Confusion - OSCE tutoring Flashcards
What syndromes cause confusion-like?
Derlirium Dementia Mental impairment Psychosis Receptive dysphasia/expressive dysphasia
What is delirium?
Acute impairment in cognitive ability together with impaired consciousness
Receptive dysphasia is caused by?
Wernicke’s problems
How do you test for receptive dysphasia?
3 step command - e.g. touch your head,
How do you test for expressive dysphasia?
3 step command - e.g. touch your head,
Name 3 animals
Name two screening tests for confusion and the number at which a patient is deemed cognitiviely impaired
AMTS - 6/10
Age Time Address to remember (42) west street Year Where are we
MMSE - less than 26/30
What cognitive test do you do after MMSE to clarify dementia?
ACE 3 congitive testing
Addenbroke’s cognitive examination
What infections can cause confusion? What questions would you ask to screen for these?
Chest infection/UTI
- productive cough, fever
- suprapubic pain, back pain, nausea and vomiting
- severe meningitis, asbcess
photophobia, neck stiffness, rashes
encephalitis
- any behavioural changes?
What infections can cause confusion? What questions would you ask to screen for these?
Chest infection/UTI
- productive cough, fever
- suprapubic pain, back pain, nausea and vomiting
- severe meningitis, asbcess
photophobia, neck stiffness, non-blanching rashe (if you press, does it go away)
encephalitis
- any behavioural changes?
Vascular cause screening
Stroke:
Limb weakness
Difficulties in speech
MI:
Central crushing chest pain radiating to neck
screen for CVD risk factors
Immune causes of confusion
Hashimotos encephalopathhy
Neuropsychiatric lupus
Trauma causes of confusion and how they present
Subdural - rupture of VEINS - acute - nausea and vomiting, - seizures, confusion, poor memory, deteriorating gait Extradural - artery bursting at pterion - lucid interval then deterioration
Intraparenchymal haemmorhage
Blurred vision, focussed defecits
Trauma causes of confusion and how they present
Subdural - rupture of VEINS
- acute - nausea and vomiting,
- seizures, confusion, poor memory, deteriorating gait
Extradural - artery bursting at pterion
- lucid interval then deterioration
- nausea
- headache worse when waking up (raised ICP)
Intraparenchymal haemmorhage
Blurred vision, focussed defecits
Endocrine causes of confusion and presentation
Severe hypothyroidism
- myoedema crisis triggered by stress
- hypothermia
- non pitting oedema
- slow heart rate
- seizure
- shallow breathing
hyper thyroidism
-sweatings, heat intolerance, palpitations, tremors
and ketoacidosis - stomach pain nausea increasing urination third hyperventilation
Metabolic causes of confusion
Hypercalcemia Hyponatremia Hypoxia Hypercapnia Hypoglycemia Folate/b12/thiamine deficiency
