Bedside Diagnostic Challenge – An Elderly Woman Presents to the Emergency Room Confused and Disoriented

Paul Griner, MD, MACPBedside Diagnostic Challenge, Emergency Medicine

confused and disoriented elderly woman diagnostic case

Bedside Diagnostic Challenge – An Elderly Woman Presents to the Emergency Room Confused and Disoriented

Bonus Follow-Up Question included in answer explanation.

An elderly woman is brought to the emergency room of a local hospital after she is found wandering along the street and, upon questioning by the police, is noted to be confused and disoriented. In the emergency room, her personal effects are examined and no information is gleaned about her name or address.

Physical examination reveals a moderately ill appearing woman who is lethargic and disoriented as to time, place, and person.

Temperature is 95.0 degrees Fahrenheit, blood pressure 94/62 mm Hg, pulse 54 and regular, and respirations 8 breaths per minute. The ambient temperature was 70 degrees Fahrenheit.

Her face and extremities appear puffy but not edematous. Her tongue is impressively enlarged. The neck reveals a mature transverse scar below the larynx.  No abnormalities are noted on examination of the lungs, heart, or abdomen. The extremities show no edema and peripheral pulses are normal.

Neurological examination shows normal motor strength and normal deep tendon reflexes.

Question:

Based on the diagnostic value of careful examination...

What disease does this patient have?

Answer Options:

Alzheimer’s Disease

Medication induced delirium

Myxedema

Adrenal insufficiency

See the Answer:


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About The Bedside Diagnostics Blog Series:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most physicians will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. These Bedside Diagnostic Challenges reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free benefit of Med-Challenger.

Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.

About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He has served the University of Rochester School of Medicine as Chief Resident in Medicine and as Professor, Department of Medicine. He has served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine. Dr. Griner is board certified in internal medicine.