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Advanced Physical Assessment.pdf
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Patient Profile Name: Harvey Hoya Age: 57 Gender: Male Occupation: Accountant Chief Complaint: "My stomach is killing me, and the pain is going straight through to my back." Pa tient: Harvey H History of Present Illness (HPI) Past Medical & Social History
biliary pathology (like cholecystitis), pain may radiate to the right scapula or interscapular region (Boas' sign) due to phrenic nerve irritation. Vital Signs & Physical Examination Findings Vital Signs: BP 145/92 mmHg | HR 102 bpm | RR 20 breaths/min | Temp 100.2°F (37.9°C) Heart: S1, S2 audible; regular rhythm; no murmurs, rubs, or gallops noted. Lungs: Clear to auscultation bilaterally; no adventitious sounds; equal chest expansion. Abdomen: Protuberant; bowel sounds are hypoactive in all four quadrants. On palpation, there is exquisite tenderness the Right Upper Quadrant (RUQ) and epigastrium. Voluntary guarding is present; no rebound tenderness noted at this time. Clinical Correlation: Based on the patient's history of cholelithiasis and the current physical exam findings (RUQ tenderness and hypoactive bowel sounds), identify the most likely anatomical structures involved in this acute presentation and justify your reasoning.