Weight loss and dizziness in a 29-year-old man

Physical Examination

  • General appearance: Slender male who appears comfortable.

  • Vital signs:
  • Temperature: 37.8° C
  • Pulse: 112 beats/min
  • Respirations: 18/min
  • BP: 75/92 mm Hg

  • Skin: Skin is slightly tanned, and his knuckles and nipples appear darkened. There is no obvious jaundice, rash, petechiae, or ecchymoses. Hair is normal.

  • HEENT: Unremarkable

  • Pulmonary: Bilateral and symmetric air entry, no crackles or wheezes on auscultation of the lungs.

  • Cardiovascular: Normal heart sounds, jugular venous pressure is not seen at 45°, there is no pitting leg edema, and capillary refill is slightly delayed due to cold peripheries.

  • Gastrointestinal: There is an old surgical scar in the epigastric area. Bowel sounds normal. Abdomen soft, with mild generalized tenderness on moderate palpation without rebound tenderness or guarding. No masses. Rectal exam non-tender, heme-negative stool.

  • Genitourinary: Unremarkable

  • Musculoskeletal: No swelling or erythema of joints or extremities. Muscles and joints non-tender, full range of motion. No asterixis.

  • Neurologic: Alert and oriented. Cranial nerves II to XII intact. Muscle tone and power are generally normal and equal bilaterally. Reflexes are +2/4 symmetrically in upper and lower limbs; plantar reflexes are downgoing. Cerebellar tests, including gait and balance, normal.

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