Mrs D confusion

Question 1

6 syndromes that cause confusion

Answer 1

1. delirium
2. dementia
3. mental impairment
4. psychosis
5. receptive dysphagia (wernicke’s damage)
6. expressive dysphagia (Broca’s damage)

Question 2

What questions should all confused patients be asked to test for cognitive impairment?

Answer 2

oriented to time, place and person, and why they are here.?
Abbreviates mental test score (AMTS) had 10 simple questions -> core <6 indicates cognitive impairment.
Alternative is the 30 minute MMSE -> <26 indicates cognitive impairment

Question 3

question to test for receptive dysphagia

Answer 3

can they follow a three step command?

Question 4

question to test for expressive dysphagia?

Answer 4

name three common objects

Question 5

If they are accompanied, what information should you try to ascertain from their companion? (3)

Answer 5

• what the patient’s normal state is
• the time course of their confusion
• drug Hx

Question 6

Causes of delirum surgical sieve

Answer 6

I nfectious (chest, urinary, encephalitis, brain abcess, spesis)
N eoplastic (brain tumour)
V ascular (strokw, MI leading to hypoperfusion)
I mmune (hashimoto's encephalopathy, neuropsychiatric lupus)
T rauma (subdural haemotoma, extradural haematoma)
E ndocrine (hypothyroidism, hyperthyroidism, diabetic ketoacidosis)
D rugs (diuretics, digoxin, thyroid medication, alcohol withdrawal/intoxication)
M etabolic (sodium/electrolyte imbalance)
D egenerative conditions that predispose patient to delirium
INVITED MD

Question 7

Vital signs most interested, in and why, with confusion?

Answer 7

1. pulse and respiratory rate - tachycardia/tachypnoea = sepsis, secondary haemorrhage
2. blood pressure - hypoperfusion to brain - decreased consciousness
3. oxygen sats - hypoxia alters consciousness
4. temperature - pyrexia indicates infection
5. blood glucose - hypo/hypergycaemia can depress consciousness. T1DM hyperglycaemia may be associated with ketoacidosis. T2DM with extreme hyperglycaemia indicates hyperosmolar non-ketonic state.

Question 8

What does a GCS <=8 indicate?

Answer 8

patient can’t maintain their airway -> intubate

Question 9

What must you do if you suspect thiamine deficiency secondary to alcoholism?

Answer 9

u must treat (e.g. with thiamine or

Pabrinex, a cocktail of vitamins, otherwise irreversible cerebral damage