ABSTRACT
Questions Diagnoses: SBAs Question 74 An 86-year-old woman is admitted to the hospital with a community-acquired pneumonia, for which treatment with appropriate antibiotics is started. Over the next few days, she progresses well, and her chest infection appears to be resolving. On the fourth day of admission, she becomes disoriented in time and place and is quite agitated, which her son says has never happened before. Which one of the following is not a metabolic cause of acute confusion? Please choose the single best answer from the following answers: 1) Hyperkalaemia 2) Hypernatraemia 3) Hypocalcaemia 4) Hypoglycaemia 5) Hyponatraemia
Question 75 A 40-year-old man who runs a local bar is brought to the emergency department after having a seizure, which was witnessed by his girlfriend. When he is assessed, he is disoriented in time and place and agitated. He is complaining of shaking and headache. He is afebrile, but feels sweaty and is tachycardic. As the casualty officer is talking to him, he says that he can see spiders running all over the floor and walls. Which of the following is the most likely diagnosis? Please choose the single best answer from the following answers: 1) Delirium tremens 2) Opiate intoxication 3) Post-ictal phenomena 4) Viral encephalitis 5) Wernicke’s encephalopathy
Management: SBA Question 76 A 50-year-old man with known cirrhosis secondary to alcohol excess has a large upper gastrointestinal (GI) bleed. He is resuscitated with fluids and made haemodynamically stable. The following day, he becomes increasingly confused and irritable, and a coarse flapping tremor is noted. He is thought to be suffering from hepatic encephalopathy. Which of the following is of use in the management of hepatic encephalopathy? Please choose the single best answer from the following answers: 1) 10% glucose infusion 2) Corticosteroids 3) High-dose intravenous B complex vitamins 4) High-protein diet 5) Non-absorbable antibiotics
Answers Diagnoses: SBAs Answer 74 1) Hyperkalaemia: All of the metabolic disturbances mentioned may cause an acute confusional state with the exception of hyperkalaemia. A possible explanation for this lady’s confusion is hyponatraemia due to the syndrome of inappropriate anti-diuretic hormone secretion (SIADH), which may be caused by pneumonia.
