The rational clinical examination

Abstract

To the Editor. —I was pleased to read your introduction to the new series on clinical examination. I thought the initial article 1 and Editorial 2 were both excellent. I would like to present the following case to pose a question: Four weeks ago, an 82-year-old woman came into my office with a 1-month history of right leg swelling. During this month, she had three separate episodes of pleuritic chest pain, the first two of which resolved spontaneously. She came to the office after the third episode of pain. On examination, she was found to have râles medial to her left scapula without audible rub. Her right leg was swollen and tender with a circumference of 40 cm compared with a left leg circumference of 35 cm. I felt absolutely certain that she had a deep-vein thrombosis with recurrent pulmonary emboli. I admitted her to the hospital where a venous