Saved the file to disk and opened with Phtotshop Elements.
The first thing that appears odd is a "shadow" next to the ear. It is visible at 100% zomm - but - if you can, zoom in!! You will notice that it is only the ear - the cheek doe not cast a similar "shadow" - furthermore at 1600% zoom - the "shadow" has white space between the ear and the shadow . . .
The next things that bothers me is the size of the hand. It seems to be out of proportion.
AND - the ONLY two things that are "in focus" is the "note" and the hand with a pencil - however - the papers leading away from the the bottom are uniformly blurred (should get more blurry the farther away from the lens (IIRC has something to do with focal length and appature settings)
just noticed one more point - there is white space between the finger and the letters printed behind it - the should just "run into" the finger, instead there is a gap.
One more point reagrding the "shadow" - look at the shadow cast by the pencil - and the papers - all of them appear to indicate that the light source is directly above - the "shadow" from the "president's" ear however would have been caused by a sorce from behind - however, notice that the back of the "president" is dark - not brightly lit!
Lastly, in this photo, the President is wearing a Blue Suit 
The picture in question seems a lot more grey!!!