Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Emergency Medicine > Approach to altered mental status > Flashcards

Approach to altered mental status Flashcards

You may prefer our related Brainscape-certified flashcards:
Royal College: Emergency Medicine flashcards
1
Q

What cause does delirium always have?

A

Organic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define delirium

A

difficulty in focusing, shifting or sustaining attention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe confusion of delirium

A

fluctuating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

4 causes of delirium

A
  1. Primary intracranial dz
  2. Systemic dz
  3. Exogenous toxins
  4. Drug withdrawal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Delirium characteristics:

A

Slide 13-note that visual hallucinations are associated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What must be present to diagnose delirium?

A

Findings in history and PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

6 Elements of MSE

A 
Appearance, behavior, and attitude
Disorders of thought
Disorders of perception
Mood and affect
Insight and judgment
Sensorium and intelligence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MMSE elements

A 
Orientation
Registration
Attention and calculation
Recall
Language
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does MMSE not detect?

A

Mild impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Quick confusion scale

A 
Year
Month
Present memory phrase
Time
Count backward
Reverse month
Repeat memory phrase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Advantage of quick confusion scale over MMSE

A

Quicker-no reading, drawing, writing

Correlates well with MMSE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tx of delirium

A

Consider sedation
-Haldol
-Lorazepam
(Reduce haldol if given with benzo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Disposition for delirium

A
  • Admit majority

- Must call internal med

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Define dementia

A

*Loss of mental capacity

Slow, insidious onset*

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

2 Categories of dementia

A

Idiopathic

Vascular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Characteristics of dementia

A

Slide 29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Memory features of dementia

A

Recent affected > long term

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Exaggerated or Asymmetric DTRs, Gait Disturbance, Extremity Weakness =

A

Vascular dementia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What does not determine presence of dementia?

A

General PE

Remember, delirium is determined by PE and hx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What must you remember to consider in dementia?

A

Co-existing causes of delirium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What must be r/o with dementia?

A

Treatable cause or delirium

22
Q

When might you be able to discharge dementia?

A

Stable, reliable caregivers, and prompt f/u AFTER life-threats excluded

23
Q

Definition of coma

A

Pt cannot be aroused

24
Q

GCS

A

Slide 41

25
Q

What condition CANNOT cause coma?

A

Stroke (unilateral hemispheric dz) except uncal herniation

26
Q

Toxic metabolic coma findings (4)

A
  • Diffuse CNS function
  • Lacks focal findings
  • Symmetrical findings
  • Pupillary response preserved
27
Q

What is an ominous finding of CNS malfunction?

A

Abnormal flexion and extension

28
Q

Which type of posturing is worse?

A

Decerebrate worse than decorticate (know positions of limbs; term not important)

29
Q

Decorticate posture

A

arms adducted and flexed, wrists and fingers flexed on chest, legs may be internally rotated and stiffly extended, plantar flexion of the feet

30
Q

Decerebrate posture

A

arms adducted and extended, wrists pronated and fingers flexed, legs may be internally rotated and stiffly extended, plantar flexion of the feet

31
Q

Decerebrate posturing indicates injury where?

A

Brain stem

32
Q

Decorticate posturing indicates injury where?

A

Corticospinal tract

33
Q

Supratentorial mass has what finding?

A

Progressive ipsilateral hemiparesis

34
Q

What does uncal herniation cause?

A

Medial temporal lobe shift-compresses upper brain stem

35
Q

What leads to abrupt coma?

A

Posterior fossa & infratentorial lesions: Cerebellar hemorrhage & infarction

36
Q

What is a unique sign of pontine hemorrhage?

A

Pinpoint pupils

37
Q

What imaging is best for abrupt coma and pinpoint pupils?

A

MRI-everything else is CT first

38
Q

What are findings of pseudocoma or psychogenic coma?

A

Pupillary, EOMs, Muscle Tone, Reflexes ALL intact & symmetric
Patient will resist manual eye opening
“Drop arm” test is positive
Avoidance gaze
Nystagmus with caloric vestibular testing

39
Q

Abrupt onset of coma is caused by:

A

trauma, stroke, seizures, cardiac

40
Q

Slow onset of coma caused by:

A

progressive CNS lesion (tumor, SDH), hyperglycemia

41
Q

PE for diagnosis of coma:

A

Assess vital signs: oxygen saturation & temperature
Look for signs of trauma, toxidrome, etc.
Bedside glucose
Neurological exam

42
Q

What is the goal of coma diagnosis?

A

rapid determination of diffuse vs focal cause of CNS dysfunction

43
Q

Study of choice for coma:

A

CT-bleeding shows white

44
Q

If you think there’s a bleed, but CT is negative, you must do:

A

LP (also when infection suspected)

45
Q

Airway issues when treating coma:

A

Don’t forget to protect the C-spine!

ICP:RSI and maintenance sedation indicated

46
Q

For status epilepticus, what should you do if not better after 30 min or if subtle?

A

Urgent EEG and/or neuro consult

47
Q

What should your treatment for coma be aimed at?

A

Underlying cause-*MUST focus on reversible causes

-Hypoxia, hypoglycemia, hypo-hypertension, hypo-hyperthermia

48
Q

What steps should be performed while taking diagnostic steps?

A

Brain-saving:
Sedate, paralyze and intubate
Elevate head of bed 30 degrees
Mannitol
Hyperventilate-last resort (only in herniation)!
Steroids for tumors, septic shock, spinal cord injury

49
Q

Coma cocktail:

A

D-50% Dextrose (D50) 1 amp IVP after finger stick
O-Oxygen at high flow
N-Naloxone (Narcan) 0.4 to 2 mg IV initially
T-Thiamine 100mg IV: prevents Wernicke’s

50
Q

For suspected seizures when treating coma, give what?

A

Lorazepam or diazepam

51
Q

If head bleed, who do you refer to?

A

Neurosurgery

52
Q

If ischemic stroke, who do you refer to?

A

Neurology

Emergency Medicine (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions