Confusion in a 78-year-old man
Inpatient Medicine — Psychiatry ConsultWalter Osei · 78yo male · CC: Confusion
History
0/11 key findingsAsk the questions your differential demands — not just the ones the case volunteers. Every diagnosis you intend to list owes you one discriminating question.
CASE SETTING: INPATIENT MEDICINE — PSYCHIATRY CONSULT
Walter Osei, a 78-year-old hospitalized man with acute-onset confusion and visual hallucinations
Vitals
Opening
You are the psychiatry consult resident. Walter Osei, 78, was admitted to medicine two days ago for poor oral intake and "altered mental status." The primary team has asked you to evaluate for "new psychosis versus dementia" because he has been seeing things and became agitated overnight. He is drowsy but rousable, and answers a few questions before losing the thread. His daughter, Adjoa, is at the bedside and has been his primary support for the last two years.
From the nursing note
Restless and calling out from roughly 8 pm to 3 am, then somnolent through most of the morning. Pulled at his IV twice. Calm and conversational for about an hour after lunch.
Admission summary
Presented with three days of poor oral intake and weakness. Afebrile on arrival, now 38.0°C. No focal neurologic findings documented at admission.
Walter Osei · 78yo male
Drowsy, plucking at the bedsheets, intermittently calling out