OBJECTIVE:  Temperature 97 degrees, pulse 86, respirations 22 and blood pressure 115/78.  The head and neck examination showed pupils equal, round and reactive to light, although the patient was noted to have a slight difference in the left cornea.  She is edentulous.  A #6 Shiley tracheostomy tube was noted with the cuff down.  A high-humidity trach collar was in place providing 35% oxygen.  The pulse oximeter showed 97% oxygen saturation.  There was no stridor.  There was no accessory muscle use for respiration.  Heart and lung examinations were within normal limits, except for scattered rhonchi.  This improved after suctioning of thick, white sputum.  The heart had a regular rate and rhythm without murmur.  The abdomen was slightly distended and hyperresonant to percussion.  A PEG tube was in place.  There was no guarding.  A Foley catheter was also in place.  No rectal sensation was noted and soft stool was in the rectal vault.  A PICC line was noted in the right arm.  There was no lower extremity edema.

Neurologic examination showed the patient to be alert and oriented x3 with mental status grossly intact.  She was able to follow conversations and was able to mouth words.  There was no vocalization.  Cranial nerves II through XII were grossly intact and a laryngectomy site was noted.  Normal tone was noted in the proximal upper extremities.  Biceps strength was 4+/5 bilaterally.  No other voluntary muscle contraction was noted.  The sensory examination was as noted by Dr. Doe in his admission history and physical.  The lower extremities were flaccid with no voluntary muscle contraction.  There was no ankle clonus.  There was no calf asymmetry.  The patient had fair head control.