

Vitals are temperature 37☌ (98.6☏), blood pressure 155/89 mm Hg, pulse 89/min, respirations 16/min, and oxygen saturation 98% on room air. Review of systems is significant for decreased appetite and feeling easily full. Patient reports a 30-pack-year smoking history and heavy alcohol use on the weekends. Current medications are sildenafil 100 mg orally as needed. Past medical history is significant for 2 transient ischemic attacks 6 months prior, characterized by a sudden right-sided weakness and trouble speaking but recovered fully within 30 minutes. He describes the abdominal pain as mild to moderate, dull, and deeply localized to the umbilical region. The patient states that his symptoms started about a week ago and have steadily worsened.

This event started when he was in class sitting for an exam. Which of the following additional clinical findings would you expect to be present?Ī 23-year-old man comes to the emergency department presenting with sudden-onset dyspnea and right-sided chest pain over the last hour. A computed tomography (CT) scan of his head is shown in the exhibit. The rest of the examination is within normal limits.

An area of bluish discoloration is seen on his left eyelids and cheek. His height and weight are at the 67th and 54th percentile for his age. Physical examination reveals normal vital signs. There is no history of fever or head trauma. His developmental milestones were slightly delayed. His birth history and family history are not available. Past medical history is significant for mild mental retardation and complex partial seizures sometimes leading to secondary generalized seizures. The headaches are moderate-to-severe in intensity, unilateral, mostly affecting the left side, and pulsatile in nature.
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