31-year-old woman with nausea and increased thirst

Physical Examination

  • General appearance: Well-appearing female with normal body habitus. She is carrying a bottle of water from which she sips during the evaluation.

  • Vital signs:
  • Temperature: 36.9° C
  • Pulse: 88 beats/min
  • Respirations 14/min, oxygen saturation 96%
  • BP 135/82 mm Hg

  • Skin: Normal fair skin.

  • HEENT: Unremarkable

  • Neck: Jugular venous pressure 5 cm above the clavicle at 45 degrees. Delayed carotid upstrokes.

  • Pulmonary: Bilateral and symmetric air entry; no rhonchi, crackles or wheezes.

  • Cardiovascular: Normal heart sounds, and jugular venous pressure is normal; no peripheral edema.

  • Gastrointestinal: Abdomen is soft, nontender on palpation; bowel sounds are normal. Rectal examination shows moderate amount of soft, brown, heme-negative stool.

  • Genitourinary: Unremarkable

  • Musculoskeletal: Unremarkable

  • Neurologic: Alert and oriented. Muscle tone is generally normal, power is 5/5 in all muscles tested. Reflexes are 2/4 and symmetric in upper and lower extremities; plantar reflexes are downgoing.

  • Mental status: Patient reports a decreased mood but no suicidal thoughts.