Case 55: Physical Exam

Case 55 Index

Vital Signs: Temperature 100.7℉, Blood Pressure 90/50 mm Hg on norepinephrine, Heart Rate 112 beats/min, SpO2 94% (FiO2 70%), Respiratory Rate 22 breaths/min on ventilator
General Appearance: critically ill
HEENT: positive scleral icterus, endotracheal tube in place
Lymph: No cervical lymphadenopathy
Cardiovascular: No JVD, regular rhythm, no rubs/murmurs/gallopsstethoscope
Pulmonary: mechanical breath sounds bilaterally
Abdominal: Soft, distended, positive fluid wave, sluggish bowel sounds
Extremities: 2+ pitting edema, cool clammy extremities
Genitourinary: foley catheter in place with minimal urine output
Skin: +jaundice

What’s on your differential diagnosis for acute kidney injury (AKI) in this patient? Pick your top 3!
Non-steroidal anti-inflammatory drug (NSAID) induced injury
Volume depletion
Calcium channel blocker toxicity
Steroid toxicity
Trimethoprim-sulfamethoxazole nephrotoxicity
Calcineurin inhibitor toxicity 
Obstructive nephropathy
Transplant renal artery stenosis (TRAS) 
Kidney Transplant Pyelonephritis
Rejection of pancreas allograft
Rejection of kidney allograft

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Case 55 Index
Case 55 Introduction