Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Oxford Clinical Cases > Confusion > Flashcards

Confusion Flashcards

1
Q

Define delirium.

A

An acute impairment in cognitive ability with impaired consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define dementia.

A

A chronic, progressive impairment in cognitive ability but with intact consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define psychosis.

A

A disorder of thought content/perceptions (e.g. delusions and hallucinations)
NOTE: the patient may NOT be confused

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define receptive dysphasia.

A

The patient may be cognitively intact but they have difficulty comprehending speech
Due to damage to Wernicke’s area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define expressive dysphasia.

A

The patient may be cognitively intact but have difficulty verbalising answers to questions
Due to damage to Broca’s area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are two important methods of screening confused patients?

A

Are they oriented in time, space and person? Can they tell you why they are there?
Can they follow a three-step command? Can they identify three common objects?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What abbreviated mental test score would indicate that the patient has a cognitive impairment?

A

< 6/10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What MMSE score would indicate that the patient has a cognitive impairment?

A

< 26/30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does three-step command and naming three common objects test?

A

Three-step command – tests for receptive dysphasia

Three common objects – tests for expressive dysphasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If the confused patient has been accompanied by a friend/relative, what are some important details to ascertain?

A 
The patient’s normal state 
Time course of confusion (acute onset is more likely to be delirium)
Drug history (including alcohol) 
NOTE: a fluctuating course is suggestive of delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the five most important and common causes of confusion?

A

Chest infection
UTI
Subdural haematoma
Drugs – diuretics, digoxin, thyroid medication
Sodium and other electrolyte abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Using the surgical sieve, list some other causes of confusion.

A

Infection –CHEST and URINARY, encephalitis, brain abscess, sepsis
Neoplastic – brain tumour
Vascular – stroke, MI causing hypoperfusion
Immune/Inflammatory – neuropsychiatric lupus, Hashimoto’s encephalopathy
Trauma – SUBDURAL HAEMATOMA, extradural haematoma
Endocrine – hypothyroidism, hyperthyroidism, DKA
Drugs –DIURETICTS, DIGOXIN, THYROID MEDICATION intoxication or withdrawal from alcohol, opiates or psychiatric medications
Metabolic –SODIUM AND OTHER ELECTROLYTES hypoxia, hypercapnia, hypoglycaemia, hypercalcaemia, thiamine/folate/B12 deficiencies
Degenerative
HYPOTHERMIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
Explain the importance of checking the following vital signs in a confused patient:
PR + RR
BP
Sats
Temp
BG
A

Pulse and Respiratory Rate
Tachycardia and tachypnea indicates infective process
Blood Pressure
Hypotension can lead to hypoperfusion of the brain  impaired consciousness
Cushing’s response (to raised ICP): high BP + low HR + irregular breathing
Oxygen Saturation
Hypoxia impairs consciousness
Temperature
Fever indicates infection
Hypothermia can cause confusion in elderly patients
Blood Glucose
Hypoglycaemia and hyperglycaemia can depress consciousness
T1DM: hyperglycaemia may be associated with DKA
T2DM: extreme hyperglycaemia may indicate hyperosmolar hyperglycaemia state (HHS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List some key features of examination of a confused patient.

A 
Consciousness
Septic focus 
Pupils 
Focal neurological signs 
Needle track marks 
Asterixis 
Breath
Bitten tongue and posterior shoulder dislocation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe some pathological variations in the pupils of a confused patient.

A

Pinpoint + sluggish to react = opiate or barbiturate overdose
Dilated + sluggish to react = drug overdose (e.g. cocaine or TCA), severe hypoxia, hypothermia, post-ictal
Asymmetrical = could be normal variant (anisocoria), but is rarely suggestive of coning secondary to raised ICP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What would a bitten tongue or a posterior shoulder dislocation suggest?

A

Convulsive seizure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the three divisions of the Glasgow Coma Scale and how many points are allocated to each?

A 
Eyes = 4
Verbal = 5
Motor = 6
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which investigations would be performed to find out whether an infection is the cause of the confusion?

A

FBC – raised WCC
CRP – raised in infection
Blood cultures
Urinalysis – check for features of UTI (leucocyte esterase + nitrites), or DKA (positive glucose + positive ketones)
Urine MC&S
Chest radiograph (check for consolidation caused by chest infection)

19
Q

Which investigations would be performed in a metabolic screen?

A

Blood gas – check hypercapnia, acid-base balance
U&Es – check for electrolyte imbalances
TFTs
Liver Enzymes – hepatic encephalopathy can cause confusion
Thiamine, folate and B12 levels – check whether the patient is malnourished

20
Q

What does disproportionately raised GGT suggest?

A

Alcohol abuse

21
Q

Why is it important to perform an ECG in a confused patient?

