Case 18: Physical Exam

Case 18 Index

Vital Signs: Temperature 99°F, Blood Pressure 150/90 mmHg, Heart Rate 90 beats/min, Respiratory Rate 20 breaths/min
General Appearance: Appears uncomfortable, speaking in short sentences on nasal cannula
HEENT: Pupils equal round and reactive to light, bilateral episcleritis, sinuses non-tender to palpation, dry mucus membranes, two shallow ulcers on sides of tongue
Lymph: No lymphadenopathy
Cardiovascular: No JVD, regular rhythm, no rubs/murmurs/gallopsstethoscope
Pulmonary: Labored breathing, clear bilaterally without wheezes, rhonchi, or rhales
Abdominal: Soft, nontender, nondistended, normoactive bowel sounds, no hepatosplenomegaly
Extremities: 2+ bilateral pitting edema to shins bilaterally, no clubbing, right great toe with tenderness and dusky discoloration
Neurologic: awake, alert, answers appropriately
Skin: Scattered palpable purpura and petechiae on bilateral lower extremities and abdomen, non-blanching, no tenderness to palpation of lesions, with several faded lesions on upper extremities

What’s at the top of your differential diagnosis? Choose 3 before moving on!
Post-infectious glomerulonephritis (PIGN)
Membranous nephropathy
Atheroembolic disease
Warfarin induced skin necrosis
Hepatitis-C associated membranoproliferative glomerulonephritis (MPGN)
Eosinophilic granulomatosis with polyangiitis
Granulomatosis with polyangiitis
Acute interstitial nephritis (AIN)
Systemic lupus erythematosus (SLE) nephritis
IgA nephropathy
Anti-glomerular basement membrane (GBM) disease
Acute tubular necrosis (ATN)

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