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Rectal examination: Yes - constipation with fecal impaction may be the cause or contributing factor in his abdominal pain.
- Mini-mental status examination: No - history not significant for mental status changes and given Mr. M’s degree of pain and discomfort this would not be an appropriate time; further, results would not be reliable, as his ability to concentrate would be limited by his symptoms.
- Neurologic examination: Yes - need to evaluate for signs of brain or spinal cord involvement or paraneoplastic syndrome in all patients admitted with advanced cancer.
- Murphy’s sign: Yes - you must consider an unrelated cause of abdominal pain such as cholecystitis (hence check Murphy’s sign).
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Pulsus paradoxus: No - while pericardial metastases may occur in a variety of advanced malignancies, he has no cardiopulmonary symptoms, vital sign or physical examination findings that are concerning for this.