CHAPTER 24 CONFUSION AND DELIRIUM

Question 1

it is a mental and behavioral state of reduced comprehension, coherence and capacity to reason

Answer 1

confusion

Question 2

acute state of confusion

Answer 2

delirium

Question 3

terms used to describe px with delirium

Answer 3

encephalopathy
acute brain failure
acute confusional state
postoperative ICU psychosis

Question 4

what is the hallmark of delirium

Answer 4

attention deficit

Question 5

associated symptoms of delirium

Answer 5

altered sleep wake cycle
perceptual disturbances such as hallucinations or delusions
affect chages
autonomic findings such as heart rate and blood pressure instability

Question 6

what are the two subtypes of delirium

Answer 6

hyperactive and hypoactive

Question 7

example of hyperactive delirium

Answer 7

severe alcohol withdrawal (delirium tremens)

Question 8

characteristics of severe alcohol withdrawal

Answer 8

hallucinations
agitations
hyperarousal

Question 8

characteristics of severe alcohol withdrawal

Answer 8

hallucinations
agitations
hyperarousal

Question 9

example of hypoactive subtype

Answer 9

benzodiazepine intoxication

Question 10

characteristics of hypoactive

Answer 10

withdrawn
quiet
prominent apathy
psychomotor slowing

Question 11

risk factors for delirium

Answer 11

older age >65
low baseline cognitive dysfunction
sensory deprivation
malnutrition
underlying medical and neurologic illness

Question 12

what population that delirium is most common

Answer 12

elderly px undergoing hip surgery

Question 13

pathogenesis of delirium

Answer 13

attention deficit due to diffuse localization within the brainstem, thalamus, prefrontal cortex and parietal lobes,

Question 14

neurotransmitters that has a role in delirium

Answer 14

acetylcholine and dopamine

Question 15

anticholinergic medications can cause delirium

Answer 15

true

Question 16

alzheimer’s disease, dementia with lewy bodies and parkinsons disease dementia are all associated with cholinergic deficiency due to degeneration of acetylcholine producing neurons in basal forebrain

Answer 16

true

Question 17

criteria in Confusion Asessment method

Answer 17

acute onset and fluctuating course

inattention accompanied by either disorganized thinking or an altered level of consciouness

Question 18

a course that fluctuates over hours and days and worsen during the night

Answer 18

sundowning

Question 19

what are the three most important pieces of history in px with delirium

Answer 19

patient’s baseline cognitive function
time course of the present illness
current medications

Question 20

most common cause of delirium

Answer 20

medications such as compounds with anti-cholinergic or sedative properties

Question 21

what to include in physical examination of px with delirium

Answer 21

screen for signs of infections such as fever, tachypnea, pulmonary consolidation, heart murmur and meningismus

Question 22

signs that signify attentional problem

Answer 22

tangential speech
fragmentary flow of ideas
inability to follow complex commands

Question 23

how to test for neuropsychological aspect of the px

Answer 23

use the digit span forward

Question 24

how do you do the digit span?

Answer 24

patients are asked to repeat successively longer random strings of digits beginning with 2 digits in a row
example: say 4-3 and repeat after me

Question 25

result of digit span with delirium

Answer 25

falters <3 digits

Question 26

result of digit span in normal healthy adult

Answer 26

7 digits before faltering

Question 27

result of confusion assessment in px with delirium

Answer 27

positive for feature 1 (acute onset and fluctuating course) and feature 2 (inattention)

Question 28

another test to use in assessing px with delirium that provides information regarding orientation, language, and visuospatial skills

Answer 28

mini-mental status examination

Question 29

cause of delirium in younger patients

Answer 29

illicit drugs and toxins and alcohol abuse

Question 30

how do infections can cause delirium such as septic encephalopathy most commonly seen in ICU

Answer 30

due to the release of proinflammatory cytokines which has diffuse cerebral effects

Question 31

what do you call the onset of delirium at the end of life in palliative care settings

Answer 31

terminal restlessness