Cortical atrophy is present in normal aging. Brain proteins involved in metabolism and neurotransmitting activity generally increase with aging. On the secondary survey , the ER physician is unable to see the disc on funduscopic exam due to white clouding of the left eye. Both TM cannot be seen due to cerumen impaction. There is a right carotid bruit.
Posterior pharynx is in good color.
Patient is edentulous . Apical rate is now 80 and regular. There are no heart murmurs. Lungs are clear to auscultation and percussion, unchanged from the initial survey. There are no crepitance or palpable irregularities over the thorax rib cage.