Level 3: Edema – Contrasting Case #2: Patient Information

Given these changes from the original case, what is your diagnosis?

What is your diagnostic explanation?

As compared to the long case, this patient is a 65 year old woman with the same patient characteristics. She reports that “For the last several weeks I’ve noticed a lot of swelling in my legs when I stand for a long time.”

HPI: The patient reports that her symptoms began several weeks ago. She states that when she urinates, the urine is foamy. She has not noticed any blood in her urine or dysuria. She also notes that although she has had small amounts of swelling in her feet for years, she has noticed that now she has significant swelling that goes up to calves. She has not had recent fever, chills, nausea, vomiting, diarrhea, or constipation.

PMH: same as in the long case.

FMH and SH: same as in the long case.

ROS: General: No fever, some mild fatigue. GU: see HPI. I have foam in my urine. No increased frequency of urination. Rest of ROS is negative.

PE: Vitals same as in the long case except BP is 140/80. General: Appears well and in no acute distress. Extremities: 3+ pitting edema of bilateral lower extremities to the level of the knee. Rest of PE is normal.

Labs: 24hr urine collection for protein, which shows 4g of protein in 24hr.