Delirium from infection — MCCQE Part 1 MCQ

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ModerateAltered Level of ConsciousnessDelirium from infectionMCCQE Part 1

An 82-year-old woman from long-term care is acutely confused and inattentive, febrile, tachycardic and has suprapubic tenderness. Which of the following is the most appropriate next step?

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Correct answer: C — Assess and treat likely infection while using non-pharmacologic delirium measures

Assess and treat likely infection while using non-pharmacologic delirium measures is the single best answer because the age, timing, examination findings and investigations in the vignette fit Delirium from infection better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to Canadian Coalition for Seniors' Mental Health delirium guidance, with attention to acuity, safety-netting and local provincial pathways.

Reference: Canadian Coalition for Seniors' Mental Health delirium guidance