Problem
Mr. X. is an 80 yr. old brought to the Emergency Department for increasing confusion and a 1-day history of increasingly agitated behavior. He is a resident in an Assisted Living facility and has mild dementia. The assisted living staff reports that he is normally very pleasant and easily re-directed. He has had no fever, but his appetite has been decreased and he has vomited three times today. He has also had diarrhea for the past 3 days. Mr. X. has a history of several lacunar strokes within the past 10 years; hypertension for 30 years; and Type 2 diabetes for 10 years, but does not require insulin. He smoked two packs of cigarettes daily for 50 years, but quit when he entered the assisted living facility 5 years ago. He used to drink heavily, but according to his family, he quit 10 years ago. He is a retired factory worker, and had work-related exposure to asbestos.
i. What additional information would you solicit from the patient and why? List a minimum of 5 questions and provide a rationale for each.
ii. What additional information would you solicit from the assisted living facility staff and why? List a minimum of 5 questions and provide a rationale for each.
iii. What parts of the physical examination (PE) would you perform and why?
iv. What specific assessment and/or screening tools could you include during the neurologic part of the PE?
v. What would be included on your list of differential diagnoses for Mr. X., and why? Limit to 4.