MBBS OSCE · neurology
OSCE — Delirium
Eight-minute OSCE station on Delirium: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Delirium.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Delirium is an acute, fluctuating disturbance of attention and awareness caused by a medical condition, substance intoxication or withdrawal, medication, toxin exposure, or multiple factors (DSM-5). It is a medical emergency and a marker of acute brain dysfunction, carrying an in-hospital mortality that can reach 25 percent and a doubled 6-month mortality in older adults. The commonest precipitants in the elderly are infection (UTI, pneumonia), drugs (opioids, benzodiazepines, anticholinergics), dehydration, metabolic/electrolyte disturbance, hypoxia, uncontrolled pain, surgery, constipation and urinary retention. Diagnosis is clinical using the Confusion Assessment Method (CAM) — acute onse
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD).
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Acute onset, fluctuating course and inattention in any ill adult - delirium unti |
| Safety | Quiet, withdrawn, drowsy or 'off legs' elderly inpatient - consider hypoactive d |
| Safety | New visual hallucinations and agitation in a hospitalised patient - think deliri |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging.