Consultant. Vol. 49 No. 4

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What’s Your Diagnosis?
Sharpen Your Physical Diagnostic Skills

Something Wrong on the Face of an Old Man

By HENRY SCHNEIDERMAN, MD—Series Editor | April 1, 2009

Dr Schneiderman is vice-president for medical services and physician-in-chief, Hebrew Health Care, West Hartford, Conn, and president of its Connecticut Geriatric Specialty Group. He is professor of medicine (geriatrics) and associate professor of pathology, University of Connecticut Health Center in Farmington and clinical professor, nursing, Yale University. He is a recipient of the American Geriatrics Society Clinician of the Year award and received the Laureate award of the Connecticut chapter of the American College of Physicians.

This article was originally presented as an independent educational activity under the direction of CME LLC. The ability to receive CME credits has expired. The article is now presented here for your reference. CME LLC is no longer responsible for the presentation of the article.

HISTORY

A 76-year-old man is seen because of redness below the right eye. Has long-standing “lazy eye” on the left, which is chronically deviated outward. Has lived in nursing home for some years due to self-care deficit from memory loss. No recent eye surgery, conjunctivitis, sinus infection, or periocular trauma.

PHYSICAL EXAMINATION

Man who does not effectively communicate how much of his moderate discomfiture is psychological versus physical. Temperature, 37.3°C (99.2°F); heart rate, 84 bpm and regular; BP, 126/84 mm Hg; respirations, 20 per minute and not labored. Face as shown. Visual function seems preserved within limits of his replies. Full ocular range of motion. Each pupil constricts on direct illumination and consensually on shining flashlight beam into opposite eye.

What’s Your Diagnosis?

(answer on next page)

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by Jaco Fishenfeld | March 08, 2011 9:01 PM EST

very good teaching

by Gary Melvin Gorlick | February 18, 2011 5:23 PM EST

An excellent discussion and teaching case.

by Yusharn Wang | January 31, 2011 3:49 AM EST

Looks like an early form of cellulitis.

by JISHA JOHN | November 20, 2010 6:55 AM EST

Pre septal cellulitis

by JISHA JOHN | November 20, 2010 6:50 AM EST

Bells palsy

Article Comment Pages: 1 2 3 Next

TOPIC INDEX

Asthma

Cardiovascular

Cerebrovascular

Developmental/Genetic

Nutritional/Metabolic

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Something Wrong on the Face of an Old Man

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