Case 39: Physical Exam

Case 39 Index

Vital Signs: Temperature 98.8°F, Blood Pressure 180/100 mmHg (same in both arms), Heart Rate 90 beats/min, Respiratory Rate 14 breaths/min, BMI 30%
General Appearance: No acute distress, overweight
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx, neck circumference <40cm
Lymph: No lymphadenopathy
Cardiovascular: No JVD, regular rhythm, no rubs/murmurs/gallops, pulses normal amplitude and symmetric throughoutstethoscope
Clear to auscultation bilaterally, no wheezes/rhonchi/rales
Abdominal: soft, non-tender, normoactive bowel sounds, no hepatosplenomegaly, no bruits heard
Extremities: warm and well perfused, bilateral trace pitting lower extremity edema
Neurologic: Alert, awake, answers questions appropriately
Psychiatric: Calm, pleasant
Skin: Warm, dry, no rash, mild acne

What’s at the top of your differential diagnosis? Choose 3 before moving on!
Primary “essential” hypertension
Renal artery stenosis (RAS)
Primary hyperaldosteronism
Coarctation of the aorta
Cushing’s syndrome
Surreptitious anabolic steroid use
Sleep apnea
Liddle’s syndrome

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