Get Answer: Case Study Year Question Guide

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Original Question

Case Study: A 55 year old man comes in for a new patient evaluation. He was diagnosed with type 2 diabetes mellitus 15 years ago. He also has hypertension and a 1-year history of right knee osteoarthritis that is well-controlled with a maximum dose of daily ibuprofen. He has not been evaluated by a physician in 3 years, and his last 90-day prescription refills were filled at that time. The patient brings empty medicine bottles for HCTZ, losartan, metformin and pravastatin. His only symptoms are fatigue, recent loss of appetite and ankle swelling. On physical exam, temperature is 98.9 degrees F, BP is 146/92 mmHg, pulse rate is 70/min and respiratory rate is 14/ minute. BMI is 31. There is no jugular venous distension. Cardiac exam reveals distant heart sounds with no murmur. The lungs are clear. There is bilateral lower extremity edema to the mid-shin. There are normal pedal pulses and sensation is intact. Labs results- glucose 230 mg/dL, sodium 142 meq/L, potassium 5.7 meq/L, creatinine 2.5. Urine protein/ creatinine ratio is 0.46 with urinalysis showing specific gravity 1.015/ 3+ protein, glucose and no casts.

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