PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 122/82, pulse 90, respirations 18, temperature 98.6, and O2 sat is 99% on room air.
GENERAL: This is a well-developed, well-nourished female in no acute distress.
HEENT: Normocephalic, atraumatic. On eye examination, the patient does have an afferent pupillary defect noted in her left eye. Her extraocular movements are intact. On funduscopic exam, it is difficult to see the patient’s fundi bilaterally. The patient appears to have some type of vitreous abnormality. However, there is no evidence of any retinal detachment. On visual fields testing, the visual fields in the patient’s right eye are completely intact. In the patient’s left eye, her inferior visual field is intact. However, she has difficulty with her superior visual field and cannot see the examiner’s fingers until they are well past her pupil. TMs are intact with good light reflex. Posterior oropharynx is pink and moist without erythema or exudate. Uvula is midline. Soft palate rises symmetrically.
NECK: Supple. No lymphadenopathy.
HEART: Regular rate and rhythm. No murmurs, gallops, rubs.
LUNGS: Clear to auscultation bilaterally.
EXTREMITIES: The patient has full range of motion of all extremities, 2+ pulses in all extremities. No clubbing, cyanosis or edema.
NEUROLOGIC: Alert and oriented x4. Gross sensation is intact. Strength is 5/5 in all extremities. Cranial nerves II-XII grossly intact, except as otherwise listed above in the ocular exam.
SKIN: Warm and dry to touch.
PHYSICAL EXAMINATION: External examination showed the pupils to be round and to react equally to light. The eyes were straight in all fields of gaze. The conjunctiva of each eye was not remarkable in appearance. The cornea and the anterior segment of each eye were clear. In the right eye, there was a posterior chamber IOL in good position. The left eye showed significant cortical and nuclear lens opacities. Examination of the fundi showed the retina in each eye to be flat in all areas with the exception of some wrinkling in the macular region of the right eye. The disks and major vessels were normal. A posterior vitreous detachment also could be seen with a microscope. An OCT was performed. The left eye showed a normal fovea, but in the right, there was a membrane over the surface of the retina.
PHYSICAL EXAMINATION: On examination, the patient’s uncorrected vision is 20/50 with pinhole improvement to 20/25 in both eyes. Anterior segment examination is unremarkable. Intraocular pressures are 20 mmHg in each eye. Fundus examination, right eye, reveals the retina to be without any retinal tears. There is a retinal hole inferotemporally. There is slight vitreous traction present on the edges of the hole. There are no pigmented cells in the vitreous cavity. Fundus examination, left eye, reveals the retina to be without any tears or holes. There are no pigmented cells in the vitreous cavity.
PHYSICAL EXAMINATION: The patient’s best corrected vision in the right eye is 20/40. Slit lamp revealed nuclear sclerotic cataract, right eye, and a hypermature cataract in the left eye. Tonometry was 17 in the right eye and 19 in the left eye. Funduscopic evaluation of the right eye was unremarkable. The left eye, unable to see the fundus. B scan performed and grossly unremarkable.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 97.6, pulse 58, respirations 20, BP 154/84, pulse oximetry 99% on room air.
GENERAL: A well-developed, well-nourished, nontoxic, ambulatory, (XX)-year-old male.
CHEST: Examination of the chest reveals equal bilateral breath sounds. Clear to auscultation with normal chest wall excursion.
CARDIOVASCULAR: Regular rate and rhythm without murmur, rub or gallop.
ABDOMEN: Benign.
BACK: Deferred.
RECTAL: Deferred.
GENITALIA: Deferred.
EXTREMITIES: Full range of motion of all extremities with pain noted to the right knee only with terminal flexion and extension. Varus and valgus stressing of the knee reveals no medial or lateral collateral ligament laxity. Lachman, McMurray and Apley tests are negative as well. The patient is ambulatory with a stable but somewhat antalgic gait, otherwise exhibits strong distal pedal pulses. Brisk capillary refill in all digits of the right foot.
NEUROLOGIC: Exam reveals no gross motor sensory deficits. The patient is alert, cooperative, and exhibits intact distal sensation in all digits of the right foot.