A

Exclude ischaemia and arrhythmia that could lead to a low-output state causing hypoperfusion of the brain

22
Q

Describe the management of a confused patient.

A

Resuscitation – assess ABC
Antibiotics – if there is an infectious cause
Conservative measures
Make sure the patient isn’t left unattended
Keep them in a quiet side room if possible
Discontinue non-essential medications
Promote good sleep
Consider providing fluids and nutrition if they are unable or unwilling to maintain a good diet

23
Q

Which sedatives may be used if a confused patient requires sedation?

A

Haloperidol

Lorazepam

24
Q

Describe the management of a patient in alcohol withdrawal.

A

Thiamine is important because it can prevent Wernicke’s encephalopathy
Chlordiazepoxide reduces the symptoms of withdrawal
NOTE: alcohol withdrawal is a medical emergency

25
Q

List some reasons why post-operative patients may be confused.

A 
Hypoxia
Opiates 
Deranged electrolytes 
Infection
Sleep loss 
Alcohol withdrawal
26
Q

Give four reasons why post-operative patients may be hypoxic.

A

PE
Basal atelectasis
Opiates causing respiratory depression
Anaemia from blood loss

27
Q

Give two reasons why surgery can lead to derangement of electrolytes.

A

IV fluids

Renal failure caused by hypoperfusion

28
Q

What is lithium used to treat? Why is it important to check serum lithium levels?

A

Bipolar disorder

It has a narrow therapeutic window and high serum lithium levels can cause confusion

29
Q

Describe the results of a lumbar puncture in a patient with meningococcal meningitis.

A

High WCC
Gram-positive intracellular diplococci
High protein
CSF: blood glucose ratio < 0.5

30
Q

What is pseudohyponatraemia and what can it be caused by?

A

This is an artifact produced by the machine that analysis U&Es in which sodium appears low although it is normal
If sodium is low, plasma osmolality should also be low
Causes of pseudohyponatraemia:
Hyperproteinaemia
Hyperlipidaemia
Hyperglycaemia/mannitol/glycine (associated with HIGH plasma osmolality)

31
Q

List three causes of hyponatraemia associated with hypovolaemia

A

Diarrhoea
Vomiting
Diuretics

32
Q

List three causes of hyponatraemia associated with euvolaemia

A

SIADH
Hypothyroidism
Adrenal insufficiency (can also be in the hypovolaemic category)

33
Q

List three causes of hyponatraemia associated with hypervolaemia

A

Cirrhosis
Cardiac failure
Nephrotic syndrome

34
Q

List some signs and symptoms of diabetic ketoacidosis.

A

Polyuria, polydipsia
Decreased mental state due to hyperglycaemia
Nausea/vomiting
Abdominal pain
Shortness of breath or Kussmaul breathing
Hypotension and tachycardia due to dehydration
Ketotic (fruity) breath

35
Q

Describe features of opiate overdose

A

‘Chill out’
Pinpoint pupils
Respiratory depression
Check for needle track marks

36
Q

Describe features of cocaine overdose

A 
‘Buzz’
Dilated pupils 
Sinus tachycardia
Hypotension 
Pyrexia
37
Q

Describe features of TCA overdose

A

Exert both sympathetic and parasympathetic effects
Sympathetic: dilated pupils, sinus tachycardia, brisk reflexes, and urinary retention
Parasympathetic: dry mouth, drowsiness

38
Q

What triad of symptoms is associated with Wernicke’s encephalopathy?

A

Confusion
Ataxia
Ophthalmoplegia

39
Q

What are the two main symptoms of Korsakoff syndrome?

A

Amnesia

Confabulation

40
Q

AMTS

What are the questions you ask?

A 
Orientate in Time
- What time is it?
- what year is it?
- How old are you?
Orientate in space?
- Where are we?
Orientate in person?
- Who am I?
- Who is she?
Establish long term memory?
- What year where you born in?
- When was the 2  nd world war?
- who is the current prime minister?
Establish short term memory?
- remember the address?
- count backwards from 20 to 1
41
Q

How many points are given to EYES in GCS scale what are they?

A

4

  • open eyes spontaneously
  • open to vocal command
  • opens to pain
  • doesn’t open
42
Q

How many points are given to verbal in GCS scale what are they?

A

5

  • speaks spontaneously
  • talks but not fluently
  • sentences don’t make sense
  • makes noises in response to pain
  • doesn’t verbalise
43
Q

How many points are given to Motor in GCS scale what are they?

A

6

  • move spontaneously
  • localises hands to painful stimulus
  • withdraws from painful stimulus
  • flexes all limbs to painful stimulus
  • extend to all limbs to painful stimulus
  • no movement in response to pain

Oxford Clinical Cases (29 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions