Confusion Flashcards
Delirium
Def, causes, ix, mx
Acute, transient and reversible state of confusion, usually the result of other organic processes (infection, drugs, dehydration), the onset is acute and the cognition of the patient can be highly fluctuant over a short period of time
Causes: (pinch me)
• Pain
• Infection
• Nutrition
• Constipation
• Hydration
• Medications
• Electrolyte
Ix:
- 4AT-
• Alertness- Normal (0), Mild sleepiness (0), Clearly Abnormal (4)
• AMT 4- Age, DOB, place, current year, 1 mistake = 1, 2 mistakes = 2
• Attention- Count months backwards, <7 correct = 1, Untestable = 2
• Acute change- Within 2 weeks lasting over 24 hours = 4
- AMTS-
• 8 or above (normal)
• 4-7 Mild Cognitive impairment
• 0-3 Severe
- bloods
- CXR
- CT
Mx:
- haloperidol
- environment
- diet
- treat underlying cause
- sedation
- polypharmacy
Dementia
Types, sx, ix, mx
Types:
- Alzheimers dementia is the most common type of dementia. The underlying pathophysiology involves brain atrophy, amyloid plaques, reduced cholinergic activity and neuroinflammation.
- Vascular dementia is the second most common type. It is caused by vascular damage and impaired blood supply to the brain. Risk factors are the same as other cardiovascular diseases (e.g., hypertension, diabetes and smoking).
- Dementia with Lewy bodies is a type of dementia associated with features of Parkinsonism. It causes a progressive cognitive decline. There are associated symptoms of visual hallucinations, delusions, REM sleep disorders and fluctuating consciousness.
- Frontotemporal dementia is a rarer type that notably affects people at a younger age (starting aged 40-60). It mainly affects the frontal and temporal lobes. The initial presentation typically involves abnormalities in behaviour, speech and language. It can be familial (inherited).
Sx:
Early-
- Forgetting events
- Forgetting names
- Difficult remembering words
- Repeatedly asking the same questions
- Impaired decision making
- Reduced flexibility
Advanced-
- Inability to speak or understand speech (aphasia)
- Swallowing difficulties (dysphagia), which can lead to aspiration and pneumonia
- Appetite and weight loss
- Incontinence
Ix:
- Six Item Cognitive Impairment Test (6CIT)
- 10-point Cognitive Screener (10-CS)
- Mini-Cog
- General Practitioner Assessment of Cognition (GPCOG)
- Montreal Cognition Assessment (MoCA)
- ACE-III
- Full blood count
- Urea and electrolytes
- Liver function tests
- Inflammatory markers (e.g., CRP and ESR)
- Thyroid profile
- Calcium
- HbA1c
- B12 and folate
Mx:
- Acetylcholinesterase inhibitors (e.g., donepezil (1st line alzheimers), rivastigmine or galantamine)
- Memantine, which works by blocking N-methyl-D-aspartic acid (NMDA) receptors
Urinary tract infection (UTI)
Stages, types, sx, dx, ix, mx
Types:
- Cystitis: lower UTI- urethra or bladder infection, prostitis, often uncomplicated but can progress to upper or complicated UTI.
- Pyelonephritis: upper –or complicated UTI, or ureters, kidney infection usually due to bacterial ascent.
- Typical: Uncomplicated, self-resolving. Common pathogens include uropathogenic E. coli, Klebsiella pneumoniae, and Enterococcus faecalis.
- Atypical: Seriously ill, Poor urine flow, Abdominal/bladder mass, Raised creatinine,Septicaemia, Failure to respond to Abx in 48 hours, Non-E.coli organisms.
- Recurrent: Two or more UTIs in six months or three or more in 12 months.
- Catheter associated UTI
Sx:
- Lower: urinary frequency, urinary urgency, suprapubic pain, dysuria, heamaturia
- Upper: fever, chills, flank pain, nausea, vomiting, costovertebral or renal angle tenderness, recurrent lower UTI symptoms
Dx:
- Nitrites: strongly suggestive of bacteriuria, as nitrates are broken down into nitrites only in
the presence of bacteria.
- Leukocyte esterases: an enzyme leukocytes produce in response to bacteria in the urine.
- On MC&S, the following findings would be consistent with a UTI:
- Bacteriuria: the presence of bacteria in urine. Historically, ≥ 105 bacterial colonies/mL of
urine were needed to diagnose a UTI. However, a UTI can be diagnosed if the symptoms are present with as low as 102 bacterial colonies/mL. If there is bacteriuria without symptoms, this is termed asymptomatic bacteriuria. It is more common in older patients, and asymptomatic bacteriuria is only treated in pregnant women, before urological
operations or if there are associated symptoms.
- Pyuria: the presence of WBCs in the urine. Sterile pyuria (WBCs in the urine, without
infection) can indicate a range of diagnoses, including renal malignancy, pelvic malignancy
and genitourinary tuberculosis
Ix:
- renal US
- USS
- CT (acute)
Mx:
- personal hygiene
- vit c supplement
- D-mannose, cranberry products
- analgesia
- first line is nitrofurantoin or trimethoprim and course is 7 days for men and 3 for women
