A 77-year-old male is brought into the emergency department ...

[JGIBBSON]

A 77-year-old male is brought into the emergency department accompanied by his daughter. She reports that her father has been complaining of right-handed weakness for 2 to 3 hours and that she has noticed him slurring his speech.
 
  On physical examination, the right hand grip strength is 1/ 5 compared to the left hand grip of 5/5. A facial droop is noted on the right side of the face. Cranial nerve dysfunction is noted in the right-sided CNVII, CN V, CNIX, CNX, CNXI, and CNXII. The clinician should request the following diagnostic test immediately:
  A. MRI of head
  B. CT of the head
  C. Lumbar puncture
  D. ECG

Question 2

An 85-year-old female patient arrives by ambulance to the emergency department accompanied by her husband.
 
  He reports that his wife had been ill with pneumonia and, 2 days ago, went to the family physician who prescribed azithromycin twice a day. The husband reports that he is making sure she gets the medicine. His wife has been staying in bed and resting. She awoke from sleep last night and was extremely agitated, left the house, and was walking outside. She did not recognize her husband and wanted to call the police. Which of the following is an appropriate question for the history?
  A. Does your wife have dementia or frequent episodes of confusion?
  B. Has your wife been running a fever?
  C. Is your wife allergic to any medication?
  D. Has your wife ever had a mental status exam?

[randomguy133]

Answer to Question 1

ANS: B
Strokes are divided into two main categories: thrombotic and hemorrhagic; however, the two can be difficult to differentiate using clinical signs and symptoms. The onset is usually an abrupt altered level of consciousness accompanied by hemiparesis or hemiplegia. Patients may experience confusion, memory impairment, and aphasia. Signs and symptoms vary with the location and severity of the stroke. Mentation and cognitive changes may be temporary or permanent depending on the extent of injury. Communication alterations stemming from fluent or receptive aphasia may be mistaken as dementia. A CT scan, without contrast, is the preferred imaging study in early stroke because hemorrhage may be difficult to determine on an MRI in the first 48 hours. In studies of ischemic stroke patients, researchers have shown the reversibility of abnormalities on CT or MRI through the use of thrombolytic therapy within a 3-hour window.

Answer to Question 2

ANS: A
Delirium can be observed in both elderly and younger patients and is generally defined as an acute confusional state, affecting all aspects of cognition and mentation. The signs and symptoms of delirium generally have a more acute or rapidly progressive onset as opposed to the slow, gradual decline noted in the organic dementias. The acute mental status change is often associated with other signs or symptomssuch as hallucinations, illusions, incoherent speech, and constant aimless activitythat help to narrow the differential diagnosis. Electrolyte disturbances, infection, and polypharmacy are frequent causes of delirium in the elderly.

[JGIBBSON]

TYSM

[JaynaD87]

Excellent