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Oxford Clinical Cases > Confusion > Flashcards

Flashcards in Confusion Deck (18)
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1

syndromes that can make a patient appear confused

delirium
dementia
mental impairment
psychosis
receptive dysphasia
expressive dysphasia

2

history taking

abbreviated mental test score
mini mental state exam
confusion assessment method
montreal cognitive assessment
can they follow a three step command?
can they name three common objects?
ascertain as much information if they are accompanied

3

differentials of confusion

INVITED MD
I - infectious
N - neoplastic
V - vascular
I - immune
T - trauma
E - endocrine
D - drugs
M - metabolic
D - degenerative conditions

4

infectious causes

chest
brain abscess
urinary
encephalitis
sepsis

5

immune causes

neuropsychiatric lupus
hashimotos encephalopathy

6

trauma causes

sub/extra dural heamatomas

7

drugs causes

intoxication/withdrawl from alcohol
opiates
psychiatric medications
diuretics
digoxin
thyroid medication

8

metabolic causes

hypoxia
hypercapnia
hypoglycaemia
hypercalcaemia
sodium electrolyte imbalance
thiamine deficiency
folate deficiency
b12 deficiency

9

Examination

vital signs
consciousness - GCS
sepsis focus
pupils
drug abuse - track marks
focal neurological signs

10

Investigations

septic screen - FBC, CRP, blood cultures, urine analysis, CXR
metabolic screen - ABG, U+E, thyroid function, liver enzymes, thiamine and folate
toxicology screen
ECG

11

sedation

haloperidol
lorazepam

12

alcohol withdrawal

alcoholics are at high risk of wernickes encephalopathy, can lead to irreversible brain damage
chlordiazepoxide and thiamine treatment for withdrawal

13

post-operative confusion

hypoxia
opiates
electrolyte imbalance
infection
sleep loss
alcohol withdrawal

14

lithium toxicity

lithium is used to treat bipolar
high levels in the serum can lead to confusion

15

meningococcal meningitis

can present with headache, photophobia, neck stiffness, rash
high WCC, protein >1g/L, blood glucose<0.5 in CSF

16

opiate overdose

pin point pupils
respiratory depression

17

cocaine overdose

dilated pupils
sinus tachycardia
hypotension
pyrexia
urinary retention
respiratory depression

18

TCA overdose

dilated pupils
sinus tachycardia
brisk reflexes
urinary retention
dry mouth
drowsiness