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ardy · Credits: 12774 My Scrapbook

an 81 yr old woman inpatient recovering frm surgical hip replacement has the onset of confusion ,anxiety ,disorientation.she has recieved several dose of meperidine fr pain control over past 24 hours.she is afebrile.electrolyte,bun,and urine analysis ar all normal.Chest Xray ok.
MRI reveals mild cortical atrophy .wht is the diagnosis
a. alzheimers dementia
b.delirium due to occult infection
c.generalised anxiety disorder
d.opoid induced delirium
ans is given d can anybody explain

nutsnitin · Credits: 15174 My Scrapbook

among the given options, d seems to be most appropriate...

a...no previous history..
b..no fever
c...no history of any disorder symptom...

though cortical atrophy confuses, but still d is best option acc to me...

ardy · Credits: 12774 My Scrapbook

how do we rule out alzheimers?

manpreet108 · Credits: 30702 My Scrapbook

alzheimers doesnot have such acute presentation...and no history has been given...also mild cortical atrophy can be a usual finding at this age--81 yrs.

clinically--alzheimer wd first present as loss of recent memory--and slowly progressive dementia.

pathologically--alzheimers wd have a diffuse gross atrophy of cerebral cortex on mri--esp hippocampus....other features like neurofibrillart tangles.
in earlier cases --neuroimaging studies may be normal--but here acute presentation goes against alzheimers..

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