Question

Part I - Mary Smith Mary is a 40-year-old female. Mary works for a pharmaceutical sales company and sits behind a desk for the majority of her day. Mary has not been feeling like herself lately and she's concerned. Mary has noticed a handful of symptoms: she has been tired and a little depressed, she's gained weight - especially around her belly, and she's noticed that her face feels fuller than usual. Additionally, her menstrual cycles have become irregular, at first she thought she was going through menopause, but then thought she's too young for that. And, she was embarrassed to mention this to her doctor, but she's noticed increased facial hair growth that she's been dealing with via waxing. Mary saw her primary care physician, and after running some tests, she sent Mary to Dr. Gupta for follow-up. Some blood work and patient info is in her chart and details are listed below. Result 33.7 165 41 82 135/97 Test BMI (weight: 215 lbs; Height: 5'7") Triglycerides (mg/dl) High-density Lipoprotein (mg/dl) Low-density Lipoprotein (mg/dl) Blood Pressure (mm Hg) Pulse Hematocrit (%) Hemoglobin (g/100 ml blood) Glucose (mg/dl) Sodium (mmol/L) Potassium (mmol/L) Normal Range 18.5-24.9 < 150 2 40 < 100 90-120/60-80 60-100 36-50 11-14 75-105 135-145 3.5-5.0 88 42 13.6 115 147 Questions

Part I-- Mary questions

1. What additional information about Mary's history would be useful in understanding her situation ? Explain your answer

2. What additional test might assist in your understanding of your patient situation ? Explain your rationale for your choice(s).

Part II- Jorge Alvarez

questions 5-6 (on picture)

Answer 1

Part-1

Ans-1- Ask merry about the daily diet she take

Ask her for any chronic diease like diabetes ,any kind of peptic ulcer ,

Ask her for using any kind of contraception like oral contraceptives method and pills

Ans-2

1- gastric esophagoscopy for peptic ulcer and test for H.pylori infection also for peptic ulce

2- progesterone and estrogens level in blood for in case of checking use of oral contraceptives

3- Blood glucose level random amd fasting for checking hyperglycemia nd Diabetes

4- complete bloood count

5- complete history of as in case of sadentary life style

6- psychiatrisy councelling for the case of depression and depression can also lead to the gain in wait

Part-2

Ans-6- Investigation for type 2 diabetes is done like HbA1c is done for checking average of last 3 month suger level

And as given random blood sugar is 200 and fasting is 155 then it is case of type-2 Diabetes and in that case insulin production is normal

Ans-7

Dignosis should be Type-2diabetes

Data support- random blood sugar-200

Fasting-155HbA1c is 8

Hyperglycemia as sugar(glucose) goes in urine

GTT is 225

These data support

Ans-8

1 - regular exercise

2- wait reduction

3- oral anti diabetes drug like

Metformin

Begutinide

Gipizide

DPP-4 inhibitors

Incritine