62-year-old female with a history of controlled HTN and 42 pack per year smoking history comes to the emergency room with two days of fevers, diffuse myalgias, and cough productive of rusty colored sputum.  She also notes sharp nonradiating right sided chest pain, made worse with coughing and deep breaths.  Her symptoms have not improved despite using Tylenol pm remedy last night.  She has never had these symptoms before and reports no recent sick contacts. 

On exam, her temperature is 101.2, her pulse is 110, her respiratory rate is 22, and her blood pressure is 104/72

Her O2 sat is 87% on arrival to the ER.  She is in mild respiratory distress and is diaphoretic.  On exam you note bronchial breath sounds with crackles in the right midaxillary line, and right chest wall and RUQ abdominal tenderness.

A 55-year-old woman presents to your office for a new patient visit, and was last seen by an Internist five years ago.  She states her health has been good with the exception of a cholecystectomy five years ago.  She fell six weeks ago fracturing her wrist, and her orthopedic surgeon suggested she may have osteoporosis.  She takes an estrogen/progesterone supplement for hot flashes.  Her mother had diabetes and a maternal grandmother had breast cancer.  The patient is not a smoker and walks 3-4 days per week.  Her vitals are: pulse – 70, BP 130/80, weight 160 and height 5’3”.

A 66-year-old man with hypertension comes in for his Medicare enrollment physical.  Patient has no complaints and no other past medical history.  He is currently taking HCTZ 25 mg qd. Vital signs are: pulse – 82, BP 135/85, Weight 185 Height 5’8”.

An 18 year old woman presents for her college entrance physical. She has no complaints and no past medical history.  She is not currently taking any medications.  Vital signs are: pulse – 68, BP 118/68, weight 155, height 5’4”.

A 46-year-old male is referred to you from the emergency room for evaluation of his blood pressure.  His ER visit was three weeks ago after a minor vehicle accident; his BP was 160/100. He has not see a physician in 10 years and is taking over the counter ibuprofen for back pain related to the accident.  He smokes cigarettes, but has no other past medical history.  His father, sister and brother all have hypertension.  He is a lawyer downtown.  On exam, his weight is 220 lbs, body mass index 29, BP 164/104.  Neck exam shows no jugular venous distension and his lungs are clear.  Cardiac exam reveals regular rate and rhythm with an S4 gallop.  The abdominal exam is normal.  Extremities have no edema.  Serum electrolytes are normal except for a potassium of 2.7 mg/dL (low).  Creatinine and liver transaminases are normal.

A 26-year-old female with no significant past medical history comes to your clinic complaining of chronic thirst and frequent urination.   She reports no fevers, chills, dyspnea, dysuria, hematuria, or pain.  Her symptoms started about 2 weeks ago, and have not improved despite drinking large amounts of water since her symptoms started.  She reports some unintentional weight gain over the past year, which she attributes to poor diet and sedentary lifestyle.  Her vital signs are normal except for a weight of 210 lbs (body mass index of 32).  She appears her stated age and is in no acute distress.  Her HEENT exam reveals dry mucous membranes, but no scleral icterus or oropharyngeal lesions.  Her heart, lung and abdominal exams are normal.  Her extremities have 1+ pretibial edema.  A basic metabolic panel is significant for sodium of 132 and glucose of 537.

A 82-year-old female with a history of COPD, CAD, and multi-infarct dementia is brought to the emergency room with 3 days of progressive somnolence, lethargy and inability to eat.  At baseline, she is able to interact and have conversations, but she currently responds only to sternal rub.  She has a temperature of 101F, pulse of 115, respiratory rate of 22, and a blood pressure of 87/60.  She has skin tenting and her mucous membranes are dry.  Labs reveal a sodium of 128, a creatinine of 1.5, and a urinalysis is significant for nitrite, leukocyte esterase, and many white blood cells.

A 32 yo female without significant past medical history comes to your office with 4 days of progressive pain, swelling, and redness of her left leg.  She reports no recent trauma, or fevers.  Her symptoms started after returning from a trip to Florida.  She takes no medications except for an occasional Tylenol and oral contraceptive pills.