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Stage 3: FOCP > Neuro week: confusion > Flashcards

Neuro week: confusion Flashcards

1
Q

Dominant symptoms of hypoactive and hyperactive delirium

A

Hyperactive: restlessness, agitation

Hypoactive: drowsiness, inactivity

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2
Q

What score on MMSE suggests dementia/delirium

A

<24

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3
Q

What drugs might be given to tranquilise a delirious person if they are at risk of harm to self or others

A
  • Haloperidol

- Lorazepam if Parkinson’s or Lewy Body Dementia

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4
Q

Describe the pathogenesis of Alzheimer’s

A
  • Decreased Ach
  • Amyloid plaques
  • Tau plaques neurofibrillary tangles
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5
Q

Risk factors for Alzheimer’s

A
  • Genetics
  • Female
  • Down’s syndrome
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6
Q

Describe the pathogenesis of vascular dementia

A

Multiple infarcts throughout cortex

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7
Q

Risk factors for vascular dementia

A
  • Smoking
  • hypertension
  • T2DM
  • high cholesterol
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8
Q

Describe the pathogenesis of Lewy Body dementia

A

Deposition of alpha synuclein protein in brainstem and cortex

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9
Q

Which types of dementia are slowly progressive/ which have stepwise deterioration

  • Alzheimer’s
  • Vascular dementia
  • Frontotemporal dementia
  • Dementia with Lewy Bodies
A

Slowly progressive:

  • Alzheimer’s
  • Frontotemporal dementia
  • Dementia with Lewy Bodies (fluctuation of symptoms)

Stepwise deterioration:
-Vascular dementia

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10
Q

Differences between delirium and dementia wrt:

  • onset
  • duration
  • deterioration
A

ONSET

  • acute in delirium
  • gradual in dementia

DURATION

  • hours to weeks in delirium
  • months to years in dementia

DETERIORATION

  • fluctuating in delirium
  • progressive in dementia
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11
Q

What kind of drugs precipitate/worsen delirium

A

Anticholinergics (including antipyschotics, Parkinson drugs, TCA)

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12
Q

What are the 4 psychomotor disturbances that can occur with delirium

A
  1. Rapid, unpredictable shifts from hypo to hyper-activity
  2. Increased reaction time
  3. Increased/decreased speech flow
  4. Enhanced startle reaction
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13
Q

What are predisposing factors for delirium

A
  • underlying brain dz (dementia, stroke, Parkinson)
  • age >65, frailty
  • polypharmacy
  • renal impairment
  • visual/hearing impairment
  • sleep deprivation
  • hip fracture
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14
Q

What are causes of delirium

PINCH ME

A
  • Pain
  • Infection eg UTI, LRTI
  • Nutrition (B12/ folate/ thiamine)
  • Constipation
  • Hydration (lack of)
  • Medication eg opioids, corticosteroids, catheter
  • Environment eg hypothermia
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15
Q

What must be ruled out when a patient appears delirious

A

Hyperglycaemia and hypoglycaemia

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16
Q

4 features of delirium

A
  1. acute confusion
  2. fluctuating cognitive impairment
  3. associated with behavioural abnormalities
  4. impaired short term memory
17
Q

Blood tests to request in investigation delirium + why

A
  • blood sugar (hyper/hypoglycaemia may cause delirium)
  • TFTs (hyper/hypothyroidism may cause delirium)
  • CRP, U&Es (check for infection)
18
Q

Most common cause of dementia

A

Alzheimer’s

19
Q

What is classified as early onset dementia

A

symptoms <65yo

20
Q

What type of dementia involves fluctuation of symptoms

A

Lewy body dementia

21
Q

What type of dementia involves spontaneous Parkinsonism:

rigidity, bradykinesia, tremor, shuffling gait

A

Lewy body dementia

22
Q

Does delirium or dementia cause impaired conciousness

A

Delirium

23
Q

Does delirium or dementia cause a disrupted sleep-wake cycle

A

Delirium

24
Q

Does delirium or dementia cause perceptual disturbance

A

BOTH

common in delirium
only occurs in later stages in dementia

25
Q

Diagnose the following (type of dementia/delirium):

  • 62M
  • become withdrawn, stopped working on hobbies
  • struggles to find the right word
  • found naked urinating in living room
  • saying inappropriate things to neighbours
  • history of hypertension
  • ex-smoker
A

Frontotemporal dementia

26
Q

Features of frontotemporal dementia

A
  • significant personality change
  • blunting of emotions, apathy
  • Broca’s and Wernicke’s
27
Q

Investigations to do for someone presenting with acute confusion

A
  • sepsis screen (FBC, CRP, MSU, blood/urine culture, CXR)

- metabolic screen (ABG, U&Es, TFT, LFT, thiamine, folate, vit B12)

28
Q

What should be prescribed to patients suffering from alcohol withdrawal

A

Thiamine (to prevent development of Wernicke’s encephalopathy)

29
Q

Common cause of confusion among patients with renal failure

A

Hyponatremia

Stage 3: FOCP (47 decks)

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