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Postoperative delirium — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Postoperative deliriumUSMLE Step 3

An 82-year-old with mild cognitive impairment is attentive after hip-fracture repair but has high delirium risk. Which postoperative bundle best reflects evidence-based multicomponent prevention?

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Correct answer: C — Orientation, early ambulation, sleep protection, hydration, and access to hearing and visual aids

The best answer is “Orientation, early ambulation, sleep protection, hydration, and access to hearing and visual aids”. Effective prevention targets several modifiable precipitants simultaneously. Anticholinergic sedatives, routine prophylactic antipsychotics, immobility, and avoidable overnight disruption undermine otherwise reasonable components of the competing bundles. Diphenhydramine adds anticholinergic burden, routine haloperidol is not preventive therapy, bed rest removes protective mobility, and repeated overnight awakening defeats sleep preservation.

Reference: AHRQ PSNet: Mismanagement of Delirium: https://psnet.ahrq.gov/web-mm/mismanagement-delirium