An 82-Year-Old Woman Is Evaluated for Confusion and Hallucinations While

An 82-year-old woman is evaluated for confusion and hallucinations while hospitalized.  The patient was brought to the hospital by her daughter 2 days ago after she slipped and fell at home while walking up the stairs.  She was found to have a left hip fracture and underwent open reduction with internal fixation with no complications.  The patient's postoperative pain has been well controlled; however, she has been increasingly anxious and irritable since the day after the surgery.  Today, the patient has difficulty attending to conversations with staff.  She appears disoriented and distracted by visual hallucinations.  The patient has a long-standing history of hypertension, insomnia, anxiety, and mild cognitive impairment.  She has no history of alcohol or illicit substance use.  Her daughter is unsure of the patient's home medications.  The patient is afebrile, blood pressure is 160/98 mm Hg, pulse is 106/min, and respirations are 18/min.  Pulse oximetry is 94%.  She is tremulous, but the examination is otherwise nonfocal; the surgical wound appears to be healing well.  Which of the following is the most likely cause of this patient's new symptoms?

A) Benzodiazepine withdrawal
B) Brief psychotic disorder
C) Dementia
D) Opioid intoxication
E) Pneumonia
F) Stroke

Correct Answer:

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