Reference no: EM134012442

Mrs. G, a 58 year old administrative assistant, presents for an annual exam.

CC: Urinary frequency.

Gets up at least 3x per night for past year. During day sometimes can't get to bathroom on time and has some incontinence.

PMHx: Cholecystectomy 1995; pneumonia 1998, 2001; Osteoarthritis in hips and knees; Hx of sciatica which flares periodically; high cholesterol treated with diet - tried Niacin two years ago but dc'd due to flushing.

Meds: •Celebrex 200 mg daily •  Uses Vicodin when sciatica flares - about twice a month

Allergies: NKDA

Fam Hx: •Mother died age 74 of heart attack, was diabetic •Father living age 82, diabetic, stroke •Sister age 54 elevated cholesterol •Sister age 53 no health problems •2 sons 22, 24 alive and well.

Soc Hx: Married, works full time as admin. asst., sedentary lifestyle, very little exercise. Hobbies include crochet and picture albums. Smoked for 30 years, quit six years ago. Drinks 2- 3 glasses of wine per night. Has never felt alcohol was a problem for her.

OBJECTIVE: PE: VS: Ht. 63" Wt. 253lb BP 142/88 HR 92 reg T 98.4

General: obese, alert, oriented, no distress, appropriate in affect and well groomed

Skin: dry and intact, multiple nevi across back and chest, none > 6mm, all uniform in color

HEENT normocephalic; PERRLA, EOMs intact, fundoscopy reveals clear disc margins, no AV nicking. Snellen 20/20 right eye; 20/25 left eye corrected;

TMs clear, gross hearing intact; nose patent, sinuses non-tender, throat/mouth clear, no lesions, dentition good, uvula rises at midline

Neck: Supple, no palpable thyroid, no palpable lymph, trachea midline, no carotid bruits

Lungs: clear to A/P

Heart: rate reg, no murmurs or gallops, S3 or S4, PMI 5th ICS MCL

Abdomen: obese, bowel sounds present, no masses, tenderness, no HSM Extremities: knees with full ROM but tenderness medially, note some arthritic enlargement especially in left knee.

Back: No tenderness, full ROM, SLR negative. Hips with full ROM, no tenderness

Neuro: CN II-XII grossly intact, DTRs present in all extremities and equal at 1-2+. Rhomberg normal, RAM normal, Tandem gait good.

Labs: Fasting: Chem panel: Gluc: 453, BUN: 25, Creat: 1.2 otherwise Chem panel WNL; Lipids: TC 285 HDL: 45, LDL 190, TG: 330; Urine dip shows 3+ glucose, no ketones, negative for leukocytes or occult blood.

1. What did you calculate for her 10 year ASCVD risk? Lifetime Risk? Which one do you use to determine BP, Cholesterol, and DM management?

2. What meds would you prescribe for Mrs. G today? and what is the rationale for such? (Write rx as if she is 100% compliant)