Endocrine/Metabolic Case Study
A 36-year-old woman comes in for her annual physical examination. She notes that her mother just died of complications of T2DM and she is worried about her own risk for T2DM, because she has been told that it runs in families. Her mother developed T2DM at age 52 and never achieved good blood sugar control; she developed heart disease at age 63 years and died at 68 years of a heart attack. The patient describes her mother as “very overweight” and sedentary. There is no other family history of T2DM.
The patient’s blood pressure is 128/82, pulse 80, respirations 18, temperature is 98.7, height is 5’5″, weight is 165, and BMI 27.5. When questioned about her lifestyle, she says that she quit smoking a couple of years ago. Because she works full time and has two children, aged seven and ten, she has little time for exercise. She tries to serve her family a healthy diet, but tends to rely on fast food on busy days. She does report increased thirst and urination. “I can’t seem to get enough to drink. I think I go to the bathroom often because I drink a lot.”
Case Questions:
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Using
OLDCARTS, what questions would have been asked as part of the medical history -
What physical aspects would have been completed as part of the physical exam and why? Include the diagnostics that you would order and rationale.
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Based on the medical history and physical exam, what is the most likely cause of her increased thirst and urination? What is the pathophysiology of these symptoms?
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What other possible diagnoses should be considered and why?
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Are there any other tests that should be completed before producing a diagnosis? Why or why not?
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What is the treatment for this patient, including education? Follow the guidelines.
