Lethargy in a 65-yr-old Man

Physical Examination

  • General appearance: Height is 5' 7"; weight is 240 lb. Patient appears nontoxic and in no apparent distress.

  • Vital signs:
  • Temperature: 37.2° C
  • Pulse: 45 beats/min
  • BP: 99/72 mm Hg
  • Respirations: 20/min
  • Pulse oximetry: 97% on room air

  • Skin: Warm, dry, normal color, and well-perfused.

  • HEENT: Pupils equal, 5 mm, and reactive to light; no scleral icterus. Head appears normal and no evidence of trauma; mucous membranes are moist.

  • Pulmonary: Lungs clear to auscultation and percussion bilaterally; no rales, rhonchi, or wheezes.

  • Cardiovascular: Regular rate and rhythm; no murmurs, rubs, or gallops.

  • Gastrointestinal: No abdominal scars observed. Abdomen soft, nontender, and nondistended. No pulsating masses or organomegaly palpated. Bowel sounds auscultated in all four quadrants. Rectal examination normal.

  • Genitourinary: Not examined

  • Musculoskeletal: Normal tone and strength; 2+ deep tendon reflexes equal bilaterally.

  • Neurologic: Cranial nerves 2 to 12 intact. Bilateral sensation to touch, vibration, and pinpoint intact. Negative pronator drift. Finger-to-nose movement intact. Speech and cognition within normal limits. Gait normal.

  • Mental status: Flat affect. Alert and oriented to self, place, and time.