1. Physical Examination On admission Upon PE General Survey Vital Signs
Conscious, coherent, stretcher-borne, in cardiorespiratory distress
Vital Signs
BP: 200/100, supine LUE; 190/100, RUE, SBP 190, LLE, SBP 190 RLE;
PR: 88, regular;
HR:88, regular;
RR:24;
T 36.5
Conscious coherent, ambulatory, not in cardiorespiratory distress
BP: 110/70;
PR: 76, regular;
HR: 76, regular;
RR: 20, regular;
T 36.0
Anthropometric Measurements:
Height: 157cm Weight: 74kg BMI: 30

2. Physical Examination On admission Upon PE Skin HEENT
Warm, moist skin, no flushing, no active dermatoses
HEENT
Pink palpebral conjunctivae, anicteric sclera, (+) ROR, hazy cornea
No nasoaural discharge, septum midline, moist buccal mucosa
No tragal tenderness AU, non-hyperemic external auditory canal AU, intact tympanic membrane AU
Warm, moist skin, no flushing, no active dermatoses
Pink palpebral conjunctivae, anicteric sclerae, (FUNDOS)
no nasal or aural discharge, no nasal deformities, midline septum
Intact tympanic membrane, no tragal tenderness

3. Physical Examination On admission Upon PE HEENT
Moist buccal mucosa, tongue midline, non-hyperemic PPW, tonsil not enlarged
no limitation in motion, Trachea midline, thyroid gland not enlarged, neck veins not distended, no cervical lymphadenopathy, (-) carotid bruits
Moist buccal mucosa, no oral ulcers
supple neck, thyroid gland not enlarged, no palpable cervical lymphadenopathy, trachea midline, neck veins not distended

4. Physical Examination On admission Upon PE Cardiovascular
Adynamic precordium, JVP 3cm at 30 degree, AB at 6th LICS 11cm from the midsternal line, tapung, 2cm in diameter, no heaves, no thrills, no lifts S1>S2 apex, S2>S1 base, no murmurs
Pulses full and equal, no edema, no cyanosis, no clubbing
Adynamic precordium, apex beat at 6th LICS 11cm from the midsternal line, no heaves trills lifts, apex S1>S2, base S2>S1, no murmurs, JVP 4cm at 30 degrees
No edema, pulses full and equal on all extremities

5. Cardiac Auscultogram CAP rapid upstroke gradual down stroke
JVP 3 cm at 30° A P T M S1 S2 S1 S2 S1 S2 S1 S2
Precordial Activity:
Adynamic precordium
No heaves, lifts, or thrills
Apex beat:
6th LICS
11 cm from midsternal line

6. Physical Examination On admission Upon PE Pulmonary
Symmetrical chest expansion, no retractions, no lagging, equal tactile and vocal fremiti, resonant on percussion, clear breath sounds
No chest retractions, no use of accessory muscles, normal breathing pattern, symmetrical chest expansion, unimpaired transmission of voice and tactile fremiti, resonant on both sides, vesicular breath sounds on both sides

7. Physical Examination On admission Upon PE Gastrointestinal
Flabby abdomen, no striaes, no visible peristalsis, NABS, (-) bruits, tympanitic on percussion, no tenderness, liver edge not palpable, Traube’s space not obliterated
Flabby abdomen, normoactive bowel sounds, tympanitic, non-tender, liver dullness 10 cm, Traube’s space not obliterated

8. Physical Examination On admission Upon PE Neurologic
Awake, alert, conscious, oriented to 3 spheres
CN: no anosmia, pupils 2-3mm ERTL, EOMs intact, V1V2V3 intact and equal, can clench teeth, can smile, can frown, intact hearing, (+) gag reflex, can raise both shoulders against resistance, uvula midline on phonation, can shrug shoulders, tongue midline on protrusion
Conscious, awake, oriented to person, place and time, can follow commands
Cranial nerves intact, (PUPIL) no facial asymmetry, can smile, frown, clench teeth, puff cheeks, normal gross hearing, uvula midline, (+) gag reflex, able to shrug shoulders, turn face against resistance

