Part 1:
L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria and polydipsia. L.N. is 5′4″ and has always been on the large side, with her weight fluctuating between 165 and 185 lb.
Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%.
Hypertension was diagnosed 5 years ago when blood pressure (BP) measured in the office was noted to be consistently elevated in the range of 160/90 mmHg on three occasions. L.N. was initially treated with lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP control has fluctuated.
One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl of microalbumin identified on a spot urine sample. L.N. comes into the office today for her usual follow-up visit for diabetes. Physical examination reveals an obese woman with a BP of 154/86 mmHg and a pulse of 78 bpm.
Questions
What are the effects of controlling BP in people with diabetes?
What is the target BP for patients with diabetes and hypertension?
Which antihypertensive agents are recommended for patients with diabetes?
Part 2:
You should consult File 1. In this document is the case that you must address to answer the questions. All responses should be case-based, refrain from giving your opinion and personal connections.
Critical Thinking Questions
1. What is the cardinal sign of Lyme disease? (always on the boards)
2. At what stages of Lyme disease are the IgG and IgM antibodies elevated?
3. Why was the ESR elevated?
4. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.
Part 3:
You should consult File 2. In this document is the case that you must address to answer the questions. All responses should be case-based, refrain from giving your opinion and personal connections.
Critical Thinking Questions
1. What was the cause of this patient’s pain and cramping?
2. Why was there decreased hair on the patient’s right leg?
3. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?
4. What would be the treatment of intermittent Claudication for non-occlusion?
attachment
File1.pdf
attachment
File2.pdf
