In this case study, we will be examining two patients: a 46-year-old woman with borderline hypertension and moderate obesity, and a 48-year-old woman with diabetes. Both patients present with specific symptoms and medical histories that require further evaluation and management.
Patient 1: 46-year-old Woman
Medical History and Risk Factors
The 46-year-old woman has a medical history notable for borderline hypertension and moderate obesity. Her family history is also significant, as both her mother and brother have diabetes and hypertension. Last year, her fasting lipid profile was within acceptable ranges. She has been advised by her preceptor to follow a low calorie, low fat diet and start an exercise program, but she finds it difficult to exercise due to her full-time job and four children. Additionally, she frequently eats out.
Physical Examination Findings
During the physical examination, acanthosis nigricans is observed at the neck, indicating a possible metabolic abnormality. However, the rest of the examination is noted to be normal.
Several laboratory values are obtained for this patient. Her blood pressure is measured as 145/95 mm Hg, indicating hypertension. Her total cholesterol (TC) level is 230 mg/dL, which is above the recommended range. The low-density lipoprotein (LDL) cholesterol level is 132 mg/dL, also considered high. The high-density lipoprotein (HDL) cholesterol level is 38 mg/dL, below the optimal range. Triglyceride levels are measured at 240 mg/dL, indicating increased risk for cardiovascular disease. Most significantly, her fasting plasma glucose level is 177 mg/dL, which exceeds the threshold for diabetes diagnosis. The glycated hemoglobin (HbA1c) level is 8.4%, confirming poor glycemic control.
Patient 2: 48-year-old Woman
Medical History and Risk Factors
The 48-year-old woman has a diagnosis of diabetes. Her blood sugar levels have been well controlled, as evidenced by a previous HbA1c level of 6.6% and a fasting blood glucose level today of 114 mg/dL. She is currently taking metformin, cimetidine, and accupril as medications.
Symptoms and Physical Examination Findings
MT presents with thickened, yellow toenails that are painful when she wears dress shoes. She also experiences some peeling of the skin on the soles of her feet. Although her blood sugar levels are well controlled, these symptoms could indicate complications related to her diabetes.
The positive toenail culture for fungus suggests a fungal infection, which may require treatment. Additionally, the peeling of the skin on the soles of her feet could be indicative of diabetic neuropathy.
In conclusion, these case studies highlight the importance of thorough evaluation of patients with multiple risk factors such as hypertension, obesity, and diabetes. The 46-year-old woman requires further management of her elevated blood pressure, dyslipidemia, and uncontrolled hyperglycemia, while the 48-year-old woman should receive treatment for her toenail fungus and evaluation for diabetic neuropathy. Both patients would benefit from lifestyle modifications including appropriate diet and exercise recommendations. The comprehensive management of these patients is essential to mitigate the long-term complications associated with their medical conditions.