Advanced Physical Assessment.pdf, Exams of Integrated Case Studies

Advanced Physical Assessment.pdf

Typology: Exams

2025/2026

Available from 04/15/2026

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Advanced Physical Assessment: Harvey Hoya (57-Year-Old Male)
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 Hoya
History of
Present Illness
(HPI)
Past Medical & Social History
Onset: 4 hours
ago, following a
heavy dinner.
Location:
Epigastric region
radiating to the
back. Intensity:
8/10 on numerical
scale. Quality:
Sharp, constant
pressure.
Associated
Symptoms:
Nausea, one
episode of non-
bilious emesis.
PMH: Hypertension, Hyperlipidemia, Cholelithiasis (diagnosed 2 years ago). Social:
Occasional alcohol (1-2 beers/week), non-smoker. Family History: Father with CAD;
Mother with Type 2 Diabetes.
Clinical Pearl: Referred Pain
Radiation of pain from the epigastrium to the back is a classic clinical sign. In pancreatic pathology, the
pain often radiates directly through to the mid-back due to the organ's retroperitoneal position. In
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Advanced Physical Assessment: Harvey Hoya (57-Year-Old Male)

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

  • Onset: 4 hours ago, following a heavy dinner. • Location: Epigastric region radiating to the back. • Intensity: 8/10 on numerical scale. • Quality: Sharp, constant pressure. • Associated Symptoms: Nausea, one episode of non- bilious emesis.
    • PMH: Hypertension, Hyperlipidemia, Cholelithiasis (diagnosed 2 years ago). • Social: Occasional alcohol (1- 2 beers/week), non-smoker. • Family History: Father with CAD; Mother with Type 2 Diabetes. Clinical Pearl: Referred Pain Radiation of pain from the epigastrium to the back is a classic clinical sign. In pancreatic pathology , the pain often radiates directly through to the mid-back due to the organ's retroperitoneal position. In

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.