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Delirium from infection — MCCQE Part 1 MCQ

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EasyDeliriumDelirium from infectionMCCQE Part 1

81-year-old man presents with acute confusion. Symptoms fluctuate, he is inattentive and has fever and urinary symptoms. Which of the following is the most appropriate next step?

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Correct answer: D — Identify and treat underlying causes while using non-pharmacologic delirium measures

Identify and treat underlying causes while using non-pharmacologic delirium measures is best because acute fluctuating inattention is delirium, often due to medical illness. Provide reassurance only and arrange no follow-up is suboptimal because mental health risk often requires structured follow-up or urgent escalation; Use long-term benzodiazepine monotherapy as default treatment is suboptimal because benzodiazepine monotherapy is rarely an appropriate long-term strategy; Avoid direct risk assessment to preserve rapport is suboptimal because direct assessment of suicide, violence, capacity and substance use is clinically appropriate; Attribute symptoms to personality or culture without assessing illness is suboptimal because diagnostic overshadowing risks missing treatable mental illness. Delirium is a medical emergency, not dementia progression.

Reference: Canadian Coalition for Seniors' Mental Health delirium guidance