delirium

Question 1

72 w/ recent behavior/memory problems. Disrobing, not

sleeping, irritable. Waxing and waning consciousness. Dx?

Answer 1

delirium

Question 2

52 y/o pt w/ hx of depression & HTN hospitalized, being
evaluated by psych resident. His family reports he had
severe HA & “has not been himself” for 10 days. On exam,
pt has poor eye contact and is inattentive, muttering, picking
at his clothes, occasionally dozing off although it is midday.
Dx?

Answer 2

delirium

Question 3

21 y/o pt is hospitalized w/ 4 wk hx of progressive paranoia, irritability, confusion and sleep disturbance. Psych MD elicits pt hx of viral illness preceding the onset of psychiatric Sx and mental status changes. No family psych hx. Benadryl markedly make Sx worse. Dx?

Answer 3

DELIRIUM SECONDARY TO VIRAL ENCEPHALITIS

Question 4

Alcoholic p/w 2 days confusion, AH/VH, disorientation,
distractibility, with fever, tachycardia, and tremor. EEG shows low-voltage fast waves superimposed on slow waves. Long term olanzapine treatment for schizoaffective d/o. Dx?

Answer 4

DELIRIUM due to ETOH WITHDRAWAL

Question 5

44 yo M found wandering aimlessly, brought into ED, BP is 200/132, HR 112 and regular. Pt is belligerent, picking his skin, feels like insects crawling on his skin. Oriented only to name, tremulous, is diaphoretic, dilated pupils, palmar erythema, and spider angiomata on chest. What explains his symptoms?

Answer 5

DELIRIUM TREMENS

Question 6

Pt presented to ED with high temp, tachycardia, dilated and poorly reactive pupils, VH, agitation, constipation, and dry skin. Dx:

Answer 6

ANTICHOLINERGIC DELIRIUM

Question 7

Doctor examines 81-year-old pt twice daily, mid morning and late afternoon. Comparing the two assessments, what findings suggest that the patient is delirious?

Answer 7

LOGICAL, COHERENT SPEECH ON FIRST EXAM,

DISORGANIZED SPEECH ON SECOND