A 70-year-old female presents to the primary care provider for a health maintenance checkup. The patient has a history of hypertension but has not seen a primary care provider in over two years. The patient denies complaints or problems. She is a widower and lives alone. Her husband died 6 months ago due to COVID. She has two adult male children who live approximately 30 minutes away from the patient. Her current medications are over-the-counter ASA 81 milligrams daily as well as hydrochlorothiazide 25 milligrams daily. She has recently been getting her script refills from the local urgent care facility. She is accompanied by one of her sons who is concerned that his mother is confused or developing dementia because she is having trouble understanding what family members are saying especially during social events. The son has not noticed any weakness or gait impairment. No dysarthria. They deny falls or head injury. Vital signs BP 130 / 80, HR 72, resp 14, SPO2 99% on room air. Physical exam is as follows: skin is intact with some age-related changes, there is a skin tear on the left forearm. Head normal cephalic atraumatic (NC/AT), conjunctiva clear, oral mucosa is moist. external ear without cerumen impaction TM’s are intact, grey, cone of light normal. Heart rate is regular. Lungs are clear respirations are regular and easy. Abdomen with positive bowel sounds, soft, nontender, no rebound or guarding. Extremities are without deformity. She has 5/5 strength proximally as well as distally including 5/5 grip strength. Laboratory studies CBC, CMP, TSH, vitamin D and vitamin B levels are normal.

1. What are your top three differential medical diagnosis. This should include two diagnosis that the patient likely has and one diagnosis that you considered but the patient does not have.
   Please give an explanation of your medical reasoning.
2. What would you do next for this patient?

Sample Solution

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