2. Confusion

Question 1

What 6 syndromes can cause confusion?

Answer 1

Delirium
Dementia
Mental impairment
Psychosis
Receptive Dysphasia
Expressive Dysphasia

Question 2

What is delirium?

Answer 2

An acute impairment in cognitive ability with impaired consciousness

Question 3

What is dementia?

Answer 3

Chronic progressive cognitive impairment with intact consciousness

Question 4

What are the 10 components of AMTS?

Answer 4

What time is it?
What year are we in?
How old are you?
What building are you in?
Who am I? Who is that person (e.g nurse)?
What is your date of birth?
What year did WW2 end?
Who is the current PM?
Please count from 20 to 1
Can you remember the address I told you? (tell address at start)

Question 5

What are 2 common infectious causes of confusion?

Answer 5

chest infection

urinary infection

Question 6

Name a neoplastic cause of confusion

Answer 6

brain tumour

Question 7

Name 2 traumatic causes of confusion

Answer 7

Subdural haematoma

Extradural haematoma

Question 8

Name 3 drugs that may cause confusion

Answer 8

Diuretics
Digoxin
Thyroid medication

Question 9

What are some of the signs of sepsis on examination?

Answer 9

Chest: dull percussion, crackles + bronchial breathing
Urine: suprapubic tenderness, cloudy urine
Cellulitis: red + warm
Meningitis: neck stiffness, photophobia + purpuric rash

Question 10

What 3 investigations may you request for someone who presented with confusion?

Answer 10

Septic screen
Metabolic screen
ECG

Question 11

What is mental impairment?

Answer 11

Permanent impairment of cognitive ability

Question 12

What is psychosis?

Answer 12

Disorder of thought content/ perception (hallucination/ delusion)

Question 13

What is receptive dysphasia?

Answer 13

Difficulty comprehending questions (Wernickes area damaged)

Question 14

What is expressive dysphasia?

Answer 14

Difficulty verbalising an answer to questions (Brocas area damaged)

Question 15

List 5 metabolic causes of confusion

Answer 15

Hypoxia
Hyercapnia
Hypoglycaemia
Hypercalcaemia
Sodium/ other electrolyte imbalance

Question 16

List 4 causes of confusion that present with dilated, sluggish pupils

Answer 16

Drug overdose e.g. cocaine, TCAs
Severe hypoxia
Hypothermia
Postictal

Question 17

List 2 causes of confusion that present with pin point, sluggish pupils

Answer 17

Opiate OD

Barbituate OD

Question 18

What 8 signs should be looked for in a confused patient?

Answer 18

Consciousness
Septic focus
Pupils
Focal neurological signs
Needle track marks: IV drug abuse
Asterixis: Hypercapnia, Hepatic encephalopathy, uraemia
Breath for alcohol
Bitten tongue: Seizure