Case 3: Physical Exam

Vital Signs: Temperature 98.2°F, Blood Pressure 155/92 mmHg, Heart Rate 102 beats/min, Respiratory Rate 18 breaths/min

General Appearance: Uncomfortable appearing but in no acute distress
HEENT: Normal conjunctiva, no scleral icterus, mildly dry mucous membranes, clear oropharynx
Lymph: No lymphadenopathy
stethoscopeCardiovascular: No JVD, tachycardic,  regular rhythm, no murmur, rub, or gallop
Pulmonary: Clear to auscultation bilaterally
Abdominal: Distended but soft, palpable and tender lower abdominal mass, no rebound or guarding, normoactive bowel sounds, no hepatosplenomegaly
Extremities: warm and well perfused, trace pitting edema in lower extremities bilaterally
Neurologic: Awake, alert, oriented only to self, no focal deficits
Psychiatric: Calm but inattentive
Skin: Warm, dry

What’s on your differential diagnosis? Choose your top 3 below:
Acute interstitial nephritis (AIN)
Membranous nephropathy
Diabetic nephropathy
Anti-glomerular basement membrane (GBM) disease
Obstructive nephropathy
Acute tubular necrosis (ATN)
Multiple myeloma

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