Problem: What are 6 differential diagnoses and initial treatment plan in the below scenario. Need Assignment Help?
You are seeing a 50-year-old female for her annual exam. She is a long time patient in the practice that you have just joined. She has no complaints and states that she feels well. Her past medical history is notable for "borderline hypertension" and obesity. Last year, her lipid panel was acceptable for someone without known risk factors or coronary artery disease. TC 214; Trig 202; HDL 32; LDL 146 [reading in summer of 2020, fasting].
Her brother and mum have HTN and Type 2 diabetes. You can tell from your review of her electronic health record that the NP that retired [the one you replaced] had counseled her on a low fat, low calorie diet and on the importance of a regular exercise regimen. However, patient admits to not having made any changes to her lifestyle. She states that she works full time and has three children; she finds it difficult to exercise. She admits that she and the family eat out frequently.
On exam today, her BP is 148/94 and her BMI is 28 kg/m2. Her exam is remarkable for brown macules with a velvet appearance along the nape of the neck and under both axillae. In addition, in the axilla there are many small skin tags where the adipose tissues have rubbed upon one another. Her waist circumference is 38.5 inches. There are no gross abnormalities on her exam; her Pap is done [it appeared normal] and a mammogram is set up. The patient is fasting today and her blood sugar is 210 mg/dL. She takes a multiple vitamin and chewable Calcium and Vitamin D3 every day. Her last menstrual period was 3 weeks ago; she uses a diaphragm for birth control [she is married and in a monogamous relationship]. She has no known allergies and she has never had surgery.
Her labs last year were normal except for cholesterol panel as cited above. Patient is fasting today and the only lab that you can do as a point of care in the office is the blood sugar, the results are listed above.