Physical examination

BW 49 kg BT 37c, RR 20/min, HR 90/min

A middle-aged Thai female. Alert.

HEENT: Not pale, no jaundice, Moon face with plethora, no

rash, no oral ulcer, Thyroid gland 50 gm, soft, no thyroid bruit

Cardiovascular:

<2s>3sCap refill

1+0Dorsalis Pedis

1+0Post. tibial

2+1+Popliteal

2+1+Femoral

1+2+Radial

1+2+Brachial

LtRtPulse

125/75123/93Lower

113/81186/81Upper

LTRTBP

Physical examination

Cardiovascular

Carotid bruit: Positive Rt.

Subclavian bruit: Positive Both

Heart: apical beat at 5th ICS and MCL, Normal S1,S2,

SEM gr III at RUPSB

Lung: no adventitious sound

Physical examination

Abdomen: not distend, active bowel sound, no hepatosplenomegaly, no abdominal bruit

Extremities: diminished pulse Rt posterior tibial & dorsalis pedis, poikilothermia Rt leg, digital necreosis Rt 4th toe

Neuro: E4M6V5 pupil 2 mm BRTL CN intact, Motor gr

V/V

IV/VIV/V

V/V

Problem list

1.) Arterial occlusion disease involving Lt subclavian artery & peripheral vascular occlusion of both lower extremities

2.) Hyperthyroidism

Lab แรกรับที่ รพ.จุฬาลงกรณ์

CBC: WBC 11400 N93% L4% Hb 9.3 Hct 30% MCV

98 RDW 20

Plt 75,000

BUN 16 Cr 0.57

Na 134 K 3.7 Cl 98 CO2 27

Lab แรกรับที่ รพ.จุฬาลงกรณ์

TB 0.74 DB 0.26 ALP 110

SGOT 32 SGPT 23

Alb 3.1

TFT: FT4 1.23 FT3 1.41 TSH 0.691

ESR 95