GENERAL: The patient is an emaciated white male of 76 years of age who
is unable to speak or to cooperate in his own examination, and appears
to have no realization of what is going on about him.
SKIN: Scar 2 inches long extending across the forehead and downward
between the eyes and across the bridge of the nose.
The skin of the groin is macerated bilaterally as a result of being
constantly moistened with urine.
EYES, EARS, NOSE AND THROAT: No marked abnormalities.
LUNGS: Hyper-resonant throughout with moderate enlargement of the chest
cage suggesting the presence of mild emphysema.
CARDIOVASCULAR SYSTEM: Apex of heart palpable at a point 1 cm medial to
the left mid-clavicular line. No evidence of right heart enlargement
could be detected. Pulse 80. Blood pressure 130/75. Pulse full and
regular except for an occasional skipped beat. The distal palpable
arteries in the wrist and ankles were markedly sclerotic.
MUSCULO-SKELETAL SYSTEM: Both legs and arms were slowly moved by the
patient although all movements of the extremities were associated with
moderate spasticity. The patient was unable to stand alone or walk when
he was held upright.
NEUROLOGICAL SYSTEM: Pupillary reaction to light normal. Deep tendon
reflexes in arms and legs were normal. Normal reaction to plantar
stimulation.
GENITO-URINARY SYSTEM: Incontinence of urine was noted at the time of
examination. Genitalia appeared normal. A prostatic examination was not
made.
GASTRO-INTESTINAL SYSTEM: Abdominal examination was normal. Incontinence
of the bowels was noted at the time of the examination.