatitis Interventions
- NPO with NG Tube to Suction
- Pain Management
- Albumin
- Lactated Ringers Solution
- Proton Pump Inhibitor (PPI)
- Antibiotics
- Surgery
- Nutrition
2 mins
Treatment of Chronic Pancreatitis
- Nonoperative
- NPO
- H2 Blockers and Pancreatic enzymes together
- Narcotic analgesics
- Insulin
- Operative
- Pancreaticojejunostomy/whipple
Acute Pancreatitis Causes
- "GET SMASHHED" Mnemonic
- Gallstones
- (Ethanol) Alcohol
- Trauma
- Steroids
- Mumps
- Autoimmune
- Scorpion Sting
- Hypercalcemia
- Hypertriglyceridemia > 1000
- ERCP
- Drugs
1 min
severe pancreatitis
- Cullen Sign
- Grey-Turner sign
- Risk Factors
- Age 75 + (+2)
- Obesity
- Alcoholism
- C-reactive protein >150 mg/dl at 48 hours after presentat1on
- incr BUN
- pulmonary infiltrates or pleural effusion
Pancreas
- Characteristics
- Acinar Cells Release Digestive Enzymes
- Ductal Epithelial Cells Release Bicarbonate
- Islets of Langerhans
- Beta Cells Release Insulin
- Alpha Cells Release Glucagon
- Delta Cells Release Somatostatin
- Somatostatin Inhibits Alpha and Beta Cells
3 mins
Pancreatic secretions
- Isotonic fluid
- Low flow → high Cl−
- High flow → high HCO3 −
- α-amylase
- Starch digestion
- Secreted in active form
- Lipases
- Fat digestion
- Proteases
- Protein digestion
- Includes trypsin, chymotrypsin, elastase, carboxypeptidases
- Secreted as proenzymes also known as zymogens
- Trypsinogen
- Converted to active enzyme trypsin, leading to activation of other proenzymes and cleaving of additional trypsinogen molecules into active trypsin (positive feedback loop)
- Converted to trypsin by enterokinase/ enteropeptidase, a brush-border enzyme on duodenal and jejunal mucosa
- nucleases
- Pancreatic Nucleases breakdown DNA/RNA
Biliary structures
- Gallstones (filling defects, red arrows in A ) that reach the confluence of the common bile and pancreatic ducts at the ampulla of Vater can block both the common bile and pancreatic ducts (double duct sign), causing both cholangitis and pancreatitis, res
- Tumors that arise in head of pancreas (usually ductal adenocarcinoma) can cause obstruction of common bile duct ÂŽ painless jaundice.
Diagnosis and Treatment of Acute Pancreatitis
- Diagnostic Workup
- Lipase is preferred test
- CT scan if lipase inconclusive but still suspect pancreatitis
- Ultrasound or ERCP to look for gall stones
- Order LFTs
- Determine Ranson Criteria
- Treatment
- Nasojejunal (J tube) NOT TPN
- IV Fluids (LRS)
- Analgesics
- Avoid narcotics
- Complications
- Pancreatic Pseudocyst
- CT to diagnose
- Drain if over 6cm AND 6 weeks old
- Infection
- CT and biopsy
- Empiric meropenem
- ARDS
- Shock (due to leaky capillaries)
- Antibiotics IF cultures positive, NO PPX
Duodenum
- Covered by Brush Border Enzymes
- Cholecystokinin
- SOURCE: I cells (duodenum, jejunum)
- ACTION: Increase pancreatic secretion
- Increase gallbladder contraction
- Decreases gastric emptying
- Increases sphincter of Oddi relaxation
- REGULATION: Increased by fatty acids and amino acids
- Acts on neural muscarinic pathways to cause pancreatic secretion.
- Secretin
- SOURCE: S cells (duodenum)
- ACTION: Increases pancreatic HCO3 – secretion
- Decreases gastric acid secretion
- Increases bile secretion
- REGULATION: Increased by acid, fatty acids in lumen of duodenum
- Increased HCO3 – neutralizes gastric acid in duodenum, allowing pancreatic enzymes to function.
- Glucosedependent insulinotropic peptide (GIP)
- SOURCE: K cells (duodenum, jejunum)
- ACTION: Exocrine: Decreases gastric H+ secretion
- Endocrine: increases insulin release
- REGULATION: Increased by fatty acids, amino acids, oral glucose
- BICARBONATE
- SOURCE: Mucosal Cells and Brunner Glands
Dementia
- Alzheimer's Dementia (neurofibrillary tangles: hyperphosphorylated intracellular tay protein)
- Pick's Disease (frontotemporal dementia + atrophy): aphasia + personality changes + parkinsonian features + spherical tau protein
- Lewy Body Dementia (dementia + visual hallucinations --> parkinsonian features)
- Prion Disease (spongiform cortex + myoclonus + rapidly progressive dementia)
Dementia
- Reversible Causes
- B12 Deficiency
- Syphilis
- Do RPR
- Subdural Hematoma
- CT
- Hypothyroidism
- Cirrhosis
- Do LFTs
- Depression (pseudodementia)
- Normal Pressure Hydrocephalus
- CT
- Symptoms improve with lumbar puncture
- Irreversible Causes
- Alzheimer's
- Pick's Disease
- Creutzfeldt-Jakob Disease
- Lewy Body Dementia
- Vascular Dementia
- Step-wise decrease in function
- CT
