A 26-year-old woman is brought in by her distraught husband.

She has been unwell for the last 3 days. She is intermittently confused and

over the last 24 hours, has refused to eat or drink and appeared to be

disengaged and cannot look after her 1- and 3-year-old children. She has no regular medications. The only sick contact is one of her children who had a diarrhoeal illness last week.

Her vital signs are HR 100/min, BP 100/80, RR 20/min, temp

39°C, BSL 4.0 mmol/L. She cannot follow your commands. She does not make eye

contact or respond to you. You find no meningism. You do not find any focus of infection on examination.

Question:

Which of the following descriptions is NOT related to delirium?

A 60-year-old man known to your ED with alcoholism presents

to your ED. He is confused, agitated, diaphoretic and ataxic. At Triage, his

vital signs are HR 120/min, BP 140/90 mmHg, RR 24/min, SAO2 95% on RA, Temp

37.5°C.

On examination, he is disorientated, appears to be

distracted by the surroundings. He is tremulous, hyperreflexic and appears to

be extremely anxious. You can smell alcohol on his breath.

On review of his history on the eMR, you note that he has

had alcohol withdrawal seizures. Your assessment is that he has delirium due to

alcohol withdrawal.

Question:

An 82-year-old woman is admitted to the ED short stay ward

overnight for observation. She presented with a generalised urticarial rash

with lip swelling after eating her Christmas lunch at home with her family. She

was given adrenaline 0.3mg IM on arrival at 8pm. Prednisone 50mg was given 15

mins later together with promethazine oral.

She is normally well, lives alone and independent in all her

daily activities. She lives close to her children and grandchildren. She has no

cognitive impairment noted in her eMR. She is on aspirin 100mg daily and

lercandipine 10mg at night for her hypertension.

This morning, she is confused and unable to attend to her

toileting and has been incontinent. HR

90/min, BP 140/90 mm Hg, temp 37°C.

Her vital signs are normal.

What is the most likely cause of her symptoms?

A 75-year-old man is admitted under the Infectious Disease

unit with Covid. However, he is in the ED due to a lack of isolation beds. You

are called to his isolation room. He is yelling and pulling at his monitoring

leads. The nurse is unsuccessful in calming him. He has now required 4 other

nursing staff to hold him to prevent him from falling. The emergency buzzer for

the room has been pressed.

Question:

The patient above had a lumbar puncture performed as part of the workup investigations for his delirium. The patient's investigations have returned.

CSF results:

Question: What is your interpretation of his CSF results?

For this patient, you are

looking for the underlying causes of his delirium. There is no further

information you can obtain from his flatmate, GP or language school. There are

no relatives to contact.

You are about to order some pathology tests. Which of the

following list of electrolyte abnormalities may cause delirium?

A 25-year-old man is brought in from the Language School due

to abnormal behaviour. His tutor noted that he was behaving oddly - distracted

in class, confused and disorientated to time, place, and person.

On examination, you find it hard to engage him. He is not fluent in English. You cannot

complete a neurological examination due to his inattention. He can focus on you

and others but only for a short period of time. He has no evidence of auditory

or visual hallucinations.

His vital signs: HR 78 bpm, BP 110/70 mmHg, temp 37°C, BSL 5.5 mmol/L.

What is your differential diagnosis at this stage?