CHIEF COMPLAINT: "My eye is red and burning." History of Present Illness:
Mr. E. is a 55-year-old machinist who comes to your office complaining of pain in his right eye for the past 24 hours. He describes the pain as severe, aching, and deep; he has noticed a decline in his vision. He does not wear corrective lenses. He denies any work-related exposures. He denies any upper respiratory infection or allergies. He has a history of hypertension and sees his physician regularly for checkups; he has been told that his blood pressure is controlled on his medication. He has not experienced nausea, vomiting, diaphoresis, or abdominal pain.
Mr. E. has smoked three packs of cigarettes daily for 40 years. He has never had surgery.
What parts of the exam would you like to perform? (Circle the appropriate areas.)
General Survey Breasts and Axillae
Vital Signs Female Genitalia
Skin Male Genitalia
Thorax and Lungs Peripheral Vascular/ Extremities
Abdomen Nervous System
What physical findings are you looking for to help determine the diagnosis?
These are the actual findings on physical examination:
Alert, muscular, middle-aged man sitting on the examining table, holding his head in moderate discomfort
BP 160/95 mm Hg; HR 90 bpm and regular; respiratory rate 12 breaths/min; temperature 98.4°F
No rash; nails without clubbing or cyanosis
Visual acuity is measured at 20/100 in the right eye (O.D.) and 20/20 in the left eye (O.S.); the right pupil is dilated and fixed; the cornea appears cloudy; the right fundus is difficult to visualize External ear canals patent, tympanic membranes with good cone of light
Oral mucosa pink; dentition good; pharynx is without exudates
Supple, without thyromegaly; no cervical or supraclavicular adenopathy
Thorax symmetric, with increased AP diameter and slight hyperresonance over both lung fields
Breath sounds resonant; no wheezes or rhonchi
JVP 6 cm above right atrium; carotid upstrokes brisk, without bruits
PMI tapping and nondisplaced
Good Si, S2; no S3 , S4; no murmurs, rubs, or clicks
Based on this information, what is your differential diagnosis?
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Your heart pumps blood throughout your body using a network of tubing called arteries and capillaries which return the blood back to your heart via your veins. Blood pressure is the force of the blood pushing against the walls of your arteries as your heart beats.Learn more...