9. Physical Examination On admission Upon PE Neurologic
Motor: 5/5 on the lower extremities, 5/5 on the upper extremities, no fasciculations, atrophy
No babinski, bilateral
No sensory deficit
No nuchal rigidity, Kernig’s, Brudzinski’s
Motor 5/5 over all extremities, good tone, no atrophy, no fasciculation
No sensory deficits
(-) Babinski , Kernig, Brudzinski
No nuchal rigidity

10. Salient Features Pertinent Positive
BP on admission: 200/100; RR: 24 (in cardiopulmonary distress)
BMI = 30
Apex beat at 6th LICS 11cm from the midsternal line
(EYE PE)

11. Salient Features Pertinent Negative Neck veins not distended
No heaves, no thrills, no lifts S1>S2 apex, S2>S1 base, no murmurs
Pulses full and equal, no edema, no cyanosis, no clubbing
No chest retractions, no use of accessory muscles, symmetrical chest expansion, unimpaired transmission of voice and tactile fremiti, clear breath sounds

12. Chest Pain
Cardiovascular
Pulmonary
Gastrointestinal

13. Blood pressure
The pressure or tension of the blood within the systemic arteries, maintained by the
contraction of the left ventricle
resistance of the arterioles and capillaries
elasticity of the arterial walls
viscosity and volume of blood
Stedman’s medical dictionary, 5th Ed

14. Blood Pressure Classification
Systolic, mmHg
Diastolic, mmHg
Normal
<120
<80
Prehypertension
80-89
Stage 1 hypertension
90-99
Stage 2 hypertension
≥160
≥100
Isolated systolic hypertension
≥140
<90
On Admission
LUE 200/110
RUE 190/100
LLE 190 systolic
RLE 190 systolic
Upon PE
110/70
Harrison’s Internal Medicine, 17th Ed

15. Clinical Disorders of Hypertension
Essential hypertension/ primary/ idiopathic
Secondary hypertension
a specific mechanism for the blood pressure elevation is apparent
a specific underlying disorder causing the elevation of blood pressure can be identified
Renal, endocrine, adrenal…
Harrison’s Internal Medicine, 17th Ed

16. Apex beat Normal left ventricular apex impulse
left midclavicular line in the 4th or 5th LICS
Left ventricular hypertrophy
exaggeration of the amplitude, duration, and often size of the normal left ventricular thrust
impulse may be displaced laterally and downward into the 6th or 7th ICS (left ventricular volume load; aortic regurgitation or dilated cardiomyopathy)
Patient’s Apex beat at 6th LICS
11cm from the midsternal line
Harrison’s Internal Medicine, 17th Ed

17. Body Mass Index weight (kg)/height (m)2 Patient’s BMI = 30
CLASSIFICATION OF WEIGHT STATUS AND RISK OF DISEASE
BMI
Risk of Disease
Underweight
<18.5
Healthy Weight
Overweight
Increased
Obesity Class I
High
Obesity Class II
Very High
Extreme Obesity Class III
≥40
Extremely High
Patient’s BMI = 30
Harrison’s Internal Medicine, 17th Ed

18. Relevant History Cardiovascular consequences, comorbidities, lifestyle
**notes from history needed
Cardiovascular consequences, comorbidities, lifestyle
Common symptoms: headache, dizziness, palpitations, easy fatigability
Duration of hypertension, previous therapies
Family history – father (+)HTN, mother (+) HTN, siblings (+) HTN, DM
Diet – fond of sweet and salty
weight change
Harrison’s Internal Medicine, 17th Ed

19. **notes from history needed
Evidence of secondary hypertension: hx of renal dse, change in appearance, muscle weakness, spells of sweating, palpitations, tremor, erratic sleep, snoring, daytime somnolence, symptoms of hypo/hyperthyroidism, use of agents that may inc bp
Evidence of target organ damage – stroke, transient ischemic attack, angina, transient blindness, MI, CHF
Harrison’s Internal Medicine, 17th Ed