Case 52: Physical Exam

Case 52 Index

Vital Signs: Temperature 98.3°F, Blood Pressure 110/80 mmHg, Heart Rate 65 beats/min, Respiratory Rate 14 breaths/min
General Appearance: awake, appears confused
HEENT: Normal conjunctiva, no scleral icterus, moist mucous membranes, clear oropharynx
Lymph: No cervical lymphadenopathy
Cardiovascular: Right upper extremity radiocephalic arteriovenous fistula (AVF) with bruit + thrill; No JVD, regular rhythm, no rubs/murmurs/gallopsstethoscope
Pulmonary: Breath sounds normal bilaterally, no rales/rhonchi/wheezes
Abdominal:  Bowel sounds present, soft abdomen
Extremities: warm and well perfused, no peripheral edema of lower extremities
Neurologic: Answers some questions but not all appropriately; oriented only to person
Skin: Warm, dry, no rash

What’s at the top of your differential diagnosis to explain altered mental status in this patient? Choose 3 before moving on!
Uremic encephalopathy
Non-steroidal anti-inflammatory drug (NSAID)-associated toxicity
Baclofen-associated toxicity
Hepatic encephalopathy
Urinary tract infection
Severe anemia
Dialysis disequilibrium syndrome

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Case 52 Index
Case 52 Introduction