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Hospital delirium — ABIM Board MCQ

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HardGeneral Internal MedicineHospital deliriumABIM Board

An 82-year-old man is hospitalized for heart failure and becomes inattentive and disoriented overnight. He has fluctuating alertness, visual misperceptions, and sleep-wake reversal. He received diphenhydramine for sleep. Temperature is normal and oxygen saturation is 95%. Which of the following is the most appropriate management?

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Correct answer: E — Stop deliriogenic medications and implement nonpharmacologic delirium measures

Delirium is managed by identifying causes and removing deliriogenic medications, correcting sensory and sleep disruption, mobilizing, hydrating, and reorienting. Antipsychotics are reserved for severe distress or safety risk after nonpharmacologic measures.

Reference: American Geriatrics Society Delirium Guidance