He then does a secondary survey . In general, Mrs. Smith appears pale, alert, and in some distress. Exam is positive only for a small cataract in the left eye and a palpable firm thyroid. No carotid bruits. Liver, kidneys, and spleen are nonpalpable.
Femoral pulses are normal and equal.
There is some crepitance when the left knee is moved. Radial, dorsalis pedalis, and posterior tibial pulses are all normal and equal. There are no tender cervical, thoracic, or lumbar vertebrae. Based on his history and physical, the ER physician orders x-rays and lab tests. The ulcer is an iatrogenic injury.