She denies IV drug use. The patient's social history includes smoking 1-2 packs of cigarettes per day. She acknowledges consumption of approximately one quart of hard liquor over the course of a week and occasional binge alcohol drinking. She has no regular housing. She admits to occasional prostitution in the past.
Funduscopic examination reveals no retinal hemorrhages.
The nasal septal mucosa on the right shows an area of erosion with active oozing but without frank bleeding. No other adenopathy. Abdomen soft and non tender, spleen not palpable. Multiple bruises both old and new are present mostly on the upper and lower extremities. This 21 year old student was surfing at Black's Beach when he was struck in the left leg by his surf board.