Day 2, Part 2

You then go to visit Mr. Elliot: he reports fevers and chills overnight and states that his left ankle is hurting more.

Physical Exam:

• General: ill-appearing, lying in bed with his left leg propped on a pillow
• Eyes: PERRL, EOMI
• HEENT: Mucous membranes moist, no pharyngeal erythema
• Resp: CTAB
• CV: Tachycardic with persistent mid-systolic murmur at base.
• Abd: Normoactive bowel sounds, no tenderness to palpation, no rebound/guarding.
• Extremities: Left ankle effusion around lateral malleolus with surrounding erythema. Warm to the touch and exquisitely tender. 3x3cm tender area on the left posterior thigh.
• Pulses: symmetrical and strong throughout.
• Neuro: AAOx3, CN II-XII intact

Mr. Elliot asks about the results of his heart ultrasound. You share that no vegetations were seen and he asks if that means he's okay and what's next.

You make a note of your findings and plan for the day just as you receive a page from your senior resident; she wants to run the list.