Which patient needs a detailed physical examination?

A detailed physical examination is most warranted for the 35-year-old female who has been in a single-car collision and briefly lost consciousness. This situation raises concern for potential neurological injuries, such as a concussion or other traumatic brain injuries, which can have significant implications for patient care. The loss of consciousness indicates that she may have sustained trauma that requires thorough assessment to rule out spinal injuries, internal bleeding, or other complications that can occur following vehicular accidents.

In trauma cases, especially those involving altered levels of consciousness, a meticulous examination is crucial since it helps to identify any unseen injuries that may necessitate immediate medical intervention. While the other patients have conditions that warrant medical attention—such as chest pain in the male with a heart history or respiratory distress in the female with a smoking background—these do not generally present the same immediate risk of serious and less obvious complications that need to be assessed through a detailed examination.

Given these considerations, the focus on neurological status and potential trauma-related complications in the context of the female patient who lost consciousness underscores the necessity for a detailed physical examination in her case.