LAB 1: GENERAL, MENTAL STATUS EXAM, SKIN

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CARDIOVASCULAR PHYSICAL EXAM
Instructions: Pick one of the following cases for your HxPxDx Exam write-up
CASE A
An 18 y/o African American male wearing a #23 jersey had chest pain & “fainted” 5 hrs ago while
playing basketball.
Physical Findings (signs):
• Vital Signs: Temp: 97.1 F, HR: 84, regular, RR: 18, Pain: 0
• Height: 5’ 8’’, Weight 145 lbs
• Palpation: PMI is at the left anterior axillary line.
• Percussion: Increased heart span
• Auscultation: 3/6 Mid-Systolic Murmur heard best over the 2nd intercostal space at the left
sternal border. The murmur can only be heard faintly over the carotids.
• Maneuvers: Murmur increases with standing and Valsalva.
• Brisk (jerky) 3/4 symmetrical pulses.
CASE B
An 80 y/o woman & avid crocheter named Prudence “wakes up at night gasping for air”. Has
happened nightly x 1 year.
Physical Findings (signs):
• Vital Signs: Temp: 98.1 F, HR: 98, regular, RR: 12, Pain: 0
• Height: 5’ 8’’, Weight 145 lbs
• Inspection: Parasternal heave
• Palpation: PMI is at the left anterior axillary line.
• Percussion: Increased heart span
• Neck: Jugular venous distention and pulsations noted bilaterally.
• Extremities:
• Pitting edema to the knee (see picture on next page)
• Stasis dermatitis in lower leg
• Red-brownish hyperpigmentation around the ankles.
CASE C
A 25-year-old male Heroin user named Frank comes in for 1 week of “horrible fever and chills”.
Physical Findings (signs):
• Vital Signs: Temp: 102 F, HR: 100, regular, RR: 20, Pain: 0
• Height: 5’ 8’’, Weight 145 lbs
• Auscultation: 3/6 Holosystolic Murmur heard best over the 5th intercostal space at the left
sternal border. The murmur increases with inspiration.
• Extremities:
• Tracklines in left antecubital fossa.
• Splinter hemorrhages under the fingernails bilaterally
• Red, nontender nodules on palms
• Red, tender lesions on fingertips (see picture on next page)
Pitting Edema
Red, tender lesions on fingertips
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