Term
| What are the major adverse outcomes of Delirium in the Elderly |
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Definition
- prolonged hospital stay (8d longer)
- increased mortality while in hospital and in months following d/c
- increased risk of complications: hospital acquired infection, pressure ulcers, incontinence and falls)
- poor physical and cognitive recovery at 6 and 12mo w lower MMSE scores at d/c
- increased risk of placement at residential home
- increased risk of developing dementia in pts w no cognitive impairment at baseline |
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Term
| What are the types of delirium |
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Definition
1) hyperactive (30%)
2) hypoactive delirium (25%)
3) mixed delirium (45%) |
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Term
| What are the DSM-IV criteria for delirium |
|
Definition
1) disturbance of consciousness (focus, inattention, reduced awareness)
2) change in cognition (or perceptual change, w memory deficits, disorientation, language disturbance
3) develop over hours to days and fluctuate throughout day |
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Term
| What are the common non-correctable risk factors for delirium |
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Definition
1) age
- male
- mild cognitive impairment, dementia, parkinsons disease
- multiple comorbiditis: renal/hepatic disease, CVA hx, hx of falls, poor mobility, hx of prior delirium |
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Term
| What are the major correctable factors for delirium development |
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Definition
- hearing impairment/visual impairment
- malnutrition, dehydration, low albumin
- social isolation, sleep deprivation, new environment, moves w/i hospital
- restraints and indwelling catheters
- new addition of three/more medication
- no time orientation
- smoking |
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Term
| What are hte major precipitating factors for delirium |
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Definition
- polypharmacy
- alcohol w/d and benzodiazepines
- sepsis, shock, hypothermia
- lyte disturbance
- endocrine disturbance
- nutritional deficiencies
- cardiac, liver, or renal failure
- pulmonary disorder
- VCA/seizure
- post-sgx
- falls and fx
- anemia/GI bleed
- pain
- Ca and terminal illness |
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Term
| A drop in what number from basline MMSE indicates delirium? A rise in what number indicates resolution of delirium? |
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Definition
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Term
| What are the components to the confusion assessment method? |
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Definition
1) acute onset and fluctuating course
2) inattention
3) disorganized thinking
4) altered mental status
*(1) and (2) required; (3) OR (4) required |
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Term
| What is the sn and sp of the CAM for delirium |
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Definition
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Term
| What are key components to the investigation of the delirious patient |
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Definition
- targeted blood tests: lytes, Cr, glucose, CBC
- u/a
- occult infection search
- EKG
- post-void residual bladder scan
- CXR
- head CT
Additional tests:
- TFT, Thyroid Ab
- drug levels
- toxicology
- B12/folate
- syphilis serology
- lumbar puncture
- EEG
- vasculitis screen including ANA and ENA |
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Term
| What is a potential biochemical marker for delirium |
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Definition
| - C-reactive protein (both predict incidence of delirium and recovery from it |
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Term
| What is the prognosis for delirium at 12 mo |
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Definition
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Term
| What are clinical features of autism spectrum disorders |
|
Definition
- lack of eye contact
- atypical language in rate, rhythm,intonation, and pronoun reversals
- sterotypy |
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Term
| Describe seonsory processing problems in autism spectrum disorders |
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Definition
- touch: defensiveness vs no pain
- vision: difficulty with contrast
- auditory: loud noises very painl
- smell: may want to smell objects/intolerance to odors
- taste: picky eaters vs eating everything |
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Term
| What is the characteristic learning method for autism spectrum disorders |
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Definition
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Term
| For autism spectrum pts What is the first part of the physical exam that should be performed? What is the last part that should be performed? |
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Definition
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Term
Define:
macule
patch
papule
plaque
nodule
tumor |
|
Definition
1) flat lesion 0-1cm
2) flat lesion 1+cm
3) raised lesion 0-1cm
4) raised lesion 1+cm
5) palpable lesion 0-2cm within the dermis/subcutis
6) palpable lesion 2+cm within the dermis or subcutis |
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Term
| Define: well marginated skin lesion |
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Definition
| - transitions from normal to abnl skin within 1mm |
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Term
| What layer of skin accumulates in hyperkeratotic skin? |
|
Definition
|
|
Term
|
Definition
| - vesicle 1+cm in diameter |
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|
Term
Define:
telangiectasia
lichenification
excoration
fissure
purpura |
|
Definition
1) fixed, visible dilated blood vessel within the epidermis
accentuation of normal skin lines due to persistent rubbing or scratching
- erosion/ulcer caused by scratching, rubbing, or picking
- linear split in skin through the epidermis and into the dermis
- extravasated blood in the skin (palpable) |
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Term
| What are hte components to the ABCDE method of skin lesion ID for melanoma |
|
Definition
1) asymmetry
- border
- color
- diameter
- evolution |
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