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Arthur is a 75 year old man with established cognitive impairment. He attended via the Emergency Department with his wife, who reports that he has recently become more irritable and less mobile. He is unable to get himself to the bathroom, and has had several episodes of soiling – both urine and faces. He has a background of hypertension, osteoarthritis and prostate cancer.

In the ED, the team noted that he was more drowsy than usual (according to his wife), and they suspected a delirium. A CXR was unremarkable, but a urine dip found leucocytes and nitrites, so he was treated for possible urosepsis. Intravenous fluids and antibiotics were started and he was transferred to medicine.

On the acute medical unit, he arrived at 4am as there was a delay in moving people through the unit. On arrival he was seen by a medical registrar who had been asked to move medically stable patient to the wards, as a load of beds had become available. As Arthur was cardiovascularly stable, and his treatment was in progress, he was transferred to the geriatric base ward.

You are the clinician receiving Arthur the next day on the geriatric ward. You find him drowsy, somewhat irritable but apparently responding well to the fluids and antibiotics – no fevers, blood pressure 120/75, pulse 84 and passing urine +++. The nurses have put him in a pad and pants, knowing that catheterisation could be harmful.

Q1: Outline the key information that you require

Q2: Outline the examination you would undertake in order to develop a stratified problem list

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