Henry Omer: Physical Exam Results
- Temperature = 98.3
- Height = 72 inches
- Weight = 163 lbs
- Blood pressure = 155/85
- Pulse (heart rate) = 100 beats/min
- Respiration rate = 20 breaths/min.
Physical examination reveals:
- A thin, Caucasian male. The patient is alert and cooperative. He denies depression and minimizes memory lapses and incorrect answers.
- Ears, nose, and throat are normal, neck is supple.
- Chest examination reveals a diastolic rumble at the LV apex consistent with mitral stneosis.
- Abdomen is soft and nontender.
Neurologic findings include the following:
- Awake and alert. Oriented time 4.
- Speech is hesitant.
- Negative for extrapyramidal effects such as masked face or resting tremor.
- Slight paralysis is noted on the left side of the face.
- Pupilary response: pupils are equally reactive to light.
- Strength is 5/5.
- Deep tendon reflexes are full and equal.
- Gait is normal.
- Babinski's negative.
Evaluation of mental and functional status
- Mr. Omer's Mini-Mental State Examination (MMSE) score is 31. He has trouble finding the right words for things, able to recall only 1 of 3 words after 5 minutes, and is slow to recall how to do everyday tasks.
- Psychometric testing reveals delayed recall performance on list learning, with only 5 of 15 items recalled
- On the Clock Draw Test Mr. Omer was able to put the numbers on the clock properly but was unable to arrange clock hands to indicate the correct time.
Questions:
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- 1. Examine Mr. Omer's vital signs. What, if any of them, are outside the normal range? Are any of them relevant to Mr. Omer's condition? Why or why not?
- 2. Now look at Mr. Omer's neurological exam. What potential causes of dementia may be ruled out by the normal results? Click all that apply.
- Pharmacological side effects
- Impaired vascular function
- Brain lesions
- Normal pressure hydrocephalus
- Hypoxia
- Metabolic causes
- 3. Open the link to the Mini-Mental State Examination (MMSE). Does Mr. Omer's score of 31 indicate a level of dementia? If so, what level is indicated?
- 4. The Clock Draw Test (CDT) examines planning and construction abilities of cognition (thinking). Click here to see Henry's clock and a key to scoring his test. What is Henry's score?
- Henry's score is 7, which represents normal cognitive function.
- Henry's score is 5, which indicates impairments in the planning and construction areas of cognition.
- Henry's score is 3, which indicates significant loss of the planning and construction areas of cognition.
- 5. Mr. Omer shows signs of dementia. If Mr. Omer will consent to a blood test, what should be included to rule out some possible causes of his dementia?
- 6. What other tests might be included? What causes might they rule out?
Next step: Lab Tests »