Maria Febi C. BillonesJanuary 13, 2010

R.Q. 61 y/o Female Married Bicutan

Dyspnea

Known diabetic x 15 years

Initially presented with 3 P’s &

weight loss

Prescribed with Glibenclamide 5mg

BID however with poor compliance

Known hypertensive x 5 years

HBP 150/100

UBP 120/90

No medications taken

1 year PTC patient noticed easy

fatigability usually after simple

household chores associated with

dyspnea on exertion

She also experienced occasional chest

heaviness lasting almost the whole day

aggravated by work and relieved

temporarily by rest

3 months PTC noted worsening of

symptoms hence had herself an ECG and

Chest Xray in a nearby laboratory clinic

However, results revealed “within normal

limits” on ECG and “Atheromatous Aorta”

on Xray hence decided not to seek

medical consult

Persistence of dyspnea as well as

easy fatigability prompted consult.

(-) cough, colds, orthopnea, PND,

edema

(-)

(-) weight loss (-) dizziness (+) headache, occasional (+) nape pains,

occasional (-) blurring of vision (-) nausea (-) vomiting (-) abdominal pain (-) diarrhea (-) constipation

(+) polyuria (+) polydipsia (+) nocturia (-) oliguria (-) paresthesias (-) fever

s/p Total Hysterectomy for multiple

myoma, 1978 at UDMC

s/p breast cyst excision, 1972

(-) asthma, allergy, PTB

DiabetesPTBHypertensionSchizophreniaBrain Tumor

previous smoker 1-2 sticks/day x 1 yr (1978)

occasional alcoholic beverage drinker College Graduate, previously worked

in a bank Eventually lost her job and currently

on financial crisis

Nulligravid Underwent total hysterectomy for

multiple myomas at 28 y/o Menarche at 16 y/o, monthly regular

interval, 5 days duration, moderate amount, (-) dysmenorrhea

PHYSICAL EXAMINATION

General Survey Conscious, coherent, not in respiratory

distress Vital Signs

BP 150/90 HR 58 RR 22 Temp 37.1

Wt 70.3kg Ht 161cm BMI 27

HEENT pink conjunctivae, anicteric sclerae, no

nasoaural discharge, no tonsillopharyngeal congestion

Neck No anterior neck mass, no cervical

lymphadenopathy, no neck vein engorgement

Chest/Lungs Equal chest expansion, no retractions, clear

breath sounds Heart

Adynamic precordium, bradycardic, regular rhythm, distinct heart sounds, apex beat at 5th ICS LMCL, no murmur

Abdomen Flabby, (+) incision scar, infraumbilical

area, normoactive bowel sounds, soft, non-tender

Extremities Full and equal pulses, pink nailbeds, no

edema, no cyanosis, no jaundice Neuro Exam

Awake, alert, follows commands, oriented Cranial Nerves

1 – N/A; 2 – pupils 3mm EBRTL; 3,4,6 – full & equal EOMs; 5 – brisk corneals; 7 – no facial asymmetry; 8 – intact gross hearing; 9,10 – good gag, 11 – good shoulder shrug, 12 – tongue midline

Neuro Exam MMT – 5/5 all extremities Sensory – 100% intact DTRs - ++ Cerebellars: no dysmetria Meningeals: supple neck, no

incontinence

t/c Chronic Stable Angina Pectoris

DM Type 2, non-insulin requiring,

Obese I

t/c DM nephropathy

Hypertension Stage 1,

uncontrolled

Diagnostic FBS, BUN, Crea, Na, K, Cl, Ca, Mg Urinalysis 12-L ECG

Therapeutics Metformin 500mg BID Losartan 50mg OD

Lifestyle Modification Low salt low fat diet, low protein high

fiber diet Daily BP monitoring, sugar

monitoring Refer to Ophtha

Among diabetic patients, what is the

sensitivity and specificity of 24 hr

urine albumin vs urine micral test in

early detection of DM nephropathy?

P – patients with diabetes

I –24 hr urine albumin vs urine micral

test

O – in early detection of DM

nephropathy

M – cross sectional studies

Among long term diabetic patients,

which is more effective between

ACE-inhibitor and Angiotensin-

receptor blocker in delaying the

progression of diabetic

nephropathy?

P – patients with long term diabetes (>10yrs)

I – ACE inhibitor vs ARB O – in delaying the progression of

diabetic nephropathy M – randomized control trial

Thank you...