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Change in Mental Status

Topic: Anatomy

Created on Thursday, December 28 2006 by jdmiles

Last modified on Thursday, December 28 2006.

A 52 year-old male weed biologist with no significant past medical history is admitted to the general medicine service overnight because of painful bunions. Apart from tender feet, his initial exam was unremarkable.
The next morning, Neurology is consulted to evaluate his change in mental status. On your exam, you find that although he is neurologically intact, he is combative, and insists that he is the head of the FBI.
Of the following, which is the most likely explanation for his mental status?

A) The patient has Pick disease

B) The patient has new onset of schizophrenia

C) The patient has dementia of the Alzheimer type

D) The intern who admitted the patient last night is lazy, and did not do a neurologic exam

E) The intern who admitted the patient last night gave him some medication to which he is having a nasty reaction.

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This question was created on December 28, 2006 by jdmiles.
This question was last modified on December 28, 2006.

ANSWERS AND EXPLANATIONS

A) The patient has Pick disease

This answer is incorrect.

This patient with no significant past medical history displayed an overnight change in mental status. This is not consistent with the course of Pick disease (See References)


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B) The patient has new onset of schizophrenia

This answer is incorrect.

This is a 52 year-old patient, with no known history of psychosis. The onset of schizophrenia is typically seen at a much younger age. Further, the diagnosis of schizophrenia requires symptoms to persist for a significant portion of time during a 1-month period. (See References)


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C) The patient has dementia of the Alzheimer type

This answer is incorrect.

This patient with no significant past medical history displayed an acute change in mental status. This is not consistent with the course of Alzheimer dementia (See References)


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D) The intern who admitted the patient last night is lazy, and did not do a neurologic exam

This answer is incorrect.

This is not a nice thing to say about your colleagues. You shouldn't even think such things (See References)


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E) The intern who admitted the patient last night gave him some medication to which he is having a nasty reaction.

This answer is correct.

The symptoms and clinical course of this change in mental status is consistent with delirium. In the setting of recent hospitalization, an adverse reaction to a medication is the likely cause. (See References)


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References:

1. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. American Pyschiatric Association, Washington, DC. (ISBN:0890420254)	Advertising:
2. DeKosky, S.T., Kaufer, D.I., and Lopez, O.L. (2004). The Dementias. In Bradley, W.G., Daroff, R.B., Fenichel, G.M., and Jankovic, J. (Eds.). Neurology in Clinical Practice, 4th Edition. Butterworth Heinemann, Philadelphia. Pp. 1901-1951. (ISBN:0750674695)	Advertising:


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anatomy
Change in Mental Status
Question ID: 12280600
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 12/28/2006
Modified: 12/28/2006
Estimated Permutations: 0