Office of Education
Yale University
School of Medicine
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300 ESH
New Haven, CT
06519 USA

Dan Yang: Physical Examination

Vital signs

Temp 98.0 degrees; pulse 80 and regular; BP 100/60 supine, 96/60 seated; height 70 inches, weight 160 pounds.

HEENT

Normal; mucous membranes dry.

Neck

Normal; no thyromegaly.

Chest

Non-tender.

Lungs

Clear to percussion and auscultation.

Heart

Regular; PMI palpable in the 5th ICS, MCL; a 3 component sound audible at the left sternal border when Dan leans far forward

Abdomen

Soft and non-tender; no organomegaly or mass.

Extremities

Normal.

Skin

Normal turgor.

Self-assessment question:

When Dr. Grey checked Dan's record there was no mention of a murmur on past examinations, including his pre-college physical 3 weeks before. Based on the clinical presentation, which of the following is the most likely explanation for this new finding?

a. Flow murmur
b. Friction rub
c. Bacterial endocarditis
d. Acute rheumatic fever

The answer is b. Friction rubs consist of 3 components and sometimes are audible only in positions that exaggerate the rubbing of pericardial membranes.

Next: Test results