Independent NAC OSCE preparation by BoardQBank
Cardiovascular examRespiratory examAbdominal examMurmur soundsOfficial resourcessupport@boardqbank.com
NAC OSCE logoNAC OSCEBoardQBank preparation
⌂
Important: Exam dates, fees and policies can change. Verify time-sensitive details on the official Medical Council of Canada website.
Home / Delirium and dementia
Older adults — complete topic guide

Delirium and dementia

Turn this presentation into an 11-minute OSCE performance: focused assessment, prioritized differential, targeted examination and investigations, immediate management, communication, disposition and safety-netting.

What you must demonstrate

  • Collateral history
  • ADL/IADL assessment
  • Cognition and delirium screening
  • Medication reconciliation
  • Capacity and substitute decision-making
Do not miss: Acute delirium · Injury after fall · Medication toxicity · Abuse or neglect · Unsafe discharge · Rapid functional decline

11-minute performance map

0:00–0:45

1. Opening and immediate safety

Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.

0:45–4:30

2. Focused assessment

Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.

4:30–6:30

3. Targeted examination

Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.

6:30–7:30

4. Synthesize

Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.

7:30–8:40

5. Investigations

Choose tests that answer a specific diagnostic or safety question; state urgent tests first.

8:40–10:15

6. Immediate management

Treat instability, begin syndrome-specific care, consult early when needed and define disposition.

10:15–11:00

7. Communication and safety net

Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.

Focused history prompts

Define the presentation

  • Onset, chronology, triggers and progression.
  • Severity and effect on function.
  • Associated symptoms that support the leading diagnosis.
  • Relevant negatives that reduce dangerous alternatives.

Risk context

  • Relevant past medical/surgical/obstetric/psychiatric history.
  • Medications, allergies and adherence.
  • Family, social, substance, travel/exposure or safeguarding factors as applicable.
  • Patient ideas, concerns, expectations and goals.

Dangerous alternatives to prioritize

  1. Acute delirium
  2. Injury after fall
  3. Medication toxicity
  4. Abuse or neglect
  5. Unsafe discharge
  6. Rapid functional decline

Targeted investigations

Medication reconciliation and orthostatic vital signs when relevant

CBC, electrolytes/renal function, glucose, urinalysis and targeted tests for acute change

ECG and imaging based on falls, focal findings or acute illness

Functional, cognitive, sensory and social assessment

Immediate management and disposition

  1. Treat acute reversible illness while preventing delirium, falls and medication harm.
  2. Review medications and function, cognition, mobility and supports.
  3. Involve substitute decision-makers only when appropriate to capacity/consent.
  4. Plan a safe disposition with follow-up and caregiver supports.
High-yield closing sentence: “I would reassess after the initial intervention, escalate if there is deterioration, explain the plan in plain language, confirm understanding and give specific safety-net instructions.”

Related complete stations

11 minutes

Older adult with acute confusion

Recognize delirium, identify precipitants and protect the patient while treating causes.

11 minutes

Driving safety in early dementia

Address unsafe driving respectfully, explain next steps and preserve mobility.

11 minutes

Recurrent falls and dizziness

Identify orthostatic hypotension, medication effects and modifiable fall risks.