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altered mental status

Practice targeted AMC-style multiple-choice questions on altered mental status.

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A GP working in a hospital is observed getting into arguments with colleagues. Later, a colleague finds her disoriented and walking in the hallway. What is the most appropriate initial step?

A. Assume it is a personal matter and take no immediate action.
B. Advise the GP to go home and rest.
C. Talk to the GP privately to understand the issue.
D. Document the observations in the GP's personnel file.
E. Notify a superior or relevant authority (e.g., medical supervisor, head of department).
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

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

A. Meningitis
B. Coil migration
C. Hemorrhagic conversion
D. Hydrocephalus
E. Vasospasm
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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. Administer IV fluids to sober her up.
B. Leave the patient alone to cool off.
C. Calmly de-escalate in a quiet room and assess for underlying causes.
D. Restrain the patient physically until she calms down.
E. Immediately administer IV droperidol 10 mg.
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

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, the patient's GCS decreases. What is the MOST likely cause?

A. Hydrocephalus
B. Post-operative delirium
C. Re-rupture of the aneurysm
D. Vasospasm
E. Cerebral salt wasting
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An elderly man presents with a 6-month history of memory decline, recurrent falls, visual hallucinations, agitation, and confusion. His wife reports he talks to people who are not visible. Which of the following clinical features is most helpful in diagnosing his condition?

A. Nystagmus
B. Parkinsonian gait/tremor
C. Ataxia
D. Aphasia
E. Hemiparesis
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A 43-year-old is unconscious with low blood glucose (1.8 mmol/L), has a history of insulin use and alcohol intake. What is the next step?

A. 16G IV + 10% glucose, 150-200 ml over 15 minutes.
B. Give oral glucose.
C. Give 1 mg of glucagon intramuscularly.
D. Give IV 50% glucose.
E. Give subcutaneous insulin.
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Post-embolization arteriogram showing coiled aneurysm (indicated by yellow arrows) of the posteriorcerebral artery with a residual aneurysmal sac.
Image by Promod Pillai, Aftab Karim, Anil Nanda CC BY 2.0 · Source

A 68-year-old woman with a history of hypertension presents with a severe headache and altered mental status. Aneurysmal subarachnoid hemorrhage is confirmed. The aneurysm was coiled. The image shows a post-operative angiogram. 6 hours later, the patient's GCS decreases. What is the MOST likely cause?

A. Rebleeding
B. Hyponatremia
C. Meningitis
D. Hydrocephalus
E. Vasospasm
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Which of the following is a key feature that helps confirm the diagnosis of Serotonin Syndrome?

A. Miosis
B. Hypotension
C. Hyperreflexia
D. Bradycardia
E. Hypertonia
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