These are the blue sheet, physical exam, diagnostic studies and differential diagnosis needed for a calf pain case in the USMLE Step 2 CS exam:
BLUE SHEET CALF PAIN:
PHYSICAL EXAMINATION
1. Lungs:
Inspection of thoracic expansion
Palpation: Tactile fremitus.
Percussion: Look for tympanic or else.
Auscultation: Patients may move the thorax without inspiration, simulating decreased breath sounds uni or bilaterally.
2. Heart:
Auscultation
PMI palpation
3. Extremities:
Inspection: lesions, edema, varicose veins.
ROM bilateral lower limbs (all joints)
Palpation: Edema, peripheral pulses.
Homan’s sign
4. Neurologic:
Motor: Strength
Sensory
Gait
POSSIBLE DIAGNOSTIC STUDIES:
- CBC, electrolytes.
- ESR.
- CPK, myoglobin.
- D-dimer.
- PT, PTT, fibrinogen.
- Wound swab with gram stain and culture
- Blood cultures
- U/S Doppler of the lower limbs
- CT/MRI as needed
DIFFERENTIAL DIAGNOSIS:
- Muscle sprain
- Muscle rupture
- Deep vein thrombosis (DVT).
- Drug-induced myopathy
- Ruptured Baker’s cyst
- Cellulitis
- Osteomyelitis
- Peripheral arterial disease
- Hematoma
- Diabetic polyneuropathy.
Founder & Autor at Ecuadoctors.com
Hematology/Oncology Fellow at BUSM | Former Internal Medicine Residency/Chief Resident at UCONN | Website Developer & Author at Ecuadoctors.com
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