Examkin

Question

Difficulty: EasyNeurocognitive Disorders

During morning rounds on a surgical ward, an internal medicine consultant is asked to evaluate a patient recovering from a right femoral neck fracture repair performed 48 hours ago. The nursing staff reports that the patient was awake, alert, and conversational yesterday, but overnight she became highly agitated, attempted to remove her urinary catheter, and claimed that insects were crawling on her bed sheets. The patient's daughter confirms her mother lived independently and had no history of memory issues or psychiatric illness prior to the fall. Physical examination reveals an inattentive patient who drifts off to sleep during questioning. Vital signs are stable, and a basic metabolic panel is unremarkable. Which of the following is the most likely diagnosis for this patient's acute presentation?

  1. A
    Brief psychotic disorder
  2. B
    Major neurocognitive disorder
  3. C
    Normal age-related cognitive decline
  4. DeliriumAnswer
  5. E
    Schizophrenia

Answer

Delirium
The correct answer is delirium. This patient presents with an acute change in mental status, marked inattention (drifting off during questioning), a fluctuating level of consciousness, and visual hallucinations (seeing insects) following a major surgery. These features, combined with a lack of prior cognitive impairment, are the classic clinical hallmarks of delirium. Delirium is a neurocognitive disorder that is typically secondary to an underlying medical condition, medication effect, infection, or the physiological stress of surgery.

Step-by-Step Solution

1
Identify the timeline and onset of the patient's symptoms.
The patient developed acute behavioral changes and hallucinations over a matter of hours (overnight) on postoperative day 2.
Establishing the timeline helps distinguish acute conditions from chronic neurodegenerative diseases.
2
Analyze the specific clinical features present on examination.
The patient exhibits marked inattention, a fluctuating level of consciousness (drifting off to sleep), and visual hallucinations (seeing insects).
These specific signs are hallmark diagnostic features of a specific acute cognitive disorder.
3
Synthesize the findings to determine the most likely diagnosis.
An acute, fluctuating change in mental status with inattention in a hospitalized patient points directly to a secondary physiological effect rather than a primary psychiatric disorder.
Ruling out primary psychiatric illnesses and chronic cognitive decline confirms the diagnosis of delirium.

Key Concept

Clinical presentation and diagnostic criteria for delirium
Estimated Time:1m 0s
Rate this question

Topics

Neurocognitive Disorders

More questions from this topic