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DAQ1 - MBBS III S2 > Delirium > Flashcards

Delirium Flashcards

1
Q

MOA of aciclovir

A

An antiviral (guanine analogue). Guanine analogues inhibit viral DNA polymerase and DNA synthesis.

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2
Q

Aciclovir indications

A

Treatment and prevention of HSV infections, shingles, acute chickenpox.

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3
Q

Aciclovir adverse effects

A

Encephalopathy, hallucinations, headache, injection site reactions, nephrotoxicity

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4
Q

MOA of levetiracetam (keppra)

A

Exact mechanism unknown. May modulate neurotransmission by binding to synaptic vesicle protein 2A.

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5
Q

Levetiracetam is only covered by PBS if used:

A

as a second-line treatment

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6
Q

Adverse effects of levetiracetam

A

Behavioural changes, drowsiness, weakness, vertigo, insomnia

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7
Q

Major causes of delirium (MNEMONIC)

A

I WATCH DEATH

Infection
Withdrawal
Acute metabolic disorder
Trauma
CNS pathology
Hypoxia
Deficiencies
Endocrine
Acute vascular
Toxins/drugs
Heavy metals

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8
Q

Drugs/toxins that are associated with delirium include:

A

Anticholinergics
Benzodiazepines
Antihistamines (in older patients)
Opioids
Recreational drugs
Alcohol use disorder
Heavy metals

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9
Q

Metabolic causes of delirium include:

A

Liver or renal failure
Diabetic ketoacidosis
Hyper/hypothyroidism
Electrolyte abnormalities
Vitamin deficiencies (B12, folic acid, thiamine)

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10
Q

Delirium features of onset

A

Sudden. Prodromal phase may proceed.

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11
Q

Delirium time course

A

Rapid and fluctuating. Hours to days.

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12
Q

Delirium level of consciousness

A

Impaired (fluctuating)

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13
Q

Delirium effect on attention

A

Impaired (fluctuating)

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14
Q

Memory changes in delirium

A

Recent memory loss

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15
Q

Delirium effects on thought process

A

Disorganised

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16
Q

Delirium and hallucinations

A

Present - often visual or tactile.

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17
Q

Delirium and psychomotor activity

A

Psychomotor activity is altered (increased or decreased)

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18
Q

Delirium reversibility

A

Delirium is a reversible condition.

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19
Q

Delirium definition

A

Acute, reversible alteration in the level of awareness and attention.

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20
Q

Concerning intracranial features of a patient with delirium

A

History of trauma
Focal neurological symptoms
Seizure
Fever with headache or meningismus

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21
Q

Diagnostic studies for delirium of a suspected intracranial aetiology

A

Neuroimaging (CT/MRI head)
EEG (shows diffuse slowing of background activity in patients with delirium
Lumbar puncture and CSF analysis

22
Q

Concerning pulmonary features in a patient with delirium

A

Fever with cough or shortness of breath
Risk factors for aspiration pneumonia

23
Q

Diagnostic studies for delirium of a suspected pulmonary aetiology

A

CXR

24
Q

Concerning cardiovascular features in a patient with delirium

A

Abnormal haemodynamics
Chest pain
Worsening peripheral oedema and/or shortness of breath

25
Q

Diagnostic studies for delirium of a suspected cardiovascular aetiology

A

ECG
Echocardiogram

26
Q

Concerning features in a patient with delirium suggestive of a nutritional aetiology include:

A

Hx of heavy drinking
Malabsorptive disorders
Malnutrition

27
Q

Diagnostic studies for delirium of a suspected nutritional aetiology

A

Vit. B12, folate and thiamine levels

28
Q

Concerning features in a patient with delirium suggestive of a toxic aetiology include:

A

Hx of alcohol or recreational drug use
Suspicion of CO poisoning

29
Q

Diagnostic studies for delirium of a suspected toxic aetiology

A

Consider urine toxicology or serum drug levels

30
Q

Concerning features in a patient with delirium suggestive of an infectious aetiology include:

A

Fever
RFs for blood borne diseases or STIs

31
Q

Diagnostic studies for delirium of a suspected infectious aetiology

A

Bacterial cultures (urine, blood)
Serum lactate
HIV, syphilis serology

32
Q

First-line investigations in the diagnosis of delirium include:

A

CBE
Serum glucose
Electrolytes
Urinalysis

33
Q

The most common causative pathogens in encephalitis are:

A
  1. Herpes simplex virus
  2. Varicella zoster virus
34
Q

All patients with suspected encephalitis should undergo the following investigations:

A

Neuroimaging (MRI brain with contrast)
Lumbar puncture with CSF analysis
EEG

35
Q

What is the pathognomonic sign of HSV encephalitis?

A

Bilateral temporal lobe involvement on imaging.

36
Q

CSF analysis in the setting of encephalitis includes:

A

PCR, gram stain and cultures

37
Q

The gold-standard diagnostic test for HSV encephalitis is:

A

CSF PCR for HSV-1 and HSV-2 (allows for early detection of pathogen and targeted treatment)

38
Q

CSF findings in HSV encephalitis

A

Increased lymphocytes (lymphocytic pleocytosis)
Normal or increased opening pressure
Normal to mildly increased lactate
Mild protein elevation
Normal glucose

39
Q

Common focal neurological deficits for encephalopathy affecting the medial temporal lobe include:

A

Altered sense of smell
Loss of vision
Aphasia
Memory loss
Hemiparesis
Ataxia
Hyperreflexia

40
Q

The most common strain of HSV implicated in adult viral encephalitis is:

A

HSV-1

41
Q

Patients with suspected viral encephalitis should begin empiric therapy immediately with:

A

aciclovir

42
Q

When administering IV aciclovir patients should be monitored for:

A

Nephrotoxicity. Manage with adequate hydration and adjust doses for renal function.

43
Q

Prognosis of HSV encephalitis

A

Fatal in up to 70% of cases if left untreated.

44
Q

Examination features of viral encephalitis

A

Fever
Vesicular rash
Focal neurological deficits
Meningismus (neck stiffness, Kernig’s sign, Brudzinski’s sign)

45
Q

Electrolyte disturbances associated with delirium include:

A

Hypernatraemia
Hyponatraemia
Hypercalcaemia

46
Q

Anticholinergics mechanism of action

A

Block the neurotransmitter Ach in the central and peripheral nervous system. Most anticholinergics are muscarinic antagonists which inhibit the effect of Ach on muscarinic receptors.

47
Q

Side effects of anticholinergics

A

Mydriasis
Delirium
Flushing
Hyperthermia
Decreased secretions/dry skin
Urinary retention
Paralytic ileus
Tachycardia

MNEMONIC: BLIND as a bat (mydriasis), MAD as a hatter (delirium), RED as a beet (flushing), HOT as a hare (hyperthermia), DRY as a bone (decreased secretions), the bowel and bladder lose their TONE (urinary retention/paralytic ileus) and the heart runs ALONE (tachycardia)

48
Q

The mainstay of delirium treatment is:

A

Treatment of the underlying condition and supportive care. Consider discontinuing causative medications e.g. anticholinergics.

Maintain adequate hydration.

49
Q

Indications for pharmacological management of delirium

A

Patient is in significant distress or considered to be a threat to themselves/others.

50
Q

The following drugs can be used in the pharmacological management of delirium (as a last resort)

A

Haloperidol
Olanzapine
Risperidone

DAQ1 - MBBS III S2 (5 decks)

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