Case 33: Physical Exam

Case 33 Index

Vital Signs: Temperature 98.5°F, Blood Pressure 155/80 mmHg, Heart Rate 90 beats/min, Respiratory Rate 14 breaths/min

General Appearance: In no acute distress
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx
Lymph: No cervical lymphadenopathy
Cardiovascular: Regular rhythm, no murmur, rub, or gallop
stethoscopePulmonary: Clear breath sounds bilaterally, no wheezes, rhonchi, or rales
Abdominal: Soft, non-distended, non-tender
Extremities: Trace peripheral edema in extremities, extremities warm with intact pulses, no cyanosis, skin findings as below
Neurologic: Awake, alert, oriented x3, no focal neurologic deficits, able to move all extremities but lower extremity exam somewhat limited by pain
Access: Left arm AV fistula without bruit or thrill;  Right arm AV graft with thrill and bruit
Skin: Normal appearing upper extremities, lower extremity shown below (both lower extremities appear similar)


Before moving on, what is on your differential diagnosis? Choose your top 2!
Calcific uremic arteriolopathy (calciphylaxis)
Warfarin necrosis
Cholesterol embolization
Purpura fulminans
Nephrogenic systemic fibrosis (NSF)

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Case 33 Index
Case 33 Introduction