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Postoperative Delirium — RACP Adult Medicine MCQ

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EasyNeurologyPostoperative DeliriumRACP Adult Medicine

A 80-year-old man post-hip fracture repair develops acute onset confusion, fluctuating consciousness, inattention, and visual hallucinations on day 2. He was cognitively normal preoperatively. He is on regular oxycodone, has a urinary catheter, and is constipated. Na⁺ 134, K⁺ 4.0, creatinine 110. What is the most likely precipitant?

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Correct answer: C — Opioid medication

Acute onset fluctuating confusion with inattention and visual hallucinations post-operatively with an identifiable precipitant (opioids) is hyperactive delirium. Opioids are a common precipitant — especially in elderly patients. The 4AT or CAM tool should be used for screening. Management: address precipitants (reduce/rotate opioid, treat constipation), non-pharmacological interventions (orientation, sleep hygiene, mobilisation). Avoid antipsychotics unless severely agitated and at risk.

Reference: eTG – 2024 – Delirium; NICE 2024 Delirium; ACSQHC 2024