NREMT Paramedic Cognitive ExamMedicalMedium
A 72-year-old female is found by family members to be confused and agitated. She has a history of dementia and atrial fibrillation. Her temperature is 101.5°F (38.6°C), BP 130/80 mmHg, HR 98 bpm, RR 22 bpm. Her skin is warm and dry. She complains of generalized weakness. What is the most likely underlying cause of her acute mental status change?
- ACardiac arrhythmia exacerbation
- BAcute ischemic stroke
- CHypoglycemia
- DUrinary tract infection
Show answer & explanationAnswer & explanation
Correct answer: D. Urinary tract infection
In elderly patients, especially those with dementia, an acute change in mental status (delirium, confusion, agitation) accompanied by a low-grade fever and generalized weakness is a classic presentation of a urinary tract infection (UTI). UTIs can cause systemic symptoms without typical urinary complaints in this population.
Why the other options are wrong
- A. An arrhythmia exacerbation could cause confusion due to decreased cerebral perfusion, but the fever and warm skin point away from a purely cardiac cause.
- B. While possible, an acute stroke would likely present with more focal neurological deficits, not just generalized confusion and fever.
- C. Hypoglycemia would typically cause diaphoresis, pallor, and a lower temperature, not a fever and warm skin.
UTI in Elderly
Urinary tract infections in older adults often present atypically, with confusion, delirium, or general weakness rather than classic urinary symptoms.
- Acute mental status change is a common presenting symptom.
- Fever may be low-grade or absent.
- Can lead to sepsis if not treated promptly.
Memory trick: In the elderly, 'I CUPS' for confusion: Infection, Cardiac, Under-medication, Pain, Stroke.