Confusion Flashcards
Syndromes causing patient to appear confused?
doctor doctor my pet runs everywhere Delirium Dementia Mental impairment Psychosis Receptive dysphasia Expressive dysphasia
What is delirium?
an acute impairment in cognitive ability together with impaired consciousness
What is dementia?
chronic, progressive impairment in cognitive abilty but with intact consciousness.
Can you diagnose dementia from a single mental status assessment?
No.
What is mental impairment?
a permanent impairment in cognitive ability
Patient with psychosis is…
hallucinating or deluded due to a deranged personality and loss of contact with reality. (patient may not be confused)
Define and differentiate receptive and expressive dysphasia
Receptive: pt may have difficulty comprehending questions (e.g. damage in Wernicke’s area)
Expressive: pt may be cognitively intact but have difficulty verbalising answer to question (e.g. damage to Broca’s area)
What functions are tested in MMSE
orientation in space and time short- and long-term memory attention language (comprehension & expression) calculation visuospatial ability
What does “acute confusional state” mean?
defined in DSM-IV and ICD-10 as an observable state of relatively sudden impaired consciousness, cognition (incl. perception), mood, affect, and behaviour. Interchangeable with the term “delirium”
Which diabetics get ketoacidosis & why?
T1 diabetics. Ketoacidosis is inhibited by even tiny amounts of insulin.
What clinical signs would you expect to see in ketoacidosis?
- poyuria, polydipsia and a decreased mental state due to hypoglycaemia
- nausea, vomiting, abdominal pain, fatigue, shortness of breath, or Kussmaul breathing due to acidosis
- hypotension and tachycardia due to dehydration
- ketotic/’fruity’ breath
What are the late signs of ketoacidosis?
Confusion and Kussmaul breathing. Hence should be taken particularly seriously
Drugs that cause confusion upon overdose?
Opiate
Cocaine
Tricyclics
Distinguish opiate overdose from tricyclic antidepressant or cocaine overdose.
OPIATES
- take to ‘chill out’
- pinpoint pupils & respiratory depression
COCAINE
- take for ‘buzz’; for sympathetic-like effects
- fixed dilated pupils, sinus tachycardia, hypotension, pyrexia
- May have respiratory depression & urinary retention
TRICYCLICS
- both sympathetic stimulatory and parasympathetic inhibitory effects
- SNS: heart & CNS; dilated pupils, sinus tachycardia, brisk reflexes, urinary retention
- ParaSNS: dry mouth, drowsiness
- may have upgoing plantar reflexes
Patient presents with confusion with history/suspicion of alcohol abuse. What treatment and why?
Immediate administration of Thiamine (e.g. Pabrinex, which contains other B vitamins) as prophylaxis for Wernicke’s encephalopathy.
- complication of alcohol abuse.
- classically presents as triad of Confusion. Ataxia, Ophthalmoplegia
- potentially reversible in early stages
Failure to reverse in early stages result in irreversible damage = Korsakoff’s syndrome
- characterised by Amnesia, Confabulation
What is confabulation?
Patients filling in gaps in their memory with fabricated stories
What is the presentation of Wernicke’s encephalopathy?
triad of confusion, ataxia, ophthalmoplegia
What are the reversible and irreversible damages done by alcohol abuse?
Reversible: Wernicke’s encephalopathy
Irreversible: Korsakoff’s syndrome
Indications for a CT scan in an adult with a head injury:
(insert pic of NICE Guidlines)
Why is it inappropriate to scan every patient? (CT)
- large dose of radiation exposure
- resource constraints
