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Delirium Quiz
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Which presentation is most characteristic of the most common subtype of delirium?
- A Fluctuating alertness with visual hallucinations You picked ✕
- B Disorganised speech with impaired attention but normal motor activity You picked ✕
- C Fixed low mood with persistent tearfulness You picked ✕
- D Withdrawn, quiet, and sleepy behaviour You picked ✓
- E Restless, agitated, and aggressive behaviour You picked ✕
Correct!
Incorrect
The answer is D: Withdrawn, quiet, and sleepy behaviour
Explanation
Why D is correct
See Presentation. Option D is correct because hypoactive delirium shows as reduced activity: the person is withdrawn, quiet and sleepy. Delirium is an acute, fluctuating disturbance of attention and awareness, and it comes in three types according to behaviour: hyperactive (restless, agitated, even aggressive), hypoactive and mixed. CKS describes the hypoactive type as the most common, with the person becoming withdrawn, quiet, lethargic and sleepy. It is also the type most easily missed, because a quiet patient causes no trouble on the ward and the change can be mistaken for tiredness, depression or dementia. NICE lists the signs that are often missed, including withdrawal, slow responses, reduced mobility and movement, worsened concentration and reduced appetite. The key to spotting it is an acute change from the person's usual self, ideally confirmed by someone who knows them well. A memory aid: hypo means under, so the patient is under-active; hyper means over, so the patient is over-active.
- Type: hypoactive delirium shows as reduced activity
- Look: withdrawn, quiet, lethargic and sleepy
- Easily missed: a quiet patient is often mistaken for tired, depressed or having dementia
- Key sign: an acute change from the person's usual self
Why the other options are incorrect
- A. Fluctuating alertness with visual hallucinations: Fluctuating alertness with visual hallucinations can occur in delirium but is not a motor presentation and is not the most common subtype. Hallucinations are more prominent in hyperactive or mixed delirium, whereas the most common hypoactive form is withdrawn and sleepy. It would not describe the reduced motor activity of the most common subtype. Your answer
- B. Disorganised speech with impaired attention but normal motor activity: Disorganised speech with impaired attention describes the cognitive disturbance of delirium rather than its motor subtype. The question asks for the most characteristic presentation of the most common motor subtype, which is reduced activity. This option could occur in any subtype and does not distinguish hypoactive delirium. Your answer
- C. Fixed low mood with persistent tearfulness: Fixed low mood with persistent tearfulness describes depression, which develops over weeks and does not cause the acute fall in attention and alertness seen in delirium. It can be confused with hypoactive delirium. It would be the answer if the picture were persistent sadness with normal attention. Your answer
- E. Restless, agitated, and aggressive behaviour: Restless, agitated and aggressive behaviour is hyperactive delirium. It is more obvious and so more likely to be noticed. It would be the answer if the question asked for the hyperactive type. Your answer
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What you will practise
More questions from this set. Start the quiz to answer them and see each explanation.
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1
Which statement best describes the core principle in the management of delirium?
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2
An 82-year-old woman becomes acutely confused and agitated on the second day after hip surgery. She is disorientated to time and place and has fluctuating alertness. Her oxygen saturation is reduced, and a new medicine has been started in hospital to help her sleep. Which listed factor is the clearest new precipitant of her delirium?
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