Introduction/Objective: 82y/o caucasian female resident of a nursing home, with a history of moderately advanced Alzheimer dementia,H.T.N and osteoarthritis hips. She was evaluated for “disruptive whistling” for three weeks. It was more profound during dining hours. This behavior caused arguments and verbal agitation among other residents around her. There were no other associated behaviors. She had good appetite. No recent falls or changes in cognitive status were reported. She was sleeping well. Bladder/bowel functions,unchanged. Her medications included Acetaminophin/Hydrocodone(500/5 mg) twice daily, Aspirin 81 mg po q daily, Donezepil 10 mg po daily, Colace 200 mg po daily, senna one tablet po q daily, Risperidone 0.5 mg po daily, and Amlodipine 5 mg po daily. She was started on Risperadone two months ago for agitation and disruptive behaviors at night; trying to get out of bed and yelling. Review of system negative for acute cognitive changes. No pain was reported or noted on visual analog.She was pleasant and followed simple commands. Osteoarthritic changes with mild contractures of both knees noted.Functional status required moderate assist with transfers and ADL (activities of daily living.). No cough, wheezing or hoarseness. O/E; B.P:120/70, H/R:72/minute, Afebrile, wt:150lbs, R/R 16/min. pleasant and cooperative, following simple commands. Euthymic mood. Heart, lungs and abdominal exams were unremarkable. Neurological exam was negative for tremors. Cranial nerves intact. Gait was unchanged. Musculoskeletal exam showed arthritic changes with mild contracture both knees with reduced range of motion. Spine showed mildly reduced range of motion. No scoliosis or kyphosis. Recent abnormal involuntry movements scale (A.I.M.S) in chart was unremarkable. On observation, whistling had expiratory character. Comprehensive panel, C.B.C. and urine analysis were normal.