Neurology Main神经内科 31-40-课件.ppt

Neurology Main 31-40 Q 31A 78-year-old woman is brought to the emergency department due to insomnia and frequent episodes of agitation over the past 2 days. The patient was confused yet calm on arrival; but now she is yelling loudly and trying to pull out her intravenous lines, take off her clothes, and run away while being examined. She is a nursing home resident. Her recent medical history includes severe memory loss and gait disturbance. The patients chronic medical issues include hypertension, type 2 diabetes mellitus, peptic ulcer disease: and chronic pyelonephritis. Her temperature is 37.2 C (99 F); blood pressure is 162/96 mm Hg, and pulse is 95/min and regular Pulse oximetry shows 96% oxygen saturation on room air. ECG shows normal sinus rhythm, left ventricular hypertrophy, a normal QTc interval, and no acute ischemic changes. Laboratory studies are as follows:Urinalysis shows trace protein, numerous leukocytes： and occasional erythrocytes. Which of the following is the best initial treatment for this patient?A. Amitriptyline B. Clopidogrel C. Haloperidol D. Lorazepam E. Memantine A 31Correct answer:CDelirium (waxing and waning alteration in consciousness) in hospitalized patients is usually due to toxic- metabolic or infectious etiologies. Advanced age and dementia are also important risk factors. A workup for the cause of delirium (review of medication list, blood work, urinalysis, possible imaging) is needed (Table). If an infection js identified, treatment should be initiated as soon as possible. In this patient with underlying dementia, delirium may be due to a urinary tract infection given the pyuria seen on urinalysis.Regardless of the etiology of her dementia and delirium, this patient has severe agitation, which may compromise her safety and interfere with medical management (egr difficulty with intravenous fluid or antibiotic administration： radiologic testing). The treatment of choice for agitation in the elderly is low-dose haloperidol. Atypical