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Medication-associated delirium with infection trigger — MCCQE Part 1 MCQ

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HardDeliriumMedication-associated delirium with infection triggerMCCQE Part 1

An 82-year-old woman in long-term care becomes acutely confused over 24 hours. She was started on oxybutynin last week for urinary urgency and now has urinary frequency and low-grade fever. Attention fluctuates during the interview, and urinalysis shows leukocytes and nitrites. What is the most likely diagnosis?

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Correct answer: D — Delirium precipitated by urinary infection and anticholinergic medication

Acute fluctuating inattention is delirium, and this patient has two common precipitants: infection and an anticholinergic drug. Dementia typically progresses over months to years rather than over 24 hours. Late-onset primary psychosis is less likely than delirium in an acutely ill older adult.

Reference: Canadian Coalition for Seniors' Mental Health delirium guidance