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Postoperative delirium — SCE Acute Medicine MCQ

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EasyPerioperative Medicine, End-of-Life Care and Patient SafetyPostoperative deliriumSCE Acute Medicine

A 84-year-old man is assessed on the acute medical unit. He is day 1 after hip surgery with fluctuating attention and visual hallucinations. Pain, urinary retention and infection are being assessed. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Delirium

Delirium is the best answer because acute fluctuating attention disturbance after surgery is delirium until proven otherwise. Acute pancreatitis is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Treat causes and use non-pharmacological measures before sedatives where possible.

Reference: NICE CG103