INTEGUMENTARY: Without diaphoresis, rash or lesions. Skin is warm and dry to touch. Normal tone and turgor.
PHYSICAL EXAMINATION:
VITAL SIGNS: Temperature 97.6, pulse 90, respirations 18, blood pressure 128/78, and pulse ox 98% on room air.
GENERAL: The patient is alert and oriented x4.
LUNGS: Clear to auscultation.
HEART: Regular rate and rhythm. S1, S2. No murmurs.
EXTREMITIES: Examination of his left wrist shows a granulated eschar but no surrounding erythema or edema or tenderness. Full range of motion of elbow, wrist and fingers. No presence of lymph nodes, epitrochlear or axillary. Examination of his right knee shows a warm but not hot knee. There is no erythema. He has generalized edema around the knee joint. Ballottement difficult to assess. He has patellar tenderness. Range of motion is 0-30 degrees and then pain is elicited. Negative McMurray and anterior/posterior drawer, tenderness over the tibial tendon. Distally full range of motion of other joints. Neurovascularly intact. Also, hip has full range of motion with no complaints of pain. No lymphadenopathy palpated.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 198/134, pulse 96, respirations 18, temperature 98.2, and O2 saturation 98% on room air.
GENERAL: This is a well-developed, slightly obese (XX)-year-old male who is alert and oriented x3 and appears to be in no acute distress. The patient is cooperative, communicates well, and is ambulatory.
SKIN: Warm and dry to touch.
HEENT: Normocephalic, atraumatic. Pupils equal, round, reactive to light and accommodation. Extraocular movements are intact bilaterally. Conjunctivae are pink without discharge. Sclerae are nonicteric. TMs appear clear. Buccal mucosa is pink and moist. Pharynx is without erythema or exudate.
NECK: Supple without lymphadenopathy. Trachea is midline. No JVD or bruits noted.
LUNGS: Clear to auscultation bilaterally. No wheezing, rales or rhonchi noted.
HEART: Regular rate and rhythm. No murmurs, rubs or gallops noted.
ABDOMEN: Soft, nondistended and nontender to palpation in all four quadrants. There is no rebound or guarding noted. There are no masses noted either. Bowel sounds present in all four quadrants.
EXTREMITIES: Distal pulses 2+ bilaterally. The patient has full range of motion of all extremities. Sensation is intact to light touch. Upon further examination of the patient’s right upper extremity, he has 2+ radial and ulnar pulses. The patient has some swelling noted extending from the first dorsal compartment of the wrist distally to the MCP of his thumb. The patient upon examination has intact sensation to both right and left upper extremities. When the patient is instructed on how to perform the Finkelstein test, the patient does have pain elicited on the right dorsolateral wrist with ulnar deviation. The patient has no pain elicited on the left upper extremity. The patient has no pain with palpation over the snuffbox or fifth metacarpal. The patient has no pain with palpation in the wrist. The patient has intact sensation to two-point discrimination and light touch. The patient has 5/5 strength of that extremity. The patient has brisk capillary refill.
NEUROLOGIC: Cranial nerves II-XII are intact. DTRs are 2+ bilaterally of both upper and lower extremities. Muscle strength 5/5 of all extremities. No focal deficits noted.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 108/72, pulse 74, respiratory rate 20, temperature 98.6 degrees, and pulse oximetry 98% on room air.
GENERAL: The patient is alert and oriented x3, in no acute distress. The patient is nontoxic, jovial, laughing and joking.
HEENT: Pupils are equal, round and reactive to light. Extraocular movements intact. Oropharynx clear. Mucous membranes moist.
NECK: Supple, nontender to palpation, no lymphadenopathy, no masses, no JVD, no carotid bruits, no meningismus. Negative Kernig and Brudzinski signs.
CHEST: Clear to auscultation bilaterally.
CARDIAC: Regular rate and rhythm. No murmurs, rubs, or gallops.
ABDOMEN: Bowel sounds are present. The belly is soft, nontender, nondistended. No masses, no hernias, no rebound, no guarding.
BACK: No CVAT. No spinous process tenderness. Straight leg raise is negative bilaterally. No evidence of trauma.
GENITOURINARY: The patient has a Foley catheter in place with a small amount of grossly bloody urine within it.
