confusion

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic and disoriented. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium: 118 mmol/L Potassium: 3.8 mmol/L Chloride: 85 mmol/L Bicarbonate: 24 mmol/L Blood Urea Nitrogen (BUN): 25 mg/dL Creatinine: 1.1 mg/dL Glucose: 95 mg/dL Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

An 18-year-old teenage girl presents with a sudden change in behavior at a music festival, appearing confused and aggressive after consuming 5-6 vodkas, with uncertainty about illicit drug use. What is the most appropriate next step in her management in the Australian context?

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal coiling was performed. The image shows a post-operative angiogram. 6 hours later, she develops a fever of 38.5°C and worsening confusion. What is the MOST appropriate next step?

A 62-year-old man presents to the emergency department with sudden onset of severe headache, nausea, and vomiting. He has a history of poorly controlled hypertension and is currently on no medications. On examination, he is drowsy but arousable, with a blood pressure of 210/120 mmHg and a heart rate of 90 bpm. Neurological examination reveals right-sided hemiparesis and a left gaze preference. A CT scan of the head shows a large hyperdense area in the left basal ganglia with surrounding edema. What is the most appropriate initial management for this patient?

A 68-year-old woman is admitted to the hospital with confusion and muscle weakness. Her medications include hydrochlorothiazide for hypertension. Initial laboratory results show: Sodium 120 mmol/L (Normal: 135-145 mmol/L), Potassium 3.8 mmol/L (Normal: 3.5-5.0 mmol/L), Chloride 90 mmol/L (Normal: 95-105 mmol/L). What is the most likely cause of her hyponatremia?

A 62-year-old woman presents to the emergency department with confusion and lethargy. Her family reports she has been increasingly forgetful over the past week and has had a decreased appetite. She has a history of type 2 diabetes mellitus and hypertension, for which she takes metformin and lisinopril. On examination, she is disoriented to time and place, with dry mucous membranes and decreased skin turgor. Her blood pressure is 100/60 mmHg, heart rate is 110 bpm, and temperature is 37.2°C. Laboratory tests reveal a serum sodium level of 118 mmol/L, serum osmolality of 260 mOsm/kg, and urine osmolality of 500 mOsm/kg. Which of the following is the most appropriate initial management for this patient?

A 72-year-old man presents to the emergency department with confusion and difficulty walking. His family reports that he has been increasingly forgetful over the past few months and has had several falls. He has a history of hypertension and hyperlipidemia, for which he takes lisinopril and atorvastatin. On examination, he is disoriented to time and place, with a blood pressure of 140/85 mmHg, heart rate of 78 bpm, and a wide-based gait. Neurological examination reveals brisk reflexes and a positive Romberg sign. A CT scan of the head shows mild cortical atrophy but no acute lesions. Which of the following is the most likely diagnosis?

A 72-year-old woman is admitted to the hospital with increasing confusion and generalized weakness over the past week. Her medical history includes hypertension, for which she takes hydrochlorothiazide 25mg daily. On examination, she is lethargic but arousable. Her blood pressure is 110/70 mmHg, heart rate is 88 bpm, and respiratory rate is 16 breaths per minute. Neurological examination reveals decreased reflexes. Initial laboratory investigations reveal the following: Sodium 118 mmol/L, Potassium 3.8 mmol/L, Chloride 85 mmol/L, Bicarbonate 24 mmol/L, BUN 15 mg/dL, Creatinine 0.8 mg/dL, Glucose 90 mg/dL. Urine osmolality is 600 mOsm/kg. Serum osmolality is 250 mOsm/kg. Which of the following is the most appropriate initial management strategy?

A 62-year-old woman with a 15-year history of type 2 diabetes mellitus presents to the emergency department with confusion, polyuria, and polydipsia over the past three days. She has been non-compliant with her medications and diet. On examination, she is lethargic and dehydrated, with a blood pressure of 100/60 mmHg, heart rate of 110 bpm, and respiratory rate of 20 breaths per minute. Laboratory tests reveal a blood glucose level of 38 mmol/L, serum sodium of 150 mmol/L, serum potassium of 4.0 mmol/L, serum bicarbonate of 22 mmol/L, and a serum osmolality of 340 mOsm/kg. Urinalysis shows no ketones. Which of the following is the most appropriate initial management step?

An 98-year-old lady with cognitive impairment has had 2 episodes of acute delirium, is pacing, and is vomiting blood. What is the immediate management?

A 25-year-old woman presents to the clinic with a 2-week history of fatigue, sore throat, and swollen glands. She also reports a low-grade fever and mild headache. On examination, she has cervical lymphadenopathy and mild splenomegaly. A monospot test is positive. What is the most appropriate advice regarding her physical activity?

A 62-year-old woman presents to the emergency department with acute confusion and weakness on the right side of her body. She has a history of atrial fibrillation and is on warfarin for anticoagulation. Her INR is 3.5. On examination, she is disoriented to time and place, with a right-sided facial droop and hemiparesis. A CT scan of the head shows a left-sided intracerebral hemorrhage. What is the most appropriate next step in the management of this patient?