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year 3 (term 1) - oxford clinical cases > 2. Confusion > Flashcards

2. Confusion Flashcards

1
Q

What syndromes can cause confusion?

A
  • Delirium
  • dementia
  • mental impairment
  • psychosis
  • dysphasia
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2
Q

What is delirium?

A

An acute impairment in cognitive ability together with impaired consciousness

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3
Q

What is dementia?

A

Chronic progressive cognitive impairment with intact consciousness

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4
Q

what is mental impairment?

A

a permanent impairment in cognitive ability.

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5
Q

what is psychosis?

A
  • when the patient is hallucinating due to deranged personality and loss of contact with reality
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6
Q

what is receptive dysphasia?

A
  • the patient might have difficulty understanding questions due to damage of Wernicke’s area of the breain
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7
Q

what is expressive dysphasia?

A
  • when the patient is cognitively intact but has difficulty verbalising answers to questions
  • damage to brocas area of the brain
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8
Q

examples of tests given to confused people?

A
  • AMTS (6/10) - abbreviated mental test score
  • MMSE (26/30) - mini mental state exam
  • CAM - confusion assessment method
  • MOCA - Montreal cognitive assessment
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9
Q

What are the components of AMTS?

A
  • TIME
  • What time is it?
  • What year are we in?
  • How old are you?
  • SPACE
  • What building are you in?
  • PERSON
  • Who am I? Who is that person (e.g nurse)?
  • LONG TERM MEMORY
  • What is your date of birth?
  • What year did WW2 end?
  • Who is the current PM?
  • SHORT TERM MEMORY
  • Please count from 20 to 1
  • Can you remember the address I told you?
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10
Q

key questions to ask anyone accompanying the confused person?

A
  • normal state? (might suggest dementia, psychosis, mental impairment)
  • time course of confusion? ( acute and fluctuating suggests delirium)
  • drug history ( important for dementia)
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11
Q

list of causes of delirium?

and the mnemonic?

A
  • INVITED MD
  • infectious
  • neoplastic
  • vascular - stroke
  • immune - rare conditions such as neuropsychiatric lupus, Hashimoto’s encephalopathy
  • trauma
  • endocrine - thyroid disorders, diabetic ketoacidosis
  • drugs
  • metabolic - electrolyte disbalance
  • degenerative - dementia predisposes delirium
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12
Q

What are infectious causes of confusion?

A

common: chest/ urinary infection
uncommon: encephalitis, brain abscess, sepsis)

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13
Q

What are neoplastic causes of confusion?

A

brain tumour

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14
Q

What are traumatic causes of confusion?

A

Subdural haematoma

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15
Q

What drugs may cause confusion?

A
  • Diuretics, digoxin, thyroid medication
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16
Q

what vital signs should be monitored and why?

A
  • pulse and resp rate: suggests infection
  • blood pressure: might suggests hypoperfusion of the brain
  • oxygen saturation: suggests hypoxia
  • temp: suggests fever therefore infection
  • blood glucose: hypo/hyperglycemia can affect consciousness
17
Q

What are some of the signs of sepsis on examination?

A
  • Chest- bronchial breathing (infection)
  • Urine- suprapubic tenderness
  • Cellulitis - inspect the skin for infection
  • Meningitis- neck stiffness, photophobia, and purpuric rash
18
Q

how to assess consciousness?

A
  • Glasgow coma scale
  • this assesses motor, verbal and eye responses
  • lowest score is 3 = coma
  • highest score is 15

a score lower than or equal to 8 suggests the patient cannot protect their own airway so needs to be intubated

19
Q

further things to examine in confused patients?

A
  • pupils (can suggest overdose)
  • Focal neurological signs (suggesting stroke or a space-occupying lesion)
  • Needle track marks: suggests intravenous (IV) drug abuse.
  • Cherry red lips: occurs in carbon monoxide poisoning
  • Asterixis: hypercapnia
  • bitten tongue: suggests convulsive seizure
20
Q

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

A
  • Septic screen: (FBC, CRP, blood cultures. urine dipstick, chest xray,)
  • Metabolic screen (blood gas, Us and Es, Thyroid function test, liver enzymes, thiamine, folate, and vit.B)
  • ECG
21
Q

how to manage confusion?

A
  • ensure patients are attended
  • make sure they have glasses and hearing aids
  • discontinue non-essential medication causing confusion
  • provide fluids and nutrition
  • as final resort sedation might be necessary
  • haloperidol may be used 30-60 mins onset
  • lorazepam could be used 5-10 mins onset

treat the CAUSE!!

year 3 (term 1) - oxford clinical cases (12 decks)

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