20 Questions
What is the primary neurotransmitter affected in delirium pathophysiology?
Acetylcholine
What is a characteristic of delirium in terms of onset and course?
Acute onset with fluctuating course
Which of the following is NOT a predisposing factor for delirium?
Hypertension
What is the primary cognitive deficit seen in delirium?
Attentional deficits
Which neurotransmitter imbalance is implicated in delirium pathophysiology?
Acetylcholine imbalance
What is the primary step in the diagnosis of delirium?
Recognition of delirium
Which region of the brain is responsible for engaging attention in the pathophysiology of delirium?
Thalamus
Which hemisphere of the brain is dominant for attention, according to evidence?
Right Hemisphere
What is a possible explanation for the pathophysiology of delirium?
Alterations in neurotransmitters, particularly a cholinergic-dophaminergic imbalance
Which cognitive function is impaired in delirium?
Attention
What is a common underlying cause of delirium?
Serious underlying medical or neurologic illness
What is the role of the Thalamic nuclei in the pathophysiology of delirium?
Screening incoming sensory information
What is the primary characteristic of a patient in a vegetative state?
Arousal present, including sleep-awake cycle, but no awareness.
Which of the following is a characteristic of delirium?
Rapidly fluctuating change in cognition.
What is the primary difference between a stupor and a coma?
Level of responsiveness to noxious stimuli.
Which of the following is a characteristic of psychogenic unresponsiveness?
Forced gaze that changes direction.
What is the primary characteristic of a minimally conscious state?
Eye contact and orientation to stimuli.
Which of the following is a characteristic of akinetic mutism?
Lack of spontaneous motor activity.
What is the primary characteristic of a locked-in syndrome?
Paralysis of extremities and cranial nerves with vertical eye movement spared.
Which of the following is NOT a characteristic of delirium?
Gradual onset of cognitive impairment.
Study Notes
Delirium
- Differential diagnosis: hypoglycemia, hypoxia, and other metabolic changes affecting acetylcholine-mediated functions
- Involvement of other neurotransmitters: dopamine, serotonin, norepinephrine, GABA, glutamine, opiates, and histamine
Clinical Characteristics
- Acute onset of mental status change with fluctuating course
- Attentional deficits, confusion, disorganized thinking, and altered level of consciousness
- Perceptual disturbances, disorientation, memory impairment, and other cognitive deficits
- Behavioral and emotional abnormalities, and sleep/wake cycle disturbances
- Alerted psychomotor activity
Diagnosis
- Two-step process: recognition of delirium and defining the cause from potential diagnoses
- General history, physical examination, and laboratory assessment
Predisposing and Precipitating Factors
- Elderly, dementia, fluid and electrolytes disturbances, dehydration, fever, drug abuse, alcohol, fractures, male gender, and depression
- Specific surgery
Pathophysiology
- Widely distributed neurological dysfunction
- Dysfunction of anterior cingulate cortex, bilateral or right frontal cortex, temporoparietal junction region, thalamus, and upper brainstem structures
- Thalamic nuclei and right hemisphere dominance for attention
- Alterations in neurotransmitters, particularly cholinergic-dophaminergic imbalance
Impairment of Consciousness
- Drowsiness: mild-to-moderate decreased level of alertness and interest in the environment
- Stupor: decreased level of alertness, requiring vigorous stimuli to be aroused
- Coma: absent response to noxious stimuli, closed eyes, and no perception of external stimuli
- Persistent Vegetative State: arousal present, including sleep-awake cycle, but no awareness
- Minimally Conscious State: makes eye contact, orients, and tracks stimuli, with abulic and emotionless behavior
- Delirium: rapidly fluctuating change in cognition, agitation, and disorientation
- Akinetic Mutism: alert appearance, lack of spontaneous motor activity, and lack of recognition of content
- Locked-in Syndrome: paralysis of extremities and cranial nerves, with preserved sensation and consciousness
- Psychogenic Unresponsiveness: forced gaze, non-epileptic abnormal movements, and characteristic responses to specific tests
This quiz assesses your knowledge of neurotransmitters and their effects on mental status, cognitive function, and behavioral changes. It covers acetylcholine, dopamine, serotonin, and other neurotransmitters, as well as their involvement in various neurological symptoms.
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