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Confusional States MCQs
Neurology · MBBS / Medicine · 27 practice questions
- Neurologic Examination - Specific Signs
- Physical Exam Findings and Underlying Causes
- Urgent Causes of Confusional States
- General Physical Examination
- Alcohol Withdrawal
- General Physical and Neurologic Exam Differentiation
- Approach to Diagnosis: Confusional State vs Dementia
- Alcohol Intoxication
1. A patient develops tremulousness, agitation, insomnia, tachycardia, and occasional visual hallucinations within 36 hours of stopping alcohol, with only mild confusion. Which of the following best describes the appropriate treatment approach for this specific syndrome?
- ASurgical intervention to reduce intracranial pressure
- BLorazepam or diazepam given intravenously at intervals until calm, then to maintain light sedation
- CImmediate IV antibiotics for suspected meningitis
- DNo treatment needed; syndrome will not respond to benzodiazepines
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B. Lorazepam or diazepam given intravenously at intervals until calm, then to maintain light sedation This describes the tremulousness and hallucinations withdrawal syndrome, treated with lorazepam or diazepam IV every 5-15 minutes until calm and hourly thereafter for light sedation.
2. An elderly patient on multiple medications with mild baseline cognitive impairment develops new confusion. Which factor mentioned in the text is LEAST likely to explain increased susceptibility to drug-induced confusional states in this patient?
- ARecent normalization of all home medication doses
- BAltered drug metabolism from hepatic or renal failure
- CAdvanced age
- DPreexisting cognitive impairment
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A. Recent normalization of all home medication doses The text lists greater-than-customary doses, drug combinations, altered metabolism, elderly age, and preexisting cognitive impairment as risk factors — normalization of doses would not increase risk.
3. A confused patient presents with fever, and physical exam reveals a petechial rash. Which of the following is the most likely underlying cause based on the described association?
- AHepatic encephalopathy
- BHypothyroidism
- CMeningococcal meningitis
- DSympathomimetic intoxication
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C. Meningococcal meningitis Petechial rash in the table is most suggestive of meningococcal meningitis, disseminated intravascular coagulation, or thrombotic thrombocytopenic purpura; combined with fever, meningococcal meningitis is most consistent.
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