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Yale University
School of Medicine
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06519 USA

Richard Wilson: Physical Examination

P.E. reveals a thin man appearing older than his age with difficulty breathing.

Vital signs

Temp 97.6 degrees; pulse 120; R 36; BP 180/100.

HEENT

Conj normal. FUNDI - sharp discs; vessels reveal "copper wiring" changes with A-V nicking but no exudates or hemorrhages; oropharynx, TMs and sinuses are benign.

Lymph nodes

None palpable.

Chest

Diminished tactile fremitus with dullness to percussion at both bases about 1/4th the way up posteriorly; breath sounds are diminished at both bases but rales are audible about 1/2 way up bilaterally.

Heart

JVP estimated at 12 cm H2O. PMI is diffuse but not dyskinetic. There is a palpable LV heave but no RV heave. Ascultation reveals regular rhythm, but tachycardia; S1 is diminished in intensity; S2 is loud and there is evidence for an S4 and S3. There is a 2/6 holosystolic murmur heard at the apex that radiates to the left axillary line and can be heard as far back as the patient's thoracic vertebral spine.

Abdomen

Soft, without hepatosplenomegaly or evidence for ascites.

G/R

Benign.

Extremities

Without edema.

Skin

Normal turgor without rash or spider angiomata.

Neurological exam

Nonfocal.

Next: Test results