Brainscape's Knowledge GenomeTM

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


See full index

Y3 Oxford Cases > Confusion > Flashcards

Confusion Flashcards

1
Q

What syndromes can make a patient appear confused

A 
Dementia
Delirium 
Psychosis 
Expressive dysphasia
Receptive dysphasia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What questions can you asked someone who presents as confused

A

Are the oriented to time, place, and person?
Can they tell you why they are here? (AMTS)
Can they follow a 3 step command? Can they name 3 common objects?
Are they in pain? Is there breathlessness, cough, or urinary symptoms

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

What questions can you ask to a confused patient’s accompaniment

A

What their normal state is
If the confusion is sudden or gradually worsening
Drug history (includes alcohol)

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

What are the categories in the INVITED MD mnemonic surgical sieve and give some examples of each in the context of confusion causes

A

Infectious (chest, UTI, encephalitis, brain abscess, sepsis)
Neoplastic (brain tumour)
Vascular (stroke, MI -> hypoperfusion)
Immune (neuropsychiatric lupus, Hashimoto’s encephalopathy)
Trauma (subdural haematoma, extradural)
Endocrine (hypothyroidism, hyperthyroidism, diabetic ketoacidosis)
Drugs (alcohol, opiates, psychiatric medications, diuretics, digoxin, thyroid medication
Metabolic (hypoxia, hypercapnia, hypoglycaemia, hypercalcaemia, electrolyte imbalance, thiamine/B12/folate deficiency)
Degenerative conditions

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

What vital signs are important in investigating confusion

A 
Blood pressure
Pulse and resp rate
Oxygen saturation
Temperature
Blood glucose
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why may BP be useful in investigating confusion

A

Hypoperfusion of the brain decreases consciousness

hypertension + bradycardia -> Cushing response to intracranial pressure

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

Why may pulse and resp rate be useful in investigating confusion

A

Tachycardia or tachypnoea can be secondary to infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why may oxygen saturation be useful in investigating confusion

A

hypoxia will affect consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why may temperature be useful in investigating confusion

A

Fever -> infection

Hypothermia can cause confusion

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

Why may Blood glucose be useful in investigating confusion

A

Hypoglycaemia or hyeprglycaemia can depress consciousness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations would you do on patients who are difficult to examine (due to confusion)

A 
Consciousness using GCS 
Septic focus 
Pupils
Focal neurological signs
Needle track marks
Asterixis 
Breath 
Bitten tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What do you focus on in assessing septic focus

A

Chest
Urine
Cellulitis
Meningitis

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

What signs would you look for in a chest infection

A

Dull percussion

Bronchial breathing and crackles

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

What signs would you look for in a urine infection

A

Suprapubic tenderness
Cloudy urine (in catheter bag)
Urinalysis + send specimen for MC&S

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

What signs would you look for in cellulitis

A

Look at the skin
Pay attention to the feet in diabetics
Check venous or arterial lines

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

What signs would you look for in meningitis

A

Neck stiffness -> meningism
Photophobia
Purpuric rash (meningococcal septicaemia)

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

What are the 3 components of GCS

A

Eyes
Motor
Verbal

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

What are you assessing in the eyes for confusion

A

Pupil symmetri, size, and direct consensual response to light

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

What causes pupils to become pinpoint

A

Drug overdose (tricyclic anti-depressants, cocaine)
Severe hypoxia
Hypothermia
Postictal

20
Q

What causes pupils to become dilated

A

Opiate or barbiturate overdose

21
Q

What causes asymmetrical pupils

A

anisocoria, can be normal

Suggestive of coning secondary to raised intracranial pressure or 3rd nerve palsy

22
Q

What focal neurological signs do you look for in confusion

A

Dysphasia, visual field defects, nystagmus, tone, reflex symmetry, plantar responses, focal weakness, ataxia and sensory or visual inattention
Suggests stroke or SOL

