Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 21: Neurocognitive Disorders

Table 21.2-7 Physical Examination of the Delirious Patient

Parameter

Finding

Clinical Implication

 1. Pulse

Bradycardia

Hypothyroidism Stokes-Adams syndrome Increased intracranial pressure

Tachycardia

Hyperthyroidism Infection Heart failure

 2. Temperature

Fever

Sepsis Thyroid storm Vasculitis

 3. Blood pressure

Hypotension

Shock Hypothyroidism Addison’s disease Encephalopathy Intracranial mass Diabetes Pneumonia Cardiac failure Fever Acidosis (metabolic)

Hypertension

 4. Respiration

Tachypnea

Shallow

Alcohol or other substance intoxication

 5. Carotid vessels  6. Scalp and face

Bruits or decreased pulse

Transient cerebral ischemia

Evidence of trauma

 7. Neck

Evidence of nuchal rigidity

Meningitis Subarachnoid hemorrhage Tumor Hypertensive encephalopathy

 8. Eyes

Papilledema

Pupillary dilatation

Anxiety Autonomic overactivity (e.g., delirium tremens) Evidence of generalized tonic-clonic seizures

 9. Mouth 10. Thyroid

Tongue or cheek lacerations

Enlarged

Hyperthyroidism

11. Heart

Arrhythmia

Inadequate cardiac output, possibility of emboli

Cardiomegaly

Heart failure Hypertensive disease

12. Lungs

Congestion

Primary pulmonary failure Pulmonary edema Pneumonia

13. Breath

Alcohol Ketones

Diabetes

14. Liver

Enlargement

Cirrhosis Liver failure

15. Nervous system

a. Reflexes—muscle stretch

Asymmetry with Babinski’s signs Mass lesion

Cerebrovascular disease Preexisting dementia

Snout

Frontal mass Bilateral posterior cerebral artery occlusion

b. Abducent nerve (sixth cranial nerve)

Weakness in lateral gaze

Increased intracranial pressure

c. Limb strength

Asymmetrical

Mass lesion Cerebrovascular disease

d. Autonomic

Hyperactivity

Anxiety Delirium

(From Strub RL, Black FW. Neurobehavioral Disorders: A Clinical Approach . Philadelphia: FA Davis; 1981:121, with permission.)