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Delirium — USMLE Step 3 MCQ

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HardPsychiatry (Outpatient Management)DeliriumUSMLE Step 3

An 82-year-old man develops delirium after hip surgery. Pain, urinary retention, hypoxia, infection, and medication contributors are being treated, but he repeatedly pulls at a central line and strikes staff despite family presence, reorientation, hearing aids, and a sitter. QTc is 430 ms and he has no parkinsonism. Which additional intervention is most appropriate?

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Correct answer: E — Use brief low-dose antipsychotic treatment with daily reassessment

The best answer is “Use brief low-dose antipsychotic treatment with daily reassessment”. Cause-directed and multicomponent nonpharmacologic care remain foundational. When severe agitation continues to threaten substantial harm despite those measures, a brief lowest-effective-dose antipsychotic may be used with daily reassessment. Benzodiazepines, routine prolonged antipsychotics, and restraints can worsen delirium or cause additional injury and are not preferred here.

Reference: American Geriatrics Society Guideline for Postoperative Delirium: https://pmc.ncbi.nlm.nih.gov/articles/PMC5901697/