Case 36: Physical Exam

Case 36 Index

Vital Signs: Temperature 98.2°F, Blood Pressure 140/88 mmHg, Heart Rate 64 beats/min, Respiratory Rate 12 breaths/min
General Appearance: No acute distress
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx
Lymph: No lymphadenopathy
Cardiovascular: No JVD, regular rhythm, no rubs/murmurs/gallopsstethoscope
Pulmonary: Breath sounds normal bilaterally, no rales/rhonchi/wheezes
Abdominal: non-tender or distended, soft, no scars
Extremities: warm and well perfused, no peripheral edema, hypertrophy of bilateral shoulders. No joint effusions or warmth
Neurologic: Alert, awake, answers appropriately; no facial asymmetry, cranial nerves intact, strength within normal in all extremities though left arm examination limited by pain. Positive Tinel’s & Phalen’s sign on right hand
Psychiatric: Calm, not anxious
Skin: Warm, dry, no rash

What’s at the top of your differential diagnosis? Choose 3 before moving on!
Cerebrovascular accident (CVA)
Isolated carpal tunnel syndrome
Septic arthritis
Calcium pyrophosphate dihydrate deposition disease (CCPD, Pseudogout)
Diabetic neuropathy
Dialysis-related amyloidosis
Multiple myeloma

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Case 36 Index
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