EXTREMITIES: Distal pulses 2+ bilaterally. No clubbing, cyanosis or edema. Calves are symmetric in color, temperature, and size. No evidence of trauma.
SKIN: No rash, no petechiae, no purpura, no jaundice.
PSYCH: Normal mood, normal affect.
NEUROLOGIC: Alert and oriented x3. Normal mental status. Cranial nerves II through XII intact. Strength 5/5 bilaterally throughout. Station and gait within normal limits.
PHYSICAL EXAM: The patient is a pleasant (XX)-year-old male weighing 204 pounds. The patient has positive cervical orthopedic tests, including a positive right and left Jackson compression test that was relieved with cervical distraction. Shoulder depression test was negative. Soto-Hall test was negative. Palpation demonstrated mild bilateral suboccipital and midline upper cervical tenderness with mild bilateral suboccipital spasm. There was mild to moderate left lumbar and midline lumbosacral as well as left lumbosacral tenderness and mild left lumbar and lumbosacral paravertebral spasm. Neurological examination revealed all upper and lower extremity DTRs, including triceps, biceps, brachioradialis, patellar, and Achilles to be +2/5, normal. Sensory examination performed with a Wartenberg pinwheel was normal and equal in both the upper and lower extremities. Gross muscle strength was normal at +5/5 in the upper and lower extremities bilaterally. Lumbar range of motion with pain in flexion, right and left rotation, and right and left lateral flexion. Right and left Kemp sign was positive for dorsolumbar pain. Right sacroiliac joint was restricted on the modified Thomas test. There was a positive left Nachlas and a negative right Nachlas. Derifield was positive. There was negative bilateral Yeoman and Ely tests. Bilateral Patrick/fabere test was negative. The leg lowering test was positive actively; it was negative passively. Right SLR was positive at 60 degrees for posterior leg and lower back pain with a positive Bragard. Left SLR and Bragard were negative.
PHYSICAL EXAMINATION: The patient has good muscle bulk in her lower extremities. The calf circumference of the left leg, 10 cm below the tibial tubercles, is 36.5 cm and on the right is 37.0 cm. There is no obvious atrophy. Her motor strength appears to be full in the lower extremities, though she seems to have pain in the left lower extremity, and she has obvious, very significant crepitus in the left knee without effusion. Light touch is grossly maintained in the lower extremities. Reflexes are 3+ knee jerks, 2+ ankle jerks. There is three beats of ankle clonus bilaterally. Plantar stimulation results in withdrawal phenomenon. Her upper extremity reflexes are additionally 2-3+ but symmetric.
PHYSICAL EXAMINATION:
VITAL SIGNS: Blood pressure 136/76, pulse 80, respirations 18, temperature 98.8, and pulse ox on room air 99%.
GENERAL: A well-developed, moderately obese Hispanic female in no acute distress. She is alert and oriented x3, well appearing.
HEENT: Normocephalic, atraumatic. Pupils are equal, round and reactive to light. Extraocular muscles intact. Mucous membranes pink and moist with no evidence of anemia. Ears are clear with no erythema, bulging retraction of the TMs bilaterally. Oropharynx exhibits no tonsillar swelling, erythema or exudate.
NECK: Supple without lymphadenopathy. No JVD or thyromegaly.
CHEST: Respirations easy and unlabored. She does have significant reproducible tenderness with palpation to the chest wall muscles. This is also reproduced when she sits forward.
LUNGS: Clear to auscultation bilaterally without wheezes, rales, rhonchi.
HEART: Regular rate and rhythm without murmur, rub or gallop.
ABDOMEN: Soft, nondistended, nontender. Bowel sounds normoactive in all four quadrants. There are no masses or hepatosplenomegaly appreciated.
EXTREMITIES: No cyanosis, edema or clubbing. There are no cords appreciated or calf tenderness.
SKIN: Warm, dry, and intact.
NEUROLOGIC: Cranial nerves II-XII are tested and intact. She has good finger-nose-finger, rapid hand movement, and heel-to-shin movement. She has full 5/5 strength with resisted movement in all muscle groups of the upper and lower extremities. There are no focal neurologic deficits.
