1. Step 6
1.1. Review session 1
1.2. Report new knowledge
1.3. glomerulopathy
1.4. Capillary-intersitial fluid shift
1.5. Uremia in relation to lethargy
1.6. 30 minutes
1.6.1. The scribe does not have to write in this step!
2. Step 8
2.1. Diagnostic decision
2.1.1. nephrotic syndrom ( membrenus nephropathy ) )
2.2. Mechanism
2.2.1. immune mediated
2.2.2. iGg and c3 deposition
2.2.3. protien loss
2.2.4. fluid shift
2.2.4.1. secondary sodium retention
2.3. Presentation
2.3.1. symptoms of nephrotic syndrom
2.3.2. hypoalbumenemia
2.4. Supporting data
2.4.1. history
2.4.2. physical exam
2.4.3. investigation
2.4.3.1. biopsy
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complaint
3.1.1.1. lethargy and swelling
3.1.1.1.1. 6 weeks
3.1.1.2. nocturia
3.1.1.2.1. 12 month
3.1.1.2.2. mild
3.1.1.2.3. with normal urenary stream
3.1.1.3. mild ankle swelling
3.1.1.3.1. progressive
3.1.1.3.2. started 3 years ago , progressed in the last 3 weeks
3.1.1.4. fruthiness in the urine
3.1.1.5. mild nosia and anaroxia
3.1.2. Previous medical / surgical history
3.1.2.1. 2 small MI
3.1.2.2. HYPERTENSIVE
3.1.2.2.1. use verapamil
3.1.2.3. CABG 5 years ago
3.1.3. Drug history / allergy
3.1.3.1. asprin 100mg
3.1.3.2. verapamil 240mg
3.1.3.3. semapastatin 20mg
3.1.4. Family history
3.1.4.1. father died at 74 from MI
3.1.4.2. mother died at 94
3.1.5. Social / occupational history
3.1.5.1. smoked 30 cigarets per day, stopped after MI
3.1.5.2. SOME SPORTS
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. vitals
3.1.7.1.1. weight
3.1.7.1.2. BP
3.1.7.1.3. heart rate
3.1.7.1.4. afebriel
3.1.7.2. CV system
3.1.7.2.1. moderet perephral edema from feet to his knees
3.1.7.2.2. jvp visibal but not raised
3.1.7.2.3. medline stenotomy scar
3.1.7.2.4. palpation abex beat was palpable normal
3.1.7.2.5. normal perephral pulses
3.1.7.3. abdominal exam
3.1.7.3.1. normal
3.1.7.4. normal lymphnodes
3.1.7.5. fonduscopy
3.1.7.5.1. thickining and tortuosity of arteriols with arias of AV nipping
3.1.8. tests results
3.1.8.1. serum biochemistry
3.1.8.1.1. elevated urea
3.1.8.1.2. decrese in albumin, total protien and calcume
3.1.8.1.3. cloride elevated 110
3.1.8.1.4. creatinin is elevated
3.1.8.1.5. colestrol elevated
3.1.8.1.6. LVT is normal
3.1.8.2. full blood count
3.1.8.2.1. HG decreased 118
3.1.8.2.2. ESR elevated 65
3.1.8.3. urine sedement
3.1.8.3.1. WHITE CELLS elevated 10
3.1.8.3.2. red cells
3.1.8.4. urine biochemistry
3.1.8.4.1. protien elevated 9.27
3.1.8.5. ECG
3.1.8.5.1. sinus rythem with left ventricular hypertrophy