The Case Files: The Absolutely Vital Need for Thorough Review of Systems and Physical Examination

By Ebeling, Brett MD; Rancour, Stephen MD; King, Andrew MD   A 19-year-old man presented with nausea, vomiting, and diarrhea for 24 hours. His vomitus was non-bloody and non-bilious, and his diarrhea contained neither blood nor mucus. His symptoms were associated with diffuse, cramping abdominal pain. He denied ill contacts, but stated that his symptoms started after eating at a fast food restaurant the day before.   He had no significant past medical history, but had emigrated from Saudi Arabia 18 months before presentation. He was a poor historian, and was unable to provide further details. Review of systems revealed several pertinent positives that helped complete the otherwise minimal history. He reported generalized weakness, increased thirst, hair loss, and a 10-pound weight loss over the past year. The social history was pertinent for frequent binge alcohol drinking, a six pack-per-day smoking habit, and daily marijuana use but no other drug use.   Initial vital signs were temperature 98.3°F, sinus tachycardia at 140 bpm, blood pressure 132/75 mm Hg, respiratory rate 20 bpm, and an oxygen saturation of 98% on room air. Physical exam revealed an anxious, thin, disheveled 19-year-old with dry mucus membranes; he was neurologically intact other than appearing to be mildly confused. His neck was supple with no meningismus, no thyromegaly, or cervical adenopathy; heart was tachycardic but regular, no murmurs, rubs, or gallops; and his lungs were clear bilaterally. His a...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research