Hypernasalilty and Ptosis in a 48-yr-old Woman

Physical Examination

  • General appearance: Normal-appearing woman who looks well for her age. Her voice has a distinct nasal quality.

  • Vital signs:
  • Temperature: 37° C
  • Pulse: 68 beats/min
  • BP: 110/76 mm Hg
  • Respirations: 14/min

  • Skin: No rash or lesions

  • HEENT: Nasal passages patent bilaterally; no discharge, lesions, or polyps. Pharynx normal. No cervical adenopathy.

  • Pulmonary: Good air entry and exit. No rhonchi, rales, or wheezes.

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

  • Gastrointestinal: No tenderness or masses

  • Genitourinary: Unremarkable; pelvic examination deferred.

  • Musculoskeletal: Unremarkable

  • Neurologic:
  • Cranial nerves: 2 to 12 grossly intact, although there appears to be minimal ptosis on the left with sustained upward gaze
  • Motor: Muscle tone in upper and lower extremities is normal and symmetric; there is no atrophy or abnormal movement.
  • Strength: 5/5 in all four extremities; no fatigue at deltoids with repetitive testing
  • Sensation: Intact to light touch, sharp pain, temperature, and vibration and symmetric bilaterally; sensation to joint position intact
  • Reflexes: Normal and symmetric
  • Coordination: Normal
  • Gait and balance: Normal; negative Romberg test

  • Mental status: Alert, oriented x 3. Normal affect. Euthymic mood. Normal memory. Normal judgment and insight.