Altered Mental Status/Dementia/Delirium

Question 1

awake, aware of surroundings, responds appropriately

Answer 1

Alert

Question 2

Lethargic

Answer 2

not fully alert, drifts off to sleep when not stimulated. Awarenesss limited, unable to pay close attention. Loses train of thought

Question 3

Obtunded

Answer 3

difficult to arouse
confused
constant stimulation to elicit minimal cooperation

Question 4

Stuporus

Answer 4

requires persistent vigorous stimulation to rouse

When aroused, will moan or mumble

Question 5

Coma

Answer 5

unarouseable
Unresponsive to stimuli (eg. reflexes)
GCS<8

Question 6

What is the most common electrolyte disorder that will cause delirium?

Answer 6

hyponatremia

Question 7

What type of injury is considered when there is little/no sphincter tone?

Answer 7

spinal cord injury

Question 8

What is the treatment for delirum (aside from removing underlying cause)?

Answer 8

SNOT

Sugar
Naloxone
Oxygen
Thiamin (Vitamin B1) 
              -*give before glucose to prevent wernicke's encephalopathy

Question 9

What is pathognomonic with a salicylate toxicity?

Answer 9

metaboic acidosis, respiratory alkalosis

Question 10

In ethylene glycol overdose what is a characteristic finding on UA?

Answer 10

calcium oxalate crystals

Question 11

What is the treatment for CO poisoning?

Answer 11

100% oxygen

Question 12

GCS score: eyes open in response to pain, inappropriate response with discernable words, decorticate posturing?

Answer 12

2+3+3= 8!

Question 13

GCS score: eyes open spontaneously, confused but can answer questions, obeys commands

Answer 13

4+4+6 = 14

Question 14

GCS score: eyes open to verbal, indiscernable mumbling, responds to pain with purposeful movement

Answer 14

3+2+5 = 10

Question 15

GCS score: eyes open to pain, inappropriate response with discernable words, withdraws from pain

Answer 15

2+3+4 = 9

Question 16

GCS score: eyes open spontaneously, confused but able to answer question, responds to pain with purposeful movement

Answer 16

4+4+5=13

Question 17

After what age do you need to periodically screen for Dementia with a mini mental exam?

Answer 17

70+

Question 18

What is the treatment for dementia with lewy bodies?

Answer 18

memantine

Question 19

What are 4 pharmacologic therapies to consider for alzheimers?

Answer 19

1. Cholinesterase inhibitors
   ex. Donepezil (if mild)
   Rivastigmine
2. Memantine (moderate to severe)
   -blocks the effect of excess glutamate