Case 5: Physical Exam

Vital Signs: Temperature 98.4°F, Blood Pressure 130/89 mmHg, Heart Rate 91 beats/min, Respiratory Rate 12 breaths/min

General Appearance: In no acute distress
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx
Lymph: No lymphadenopathy
StethoscopeCardiovascular: No JVD, Regular rate and rhythm, no murmur, rub, or gallop
Pulmonary: Clear to auscultation bilaterally
Abdominal: Soft, obese, nontender, nondistended, normoactive bowel sounds, no hepatosplenomegaly
Extremities: 3+ pitting edema of bilateral lower extremities, warm and well perfused
Neurologic: Alert, oriented  to person, place, and time, no focal deficits
Psychiatric: Calm, pleasant
Skin: Warm, dry, no rashes

What’s at the top of your differential diagnosis? Choose 3 before moving on!
Post-infectious glomerulonephritis (PIGN)
Primary membranous nephropathy
Systemic lupus erythematosus (SLE) nephritis
Diabetic nephropathy
Hepatitis B-associated glomerular disease
Hepatitis C-associated glomerular disease
Focal segmental glomerulosclerosis (FSGS)
Anti-glomerular basement membrane (GBM) disease
Acute tubular necrosis (ATN)
IgA nephropathy
Minimal change disease

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Case 5 Index
Case 5 Introduction