Table 1.
Description of Case Histories and Associated Examination Scenarios Presented in a Survey of 684 Medical Students, Internal Medicine Residents, and Academic General Internists at Three U.S. Medical Schools, 2008
| Condition | History components | Physical examination components |
|---|---|---|
| Ascites | 62-year-old man with three weeks of progressively increasing abdominal girth, 12-pound weight gain, and ankle edema; no known history of liver, kidney, or heart disease; has consumed six cans of beer daily for 35 years; no history of illicit drug use, tattoos, or blood transfusions | Presence of bulging flanks, shifting dullness, fluid wave, and leg edema |
| Absence of bulging flanks, shifting dullness, fluid wave, and leg edema | ||
| Congestive heart failure | 78-year-old non-smoking woman with hypertension and coronary artery disease status post myocardial infarction six years ago presents to the Emergency Department with three days of dyspnea and orthopnea; denies paroxysmal nocturnal dyspnea, chest pain, palpitations, and lightheadedness; no history of congestive heart failure exacerbations; reports compliance with low-salt diet and medications, which include aspirin, lisinopril, metoprolol, and simvastatin | Presence of jugular venous distention, rales, third heart sound, murmur, and leg edema |
| Absence of jugular venous distention, rales, third heart sound, murmur, and leg edema | ||
| Group-A beta-hemolytic streptococcal pharyngitis | 24-year-old woman presents to primary care physician’s office with complaint of a sore throat for two days accompanied by subjective fevers, chills, and myalgias; denies cough and coryza; reports friend recently had “strep throat” | Presence of fever, tonsillar swelling and exudates, tender cervical lymphadenopathy |
| Absence of fever, tonsillar swelling and exudates, and tender cervical lymphadenopathy | ||
| Acute anterior cruciate ligament tear | 24-year-old man presents to primary care physician’s office with complaint of two days of right knee pain, which began while he was playing football; heard a “pop” after being hit by another player; has been using ice and ibuprofen with improvement in pain; knee feels like it is going to buckle; no previous knee injuries or traumas | Positive response to the anterior drawer and Lachman tests |
| Positive response to the anterior drawer test and negative response to the Lachman test |