Delirium — MRCPsych Paper B MCQ

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EasyOld Age PsychiatryDeliriumMRCPsych Paper B

A 60-year-old woman with no psychiatric history presents to the liaison psychiatry team after a hip replacement with acute-onset confusion, fluctuating consciousness, visual hallucinations and disorientation. She was well before surgery. Observations show a low-grade temperature. What is the most likely diagnosis?

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Correct answer: B — Delirium

The correct answer is B, delirium. The decisive features are onset following surgery over a short period, fluctuation in consciousness, confusion, disorientation and visual hallucinations. NICE describes delirium as an acute, fluctuating disturbance affecting cognition, consciousness or perception. A physical precipitant should be sought; the postoperative state, medication exposure, pain and possible infection are relevant possibilities, although the temperature alone does not establish infection. Dementia generally develops progressively rather than abruptly in a previously well patient. Late-onset schizophrenia and psychotic depression do not characteristically cause fluctuating consciousness and global disorientation. Charles Bonnet syndrome causes visual hallucinations in people with visual impairment while cognition and insight are otherwise relatively preserved.

Reference: National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and management in hospital and long-term care. NICE guideline CG103, sections 1.3 and 1.6. Published 2010; updated 18 January 2023. https://www.nice.org.uk/guidance/cg103/chapter/Recommendations