Case #1:

HPI: M.F. is a 66-year-old white male that presented to you for a physical since he has not seen a doctor since age 21. He states he has felt well and is really without any complaints.

PMH: Medicines - none. Allergies - none. Illnesses - none. Injuries - none. Hosp: s/p T&A as a child.

ROS: HEENT - He complains of a hoarse voice which is worse in the morning, and a continuous non-productive cough. GU - He also has some difficulty with voiding with decreased force of stream of urination.

Social history: He smokes 3 packs per day which he began at age 16. He denies alcohol. He worked as a postal carrier but retired in 1989 to take care of his disabled wife who recently died from complications of diabetes mellitus.

Physical exam: VS - Blood pressure in the right arm was 180/110, in the left arm was 176/112. Pulse was 72, respirations were 16 and unlabored. Generally he was a short, thin, well-developed male who appeared slightly anxious and smelled of cigarettes. HEENT: He had a 1 x .5 cm white non-raised lesion on the left, buccal mucosa. Neck: pulses were 2+ with a 2/4 left carotid bruit. There was no thyromegaly, no lymphadenopathy.

Cardiovascular: Regular rate and rhythm with a normal S1 and increased S2, positive S4 and no murmurs. His abdominal exam revealed normoactive bowel sounds without organomegaly or masses.

Extremities: He had no dorsalis pedis pulses palpated. His posterior tibial and popliteal pulses were 2+. There were both right and left femoral bruits.