Delirium flashcards
12 high-yield MRCP Part 1 cards from the Intellect Medicos Geriatrics & Palliative Care course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the first-line bedside screening tool for delirium on a general ward?
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The 4AT.
Why? The 4AT is quick (under 2 minutes), needs no training and can be used in drowsy or agitated patients.
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Which delirium assessment tool is designed for ventilated or critically ill patients in ICU?
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CAM-ICU (Confusion Assessment Method for the ICU).
Why? It uses non-verbal tasks, so it works in intubated patients who cannot speak. NICE CG103 lists the ICDSC (Intensive Care Delirium Screening Checklist) as the alternative.
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Delirium has an ______ onset and a fluctuating course, with inattention as the core cognitive feature.
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acute
Why? Sudden onset and fluctuation (often worse at night, with lucid periods) are what separate delirium from dementia.
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Delirium has an acute onset and a ______ course, with inattention as the core cognitive feature.
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fluctuating
Why? Sudden onset and fluctuation (often worse at night, with lucid periods) are what separate delirium from dementia.
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Name three features that favour delirium over dementia.
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Any three of: acute onset, impaired consciousness, fluctuating symptoms (worse at night, lucid periods), abnormal perception (illusions/hallucinations), agitation/fear, delusions.
Why? Dementia is gradual with clear consciousness; delirium is an acute brain failure with a clouded, fluctuating state.
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Name three groups at high risk of delirium.
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Any three of: age over 65, dementia/cognitive impairment, frailty or multimorbidity, polypharmacy, hip fracture or other trauma.
Why? These patients have little cognitive reserve, so a small insult tips them into delirium.
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Name three common precipitants of delirium in an older inpatient.
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Any three of: infection (UTI, pneumonia), metabolic upset (Na, Ca, glucose, dehydration), pain, constipation, alcohol withdrawal, new drugs, change of environment.
Why? Delirium is usually multifactorial, so look for every precipitant, not just one.
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What is the first step in managing delirium?
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Identify and treat the underlying cause(s), with non-drug supportive measures.
Why? Delirium is a symptom of an acute illness; it settles only when the precipitant is corrected.
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What is the first-line drug for a severely agitated patient with delirium who does NOT have Parkinson's disease or Lewy body dementia?
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Low-dose haloperidol (e.g. 0.5 mg).
Why? Drugs are only for distress or risk to self/others after de-escalation fails. NICE CG103 advises short-term use (usually 1 week or less) at the lowest dose.
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An 80-year-old man with Parkinson's disease develops delirium from a chest infection. He is pulling at lines and hitting staff despite de-escalation. If a drug is needed to calm him, which options are used?
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Low-dose lorazepam or quetiapine — avoid haloperidol.
Why? Haloperidol is a strong D2 blocker and can cause severe worsening of parkinsonism or neuroleptic sensitivity in PD and Lewy body dementia.
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Which drug class is used for delirium caused by alcohol withdrawal?
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Benzodiazepines — NICE: oral lorazepam is first-line for delirium tremens.
Why? Withdrawal is GABA under-activity; benzodiazepines replace the GABA effect and prevent seizures. If symptoms persist or oral drugs are refused, NICE CG100 advises parenteral lorazepam or haloperidol.
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Which motor subtype of delirium is most often missed?
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Hypoactive delirium.
Why? Quiet, withdrawn, drowsy patients are mistaken for depression or tiredness, so delirium goes unrecognised.