Delirium Flashcards
What is delirium?
1 - disturbance in attention
2 - develops over a short period and tends to fluctuate in severity
3 - disturbance in cognition
4 - direct consequence of another medical condition
5 - cannot be explained by another neurological disorder
6 - all of the above
6 - all of the above
- according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
Delirium can occur at all ages in men and women. What % of patients on a general ward (medical or surgical) are likely to experience delirium?
1 - 3%
2 - 13%
3 - 33%
4 - 63%
3 - 33%
Delirium can occur at all ages in men and women. What % of patients in ICU are likely to experience delirium?
1 - 3%
2 - 13%
3 - 33%
4 - 70%
4 - 70%
- association between physical illness and risk of delirium
- more common in ICU / HDU admission, Post emergency laparotomy, Hip fracture and Stroke, >65, ALL OF THESE PATIENTS SHOULD BE SCREENED FOR DELIRIUM
Almost any illness can lead to delirium, but is there an association between illness severity and delirium?
- yes
- more severe illness is more likely to cause delirium
Which of the following is NOT a risk factor for delirium?
1 - Age
2 - Gender
3 - Pre-existing cognitive impairment
4 - Frailty
2 - Gender
- age is the main risk factor for delerium
Although delirium can occur in anyone, which groups of patients have a greater risk of developing delirium when compared to the general public?
1 - dementia patients
2 - neurological conditions
3 - mood disorder (depression, bipolar etc..)
4 - anxiety disorder
5 - all of the above
5 - all of the above
- dementia patients account for up to 50% of delirium cases
Which of the following is a typical differential for delirium?
1 - dementia
2 - depression
3 - non-organic psychosis
4 - Encephalitis
5 - Non-convulsive status epilepticus
6 - Post-ictal (following seizure) phase
7 - Psychiatric diagnoses
8 - all of the above
8 - all of the above
- organic = specific illness with physical, biochemical or imagery to confirm diagnosis
- inorganic = unknown cause and unclear of the causer
When trying to diagnose a patient with delirium, does the patient or a collateral more likely go provide more useful information?
- collateral
- family, carer etc..
According to NICE guidelines, which assessment tool should be used in a patient with suspected delirium?
1 - Abbreviated mental test score (AMTS)
2 - Mini-mental state examination (MMSE)
3 - V Montreal Cognitive Assessment (MoCA)
4 - 4AT assessment
4 - 4AT assessment
- score >4 indicates delirium
- Abbreviated mental test score (AMTS) may also be useful
All of the following are common presentations of delirium, EXCEPT which one?
1 - impaired awareness, attention and concentration
2 - disorientated
3 - palsy
4 - memory present, but lack of awareness
5 - hallucinations, especially visual
6 - delusions
7 - mood
3 - palsy
Which of the following is important when trying to diagnose a patient with delirium?
1 - full history
2 - physical examination
3 - medication history
4 - substance misuse history
5 - all of the above
5 - all of the above
Which of the following are important physical investigations when trying to diagnose a patient with delirium?
1 - biochem and haematology
2 - blood and urine culture
3 - ABG
4 - ECG
5 - chest X-ray
6 - abbreviated mental test score (AMTS)
7 - mini mental state examination (MMSE)
8 - 4-AT
9 - all of the above
8 - all of the above
In patients with delirium, do they always experience a suppression of their normal cognitive state?
- no
- can be hyper, hypo or mixed
When talking about hallucinations and delusions, which one goes with the following definitions?
1 - false belief
2 - sensory perception
1 - false belief = delusions
2 - sensory perception = hallucinations
Which of the following is NOT associated with hyperactive delirium?
1 - Hallucinations
2 - Confusion
3 - Delusions
4 - Anger
5 - Irritability
2 - Confusion
- least common, but are often the most common to present early
Which of the following is NOT associated with hypoactive delirium?
1 - somnolence (drowsiness and need to sleep)
2 - withdrawn
3 - fatigued
4 - angry
4 - angry
- more common than hyperactive, but less likely to be detected
Which of the 3 is the most common subtype of delirium?
1 - hyperactive
2 - hypoactive
3 - mixed
3 - mixed
- periods of hypo-activity and hyperactivity
- fluctuating over hours and days
Is hypoactive or hyperactive delirium associated with worse outcomes?
- hypoactive delirium
- mistaken for just being tired and lethargic
- reduced oral intake
- immobilisation
- pressures sores
- hospital acquired infection
- longer length of stay
- institutionalisation
- increased mortality
What is often the best way to identify if a patient has delirium?
1 - acute onset
2 - duration of symptoms
3 - severity of symptoms
4 - changes in cognition
1 - acute onset
Which of the following is NOT a differential for when a patient presents with hypoactive delirium?
1 - Severe depression
2 - Post-ictal phase
3 - Non-convulsive status
4 - Encephalitis
5 - Psychosis
5 - Psychosis
- Encephalitis is inflammation of the brain causes confusion, drowsiness, weakness
Which 2 of the following are differentials for when a patient presents with hyperactive delirium?
1 - behavioural and psychological symptoms of dementia
2 - epilepticus (seizure >5 mins)
3 - psychosis
4 - severe depression
1 - behavioural and psychological symptoms of dementia
3 - psychosis
When we compare dementia and delirium, which has rapid onset and which has a gradual development over time?
- rapid onset = delirium
- gradual decline = dementia
When we compare dementia and delirium, which can cause a change in alertness?
- delirium = alertness can increase or decrease
- dementia = remains normal
When we compare dementia and delirium, which has changes in attention?
- delirium = impaired attention
- dementia = normally preserved
When we compare dementia and delirium, which is more likely to have hallucinations?
- delirium = common
- dementia = rare (except in Dementia with Lewy bodies)
When we compare delirium and dementia, which has fluctuations in cognition and awareness?
- delirium = fluctuations during day
- dementia = gradual change over time
When we compare delirium and dementia, which has changes in mood?
- delirium = mood often fluctuates
- dementia = mood may be low, doesn’t usually fluctuate
What % of patients with a hip fracture will experience delirium?
1 - 1%
2 - 10%
3 - 20%
4 - 50%
4 - 50%
- 4-12% in the community
- 4-38% in nursing homes)
To help identify the cause of delirium, we can use the mnemonic PINCH ME. What does the P stand for?
1 - pain
2 - pressure (BP)
3 - pleural effusion
4 - percussion of chest is dull
1 - pain
To help identify the cause of delirium, we can use the mnemonic PINCH ME. What does the I stand for?
1 - insomnia
2 - infection
3 - idiopathic
2 - infection
To help identify the cause of delirium, we can use the mnemonic PINCH ME. What does the N stand for?
1 - NAFLD
2 - narcolepsy
3 - nutrition
4 - nystagmus
3 - nutrition
To help identify the cause of delirium, we can use the mnemonic PINCH ME. What does the C stand for?
1 - colon obstruction
2 - cancer
3 - cataracts
4 - constipation
4 - constipation
To help identify the cause of delirium, we can use the mnemonic PINCH ME. What does the H stand for?
1 - hydration
2 - heart disease
3 - hearing loss
4 - haemorrhage
1 - hydration