HISTORY
A 77-year-old woman with Alzheimer dementia admitted to a behavioral hospital because of intractable agitation. Denies prior breast problems. Subsequently, her daughters state that she had a diagnostic breast biopsy 5 years earlier; diagnosis confirmed by review of pathology report. Patient has adamantly and consistently refused further investigation or treatment of breasts.
Has recently lost weight unintentionally.
PHYSICAL EXAMINATION
Distressed woman. Normal vital signs. No palpable lymphadenopathy. Chest without crackles, wheezes, or rhonchi. No tenderness over the spine. Normal neurological findings.
Sometimes speaks sociably and lucidly; at other times inconsolable.
What’s Your Diagnosis?
(answer on next page)
