QuestionSBA
QuestionChoice
The patient is afebrile without any audible crackles, making this an unlikely option.
10035498
b
Pneumonia
QuestionChoice
This is a case of delirium, of which constipation is a common cause. Given the patient is afebrile and appears euvolaemic based on her observations and examination, the most likely cause is constipation, which can present with mild lower abdominal tenderness.
10035497
a
Constipation
QuestionChoice
Whilst pain itself can cause delirium, the abdominal pain is described as mild. Additionally, the patient has normal observations, which you may not expect in the case of acute pain. This makes constipation a more likely cause of this patient’s delirium.
10035499
c
Pain
QuestionChoice
As the patient has moist mucous membranes, is not tachycardic and is normotensive for an older female, this is unlikely to be the cause of her delirium. This is however an important cause of delirium that should always be considered.
10035501
e
Dehydration
QuestionChoice
As this patient was acutely confused before medical attention was sought, this is unlikely to have caused her delirium.
10035500
d
Change of environment to a medical setting
Concept
Chapter
2693
4045
Delirium
Topic
191
Geriatrics
19503
Constipation is a common cause of delirium in elderly patients, often presenting with confusion and mild abdominal tenderness.
A 93-year-old female has 2 days of confusion and loss of appetite. She does not answer questions directly when asked and appears drowsy throughout the assessment. She lives with her daughter who states she is much more confused than normal and reports she was otherwise well before this presentation.

Observations:

* Respiratory rate: 14
* Oxygen saturations: 95% on room air
* Heart rate: 58
* Blood pressure: 95/58 with no significant postural drop
* Temperature: 37.2 degrees celsius

On examination, she has moist mucous membranes. Her chest is clear and no added heart sounds are heard. Her abdomen is mildly tender on palpation of the left iliac fossa with bowel sounds present.

What is the most likely cause of her presentation?
a