Mrs. Smith is an 85 year female with a history of Hypertension, diabetes and osteoarthritis. Her daughter who cares for her reports that she became suddenly confused beginning last night. She recognizes her daughter but has been unable to remember her grandchildren’s names. She continuously asks her daughter “What are those kids doing in our house?” Her mother was in and out of bed all night and slept very little. Her daughter does say that her mother seemed better this morning, but on the way to your office she became more confused again. Review of systems is significant for a dry cough for the past few days. She has not had a fever. Her appetite has been poor. Her exam is normal except for some fine crackles in her left lung base. Mrs. Smith’s daughter says, “My dad had Alzheimer’s and now it looks like I am going to have to go through that with my mother”
1) What are the possibilities for change in Mrs. Smith’s current mental status?
2) What is your top differential diagnosis? Give 3 reasons why you chose that diagnosis.
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3) How can you differentiate depression, dementia and delirium?
4) Explain to Mrs. Smith’s daughter what treatment is needed and what you think her prognosis is.
A 40-year-old male comes to see you for follow up. He states that he had a seizure at home yesterday and was taken to the emergency room. He is accompanied by his wife who witnessed the seizure. He states he has never had a seizure in the past.
1) What would you ask him and his wife regarding the seizures, and why?
2) What would be the most important parts of a physical exam in this patient and why?
3) What lab or radiology tests would you want to do and why? He tells you he has no insurance so be sure to defend the importance of a particular test.
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