23
Q

What does asterixis suggest

A

Hypercapnia
Hepatic encephalopathy
Uraemia

24
Q

What do you look for in the breath on investigation

A 
Alcohol
Fetor hepaticus (liver failure)
Uraemic fetor (renal failure)
Fruity breath (ketones in ketoacidosis)
25
Q

What does a bitten tongue suggest

A

convulsive seizure

26
Q

What does a confusion screen consist of

A

Septic screen
Metabolic screen
Toxicology screen
ECG

27
Q

What are the positive signs of infection in urine analysis

A

MSU - +ve leucocyte esterase and nitrites

28
Q

What does glucose and ketones in the urine suggest

A

Diabetic ketoacidosis

29
Q

Which electrolyte imbalances cause confusion

A

Low sodium

High calcium

30
Q

What is in a septic screen for confusion

A 
FBC
CRP
Blood cultures
Urine analysis
Urine MC&S
CXR
31
Q

What is in the metabolic screen for confusion

A 
Blood gas
U&Es
TFTs
Liver enzymes
Thiamine
Folate
B12
32
Q

What in LFTs may suggest alcohol abuse

A

Raised gamma-glutamyl transferase (GGT)

33
Q

What is the management for confusion

A 
Ensure patient is not left unattended 
Put them in a quiet side room if possible 
Discontinue non-essential medications
Promote good sleep hygiene 
Fluids and nutrition
34
Q

If you are unable calm a confused patient, what are your next steps

A

Haloperidol - 30-60 minutes (can have extra-pyramidal effects)
Lorazepam - 5-10 minutes

35
Q

What does high or normal osmolality with hyponatraemia suggest

A

Pseudohyponatraemia
Low sodium due to artefact
High - hyperglycaemia, mannitol, glycine
Normal - hyperlipid, hyperprotein

36
Q

What are the causes of hyponatraemia if the patient is hypervolaemic

A

Congestive cardiac failure
Hepatic failure
Nephrotic syndrome

37
Q

What are the causes of hyponatraemia if the patient is euvolaemic

A

High urine osmolality - SIADH

Normal urine - fluid overload, hypothyroidism

38
Q

What are the causes of hyponatraemia if the patient is hypovolaemic

A

Na loss is renal - Diuretics, renal failure, addisons, pyelonephritis
Na loss is not renal - vomiting, diarrhoea, cutaneous loss through sweating and burns, pancreatitis, small bowel obstruction

39
Q

What is the treatment for hypoglycaemia

A

Conscious - sweet drink or glucose tablets

Unconscious - Dextrose gel, 50 mL 20% glucose / 250ml 10% glucose IV, IM glucagon

40
Q

What are the clinical signs of DKA

A

Polyuria, polydipsia and reduced mental state (hyperglycaemia)
Nausea, vomiting, abdo pain, fatigue, SOB, Kussmaul breathing
Hypotension and tachy (dehydration)
Ketotic breath

41
Q

How does opiate overdose compare to cocaine overdose

A

opiates - pinpoint pupils and respiratory depression

Cocaine - dilated pupils, sinus tachy, hypotension and pyrexia. May have resp. distress and urinary retention

42
Q

How do tricyclics overdose present

A

Sympathetic - pupil dilation, tachy, brisk reflex, urinary retention

Para - dry mouth and drowsiness

43
Q

What treatment should be given for confusion with Hx of alcohol abuse and why

A

Thiamine e.g. pabrinex

Prevent Wernicke’s encephalopathy -> Korsakoff’s syndrome (amnesia and confabulation)

44
Q

What are the indications for immediate CT scan

A 
GCS <13 on arrival
GCS <15 2h post incident
Post traumatic seizure
Focal neurological deficit
Vomiting > 1
Suspected skull fracture
45
Q

What are the criteria for urgent (8h) CT head

A

Any head injury on warfarin
Loss of consciousness or amnesia + >65, fall > 1m or > 5 stairs, pedestrian/bicycle vs vehicle, more than 30mins amnesia before injury

Y3 Oxford Cases (29 decks)

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