Confusion

Question 1

What syndromes can cause a patient to appear confused (6)

Answer 1

Delirium
Dementia
Mental impairment
Psychosis
Receptive dysphasia
Expressive dysphasia

Question 2

What area is damaged in receptive dysphasia

Answer 2

Wernicke’s area

Question 3

What area is damaged in expressive dysphasia

Answer 3

Broca’s area

Question 4

Damage to Wernicke’s area causes what

Answer 4

Receptive dysphasia

Question 5

Damage to Broca’s area causes what

Answer 5

Expressive dysphasia

Question 6

What topics do the questions of the AMTS cover and how many questions in each area?

Answer 6

Orientation in time 3
Orientation in space 1
Orientation in person 1
Long term memory 3
Short term memory 2

Question 7

What are the questions of the AMTU?

Answer 7

Orientation in time
What time is it (nearest hour)? What year are we in?
How old are you?

Orientation in space
What building are you in?

Orientation in person
Who am I? Who is that person (e.g. nurse)?

Long-term memory
What is your date of birth?
What year did the Second World War end (or alternative date, e.g. particular Olympic Games)? Who is the current Prime Minister?

Short-term memory
Please count backwards from 20 to 1. Can you remember the address I told you?

Question 8

What should you ask for a quick screen of confusion? (7)

Answer 8

AMTS
Can they follow a three step command? (Testing receptive dysphasia)
Can they name three common object? (Testing expressive dysphasia)
Are they in pain?
Breathlessness?
Cough?
Urinary symptoms?
(As a chest or UT infection is the most common cause of confusion)

Question 9

If a confused patient is accompanied by someone else, what should you try ascertain from them? (

Answer 9

Normal state
Time course of their confusion
DHx including alcohol (both introduction and cessation of drugs can induce delirium)

Question 10

What does an acute onset of confusion argue against and for?

Answer 10

An acute onset argues against dementia

and in favour of delirium.

Question 11

INVITED MD

First I causes of confusion? (5)

Answer 11

Infectious (e.g. chest, urinary, encephalitis, brain abscess, sepsis)

Question 12

What mnemonic can help remember causes of confusion?

Answer 12

INVITED MD

Question 13

INVITED MD

N causes of confusion?

Answer 13

Neoplastic (e.g. brain tumour)

Question 14

INVITED MD

V causes of confusion? (2)

Answer 14

Vascular (e.g. stroke, myocardial infarction causing hypoperfusion)

Question 15

INVITED MD

Second I causes of confusion? (2)

Answer 15

Immune (e.g. rare conditions such as neuropsychiatric lupus, Hashimoto’s encephalopathy)

Question 16

INVITED MD

T causes of confusion? (2)

Answer 16

Trauma (e.g. subdural haematoma, extradural haematoma)

Question 17

INVITED MD

E causes of confusion? (3)

Answer 17

Endocrine (e.g. hypothyroidism, hyperthyroidism, diabetic ketoacidosis)

Question 18

INVITED MD

D causes of confusion? (6)

Answer 18

Drugs (e.g. intoxication or withdrawal of alcohol, opiates, or psychiatric medications; or use of diuretics, digoxin, thyroid medication). Drug toxicity accounts for 30% of delirium

Question 19

INVITED MD

M causes of confusion? (7)

Answer 19

Metabolic (e.g. hypoxia, hypercapnia, hypoglycaemia, sodium or other electrolyte imbalances, thiamine, folate, or vitamin B12 deficiencies)

Question 20

INVITED MD

D causes of confusion?

Answer 20

Degenerative conditions. These will be chronic and will not cause the delirium, but they will predispose patients to becoming delirious

Question 21

A cause of confusion that isn’t in INVITED MD?

Answer 21

Hypothermia