Altered Mental Status

Question 1

A Glasgow coma scale of 8 indicates what action?

Answer 1

Intubate the patient as they cannot protect their own airway

Question 2

What does the acronym ABCDEF stand for in the emergency management of a patient with AMS?

Answer 2

Airway, breathing, circulation, disability, environment, fingerstick

Question 3

What does the acronym AEIOU-TIPS stand for in considering differential diagnosis in a patient with AMS?

Answer 3

Alcohol, electrolytes, insulin, opiates/oxygen, uremia, trauma, infection, poison, shock/stroke/seizure

Question 4

A 79y/o patient presents to the ER with sudden AMS from his home. He talks about seeing someone in the room that isn’t there, and his children tell you he’s a professor at a local college who has normal daytime functioning and has had spells like this in the evenings before. His vitals and PE are unremarkable. What is the likely dx?

Answer 4

Delirium: This usually has a sudden onset of combative or confused behavior in an otherwise normal functioning person; can happen in geriatric PT at night (sun downing)

Question 5

A patient experiences >5 minutes of continuous seizures or >2 seizures in between which they don’t regain consciousness. What is the dx?

Answer 5

status epilepticus

Question 6

A patient presents with sensation of movement when there is none, what is the likely dx?

Answer 6

vertigo

Question 7

What are the two classifications of vertigo?

Answer 7

Peripheral caused by the 8th cranial nerve
Central involving the cerebellum or brainstem

Question 8

What are the two classifications of strokes?

Answer 8

Ischemic: lack of blood
Hemorrhagic: brain bleed

Question 9

There are two types of ischemic strokes. What are they and define them?

Answer 9

Embolic: when a clot comes from somewhere else in the body and gets to the brain;

Thrombotic: a clot that forms in the arterial supply of the brain

Question 10

This type of ischemic stroke is painless, causes sudden neuro deficits, and comes on in an instant

Answer 10

Embolic

Question 11

This type of ischemic stroke has gradual onset of sx due to fluctuating hyperperfusion and gradual artery occlusion?

Answer 11

thrombotic

Question 12

What are the two types of hemorrhagic strokes and their definitions?

Answer 12

Intracerebral: bleeding into the brain parenchyma
Subarachnoid: bleeding into the subarachnoid spaces

Question 13

What are the indications for administering thrombolytic therapy in ischemic stroke patients?

Answer 13

• give within 3 H of stroke sx
• Blood pressure must be at least 180
• There cannot be an active bleed

Question 14

What are 3 contraindications to administering thrombolytic therapy to an ischemic stroke pt?

Answer 14

• head trauma in last 3 months
• platelet count <100,00
• active bleed (anywhere, inside or out)
• stroke in last 3 months
• Its been over 3H since onset of stroke sx

Question 15

If a patient presents with a sudden headache, unilateral eye pain, and vision loss you should consider this emergent dx?

Answer 15

angle closure glaucoma

Question 16

If a patient presents to the ED with a headache and fever you should suspect these three emergent causes?

Answer 16

CNS infections: meningitis, encephalitis, brain abscess

Question 17

What three things concerning onset of a headache are considered high-risk?

Answer 17

Sudden onset
onset with trauma
onset after exertion

Question 18

What accompanying sx make a headache a more emergent complaint?

Answer 18

AMS
Fever
Neuro deficits
Seizure
vision changes

Question 19

What are three indications that a patient presenting to the ED with a headache requires imaging?

Answer 19

• Worse headache of life
• HIV with severe headache (infectious cause)
• Different than normal headache
• Neuro deficit
• Headache lasting >3 days
• Vomiting in the morning with regular headaches
• Serious recent or past trauma

Question 20

Treatment for Idiopathic intercranial hypertension?

Answer 20

Acetazolamide

Question 21

Treatment for temporal arteritis?

Answer 21

prednisone

Question 22

Treatment for cluster headache?

Answer 22

oxygen, then sumatriptan in O2 doesn’t help

Question 23

If you suspect a patients seizures are from a toxin, what is the treatment?

Answer 23

benzos or barbituates

Question 24

What are the three categories in which AMS is organized into? How can you differentiate them by onset and progression of course?

Answer 24

Delirium: rapid onset, course fluctuates (okay now, not okay later)
dementia: slow onset and very progressive course (slow, overtime)
psychosis: variable onset and course; can be unpredictable especially if undiagnosed or off meds

Question 25

A patient experiencing disturbing hallucinations, with normal vitals and who is alert and oriented to a normal level is likely experiencing what categorization of AMS?

Answer 25

psychosis