Confusion

Question 1

syndromes that can make a patient appear confused

Answer 1

delirium
dementia
mental impairment
psychosis
receptive dysphasia
expressive dysphasia

Question 2

history taking

Answer 2

abbreviated mental test score
mini mental state exam
confusion assessment method
montreal cognitive assessment 
can they follow a three step command?
can they name three common objects?
ascertain as much information if they are accompanied

Question 3

differentials of confusion

Answer 3

INVITED MD
I - infectious
N - neoplastic
V - vascular
I - immune
T - trauma
E - endocrine
D - drugs
M - metabolic
D - degenerative conditions

Question 4

infectious causes

Answer 4

chest
brain abscess
urinary
encephalitis 
sepsis

Question 5

immune causes

Answer 5

neuropsychiatric lupus

hashimotos encephalopathy

Question 6

trauma causes

Answer 6

sub/extra dural heamatomas

Question 7

drugs causes

Answer 7

intoxication/withdrawl from alcohol
opiates
psychiatric medications
diuretics
digoxin
thyroid medication

Question 8

metabolic causes

Answer 8

hypoxia
hypercapnia
hypoglycaemia
hypercalcaemia
sodium electrolyte imbalance
thiamine deficiency
folate deficiency
b12 deficiency

Question 9

Examination

Answer 9

vital signs
consciousness - GCS
sepsis focus
pupils
drug abuse - track marks
focal neurological signs

Question 10

Investigations

Answer 10

septic screen - FBC, CRP, blood cultures, urine analysis, CXR
metabolic screen - ABG, U+E, thyroid function, liver enzymes, thiamine and folate
toxicology screen
ECG

Question 11

sedation

Answer 11

haloperidol

lorazepam

Question 12

alcohol withdrawal

Answer 12

alcoholics are at high risk of wernickes encephalopathy, can lead to irreversible brain damage
chlordiazepoxide and thiamine treatment for withdrawal

Question 13

post-operative confusion

Answer 13

hypoxia
opiates
electrolyte imbalance
infection
sleep loss
alcohol withdrawal

Question 14

lithium toxicity

Answer 14

lithium is used to treat bipolar

high levels in the serum can lead to confusion

Question 15

meningococcal meningitis

Answer 15

can present with headache, photophobia, neck stiffness, rash

high WCC, protein >1g/L, blood glucose<0.5 in CSF

Question 16

opiate overdose

Answer 16

pin point pupils

respiratory depression

Question 17

cocaine overdose

Answer 17

dilated pupils
sinus tachycardia
hypotension
pyrexia
urinary retention
respiratory depression

Question 18

TCA overdose

Answer 18

dilated pupils
sinus tachycardia
brisk reflexes
urinary retention
dry mouth
drowsiness