The Last-Resort Prescription - Geriatric Medicine clinical simulation case. You are called to the memory-care unit by the charge nurse about Mr....
Age: 45 • Setting: Outpatient Consultation
Clinical Presentation & History
You are called to the memory-care unit by the charge nurse about Mr. Henderson, an 81-year-old resident with a 4-year history of Alzheimer dementia. He struck a caregiver with a closed fist yesterday and shoved a co-resident to the floor this morning. The nurse hands you the behavior chart and asks for help. You sit at eye level with him.
Differential Diagnoses to Consider
Primary differential diagnoses evaluated in this clinical scenario:
Delirium superimposed on dementia, precipitated by acute urinary retention (with possible occult urinary tract infection)
Late-onset schizophrenia de novo in elderly
Antisocial personality disorder manifesting in old age
Behavioral and psychological symptoms of dementia (BPSD) refractory to nonpharmacologic measures, with concurrent untreated delirium
High-Yield Clinical Pearls
Maintain a systematic approach from history taking to definitive intervention.
Diagnostic stewardship minimizes patient harm and diagnostic delay.
Diagnostic Pitfalls & Cognitive Error Warnings
Key reasoning traps and premature closure risks associated with this presentation:
Premature closure without complete investigation carries high diagnostic error risk.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.