Psychiatry Case Challenge: Nightmares and Poor Grades in a Third Grader Allergic to Cats

Bettina Bernstein, DO


August 17, 2022

Physical Examination and Workup

Physical Examination and Workup

The patient's vital signs are within the normal limits for his age. His blood pressure is 98/68 mm Hg; his heart rate is 92 beats/min; and his respiration rate is 12 breaths/min, with no apparent respiratory distress. He is 4 ft 10 in (1.47 m) tall and weighs 75 lb (34.02 kg) (in the 39th percentile), and his body mass index is 15.7.

His head is normocephalic, and his eyes and ears are normal. His nose is clear, and his mouth has normal dentition, with no missing teeth. His neck is supple, his thyroid is not enlarged, and no lymphadenopathy is noted. His skin is intact and has no lesions. Breath sounds are normal, without wheeze or hyperinflation, and the result of the single breath–counting test is normal at above 35. The cardiac examination reveals normal S1 and S2 heart sounds, without any murmurs, gallops, or friction rubs.

The abdomen is scaphoid and tympanitic throughout, with intact bowel sounds in all quadrants and no tenderness. No organomegaly or masses are noted. The genital and rectal examination is deferred.

The cranial nerve examination is normal. Motor strength and reflexes are normal. Pupils are equal and reactive. Light touch, pain, position, and vibration senses are normal for all extremities.

The patient is alert and oriented to time, place, person, and situation. His affect is full range and predominately anxious. His thoughts are goal oriented. He denies any suicidal or homicidal ideation or plan. His intellectual capacity appears to be in the average range for his age. His immediate, recent, and distant recall are good.

The patient can do serial 7's to 44. He does not report any auditory or visual hallucinations or feeling as if people are talking about him behind his back. He does not know the meaning of the phrase "an ounce of prevention is worth a pound of cure." He has a best friend, and he wants to be an engineer when he grows up because he likes to build things.


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