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Delirium from infection — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsDelirium from infectionSCE Acute Medicine

A 63-year-old woman presents with acute neurological symptoms. Relevant history includes vascular, infectious or neuromuscular risk factors. On assessment, neurological examination shows focal or global dysfunction. Investigations show acute fluctuating inattention with fever and catheter-associated UTI. What is the most appropriate next step in management?

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Correct answer: D — Treat underlying infection and use non-pharmacological delirium measures

The key discriminator is that acute fluctuating inattention with fever and catheter-associated UTI, which makes Treat underlying infection and use non-pharmacological delirium measures the single best answer. Give targeted antidote or reversal therapy is less appropriate because it does not address the dominant acute risk in the vignette; Arrange urgent CT imaging would fit a different presentation or later stage of care. Arrange routine outpatient follow-up and Start broad-spectrum intravenous antibiotics are suboptimal because they would either delay time-critical treatment or follow the wrong acute pathway. Teaching point: SCE-style acute medicine questions usually test prioritisation using physiology, timing and a guideline-defined threshold, rather than isolated factual recall.

Reference: NICE CG103; NICE NG253