Internal
Renal & Urinary System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F2.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Good morning!\u0022 you say to your nurse as you arrive at the clinic.\n\n\u0022Good morning Doctor! We have a full house today,\u0022 she replies, pointing towards the waiting room.\n\nYou take a seat at your desk and browse through the patient list. The first patient is a 25-year-old woman, Lucy Meyers, whom you call over the intercom.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F4.jpg"}},{"insert":"\n\n"},{"insert":"\u0022Hello Ms. Meyers,\u0022 you greet your patient as she enters your office. \u0022Hello, doctor.\u0022 she answers.\n\n\u0022So, what seems to be the problem?\u0022 you start.\n\n\u0022Well doctor, my legs have swollen up a lot. I thought that it was because I spend a lot of time on my feet, but well, the swelling has just become worse and worse over time,\u0022 Lucy says.\n\n\u0022When did you first notice this?\u0022 you ask. \u0022Around a month ago,\u0022 she responds.\n"}]}
2
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F5.jpg"}},{"insert":"\n\n"},{"insert":"You ask several follow-up questions and find out that Lucy has had mild facial swelling since last week. She has also experienced arthralgia of the hands and wrists for several weeks. This was worst in the morning, resolving slowly over the course of the day.\n\nLucy has also had a rash over her face and chest, which was worsened by exposure to sunlight. She feels tired and sleepy all the time and has gained 10 kg in weight since the swelling started.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F8.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to a careful review of systems. During this, Lucy suddenly blurts out: \u0022Oh, doctor! I forgot - my fingers turn purple when it\u0027s cold!\u0022\n\nYou note down the presence of Raynaud phenomenon and continue.\n\nWhen asking questions about the urinary system, you find out that Lucy\u0027s urine has been unusually foamy for the last several weeks as well.\n\n\u0022It looks like I\u0027m peeing beer!\u0022 she says.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F9.jpg"}},{"insert":"\n\n"},{"insert":"Lucy\u0027s medical, surgical, gynecological, and family histories are unremarkable.\n\nShe is currently on the oral contraceptive pill and is not on any other medications, including over-the-counter drugs and herbal supplements.\n\nHer most recent routine medical checkup was around six months ago. \u0022I had a bunch of tests done, and all of them were normal.\u0022 she says, handing over a sheaf of reports.\n\nYou see normal liver and renal profiles, normal lipid levels, and a normal urinalysis, including microscopy.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F10.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to the physical examination. Her pulse is 88\/min, blood pressure is 146\/82 mmHg, respiratory rate is 12\/min, and saturation on room air is 99%.\n\nThe general examination shows marked bilateral pitting edema extending up to the knees. There are also scattered petechiae over both lower limbs.\n\n\u0022How long have you had these?\u0022 you ask, pointing at the petechia. \u0022Around two months or so,\u0022 Lucy replies.\n\n\u0022How has your blood pressure been?\u0022 you continue. \u0022Well, I\u0027m not sure how much it usually is, but during all routine checkups in the past, my doctors told me that it was quite normal\u0022 she responds.\n\nExamination of the heart, lungs, and abdomen shows no abnormalities, and you wrap up the examination.\n"}]}
6
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M56_F14.jpg"}},{"insert":"\n\n"},{"insert":"You start to piece together the puzzle. You have a young woman with worsening peripheral edema, arthralgias, photosensitivity, Raynaud phenomenon, foamy urine, petechiae, and hypertension.\n\nWhat are you thinking of?\n"}]}
1. Nephritic syndrome
2. Nephrotic syndrome
3. Isolated proteinuria
8
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10
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9
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7
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