University of Missouri-Columbia School of Health Professions Link to MU Homepage link to MU Homepage School of Health Professions
search  
Virtual Health Care Team
Case StudiesAbout VHCTContinuing EducationHealth ReferencesContact UsHome

Table of Contents

Introduction
• Team Information
Objectives
Emma Curtis Case Study
• Information
• Medical History
• Physical Exam
    » Lab Results
    » EMG exam
• Action Plan

Authors:

Dovie Weston, MEd, OTR/L, †

Richard E. Oliver, PhD, †

Larry J. Petterborg, PhD, ‡

P. Kevin Rudeen, PhD, *

David D. Cravens, MD, §

Diana J. Baldwin, MA, OTR/L, FAOTA, †

Tarilyn Dobey, MEd, RRT, †

Marilyn Sanford Hargrove, PT, PhD, †

Damascene Kurukulasuriya, MD, §

Stephanie Reid-Arndt, PhD, †

Barry L. Slansky, PhD, CCC-SLP †


† School of Health Professions, University of Missouri-Columbia

‡ School of Physical Therapy, Texas Women's University, Dallas TX

§ School of Medicine, University of Missouri-Columbia

* College of Allied Health, University of Oklahoma, Oklahoma City, OK
printer Printer-Friendly Version
envelope Forward to a Colleague
checkmark Permission for Use

Interdisciplinary Geriatric Assessment:
Mrs. Curtis

Physical Exam


Vital Signs: Ht: 5' 2" Wt: 145 lbs. T: 96.7° F.
P: 64/min. R: 20/min. BP: 140/96 mmHg
General: Overweight, slow to respond, somewhat confused. When standing, she showed mild thoracic kyphosis.
Skin: No rash or lesions. Several areas of ecchymoses on the arms, hips & thighs.
BEENT: Normal conjunctiva and sclera. Pupils equally round and reactive to light and accommodation. Extraocular movements intact. Small central cataract OD [ocular dexter: right eye] without significant loss of visual acuity. Pseudophakic OS [ocular sinister: left eye] with limited vision. Fundi normal. No nystagmus. Ears with normal canals and tympanic membranes (TM's). Nose normal with septum midline. Mouth and throat normal with good native dentition. Moist mucus membranes. Breath was malodorous.
Neck: Supple with no masses or bruits.
Lymphatics: No cervical, supraclavicular, axillary, or inguinal adenopathy.
Back: No costovertebral angle tenderness. Well-healed thoracic vertebra, nontender spine.
Lungs: Diminished in bases.
Heart: Regular rate and rhythm with no murmur or gallop.
Abdomen: Normal bowel sounds. Soft and supple with no masses or organomegaly. There was mild tenderness to deep palpation above the umbilicus with no rebound tenderness or guarding.
Pelvic: Genitalia normal. Normal introitus, cervix and uterus. No urethral redness.
Extremities: No clubbing, cyanosis, or edema. Good and equal pulses throughout. No evident joint inflammation. Heberden's and Bouchard's nodes of OA observed in hands. Functional ROM in UEs; active ROM limited by weakness in LE's.
Neurologic: Cranial nerves II through XII were intact. Tongue fasciculations were noted with patient maintaining protruded tongue. Cerebellar: normal finger-to-nose and rapid arm movements. A fine, rapid tremor was noted when writing or pointing. She was unable to perform heel-to-shin testing due to weakness in hip flexors. Deep tendon reflexes were absent throughout. Sharp/dull discrimination was intact throughout. Light touch sensation was intact but she had decreased sensation distally, up to just below the knee on the right, and up to just above the ankle on the left. Proprioception was impaired in dorsiplantar flexion and knee flexion. Vibration sense was absent in ankles and knees, but present in hands. She was barely able to stand and could only do so by holding on to her wheelchair. The one step she took seemed to be a high-stepping gait with some foot drop on the right. Strength was 3/5 for grip, arm and shoulder muscles, hip flexors, knee extensors, and plantar flexors; strength was 2/5 for ankle dorsiflexors and great toe extensors. She seemed to be a bit weaker overall in her right lower extremity compared to the left.
Mental Status: Her Mini-Mental State Exam score was 24 of 30. She scored a 7 on the 15-item Geriatric Depression Scale. She indicated she had had difficulty sleeping for months, and had been feeling "down in the dumps" off and on. Some days she indicated she just didn't feel like "getting out of bed."

Lab results were also received.
Previous: Medical History
Next: Action Plan

Published by the Virtual Health Care Team ®
School of Health Professions
University of Missouri-Columbia
Questions? Comments? Contact Us
Copyright © 2006-2008 — Curators of the University of Missouri
DMCA and other copyright information.
An equal opportunity/ADA institution.
All rights reserved. Disclaimer and Terms of Use
Last Update: June 17 2008