QuestionSBA
QuestionChoice
The patient likely has hyperactive delirium. Urinary retention is a common cause of delirium in the elderly. Resistance of examination of the suprapubic region suggests there may be a tender, enlarged bladder. A bladder scan will confirm whether this is the case.
10028251
a
Bedside bladder scan
QuestionChoice
An abdominal x-ray may show faecal loading/constipation, another common cause of hyperactive delirium in older patients. However, this would not be the most appropriate next investigation as a bladder scan can be done at the bedside.
10028252
b
X-ray abdomen
QuestionChoice
A CT head may be carried out given that this patient is acutely confused, however, considering the history and examination findings, it is not the next most appropriate investigation. A bedside bladder scan can be done extremely quickly and may reveal the underlying cause for the delirium.
10028255
e
CT head
QuestionChoice
If a bladder scan does not demonstrate retention and the patient is still resisting examination of the abdomen (suggesting pain), a CT abdomen may be required. This is not currently the case.
10028254
d
CT abdomen (with contrast)
QuestionChoice
This would be a useful investigation to look for renal calculi or hydronephrosis. The history is not suggestive of this at present. The most pressing issue is investigating the cause of the patient's hyperactive delirium, which can be done in the first instance with a bladder scan.
10028253
c
CT Kidneys, Ureters, Bladder (non-contrast)
Concept
Chapter
2693
4045
Delirium
Topic
191
Geriatrics
18048
A bladder scan is a non-invasive tool used to assess urinary retention in the elderly by measuring post-void residual urine volume to determine if there is incomplete bladder emptying.
A 75-year-old man is admitted to hospital from a nursing home as his carers think she is significantly more confused than normal. She has a history of Alzheimer's disease and multiple strokes.

On examination, the patient is agitated and is shouting. There is no obvious focal neurology and the patient is moving all four limbs. The patient resists examination of the suprapubic region, pushing the doctor's hands away forcefully.

What is the next most appropriate investigation?
a