Reference no: EM133635329
Question: ID: Ms. T.J 28 Y.O African American female who presents for a pre-employment physical prior to initiating employment.
Type 2 diabetes, diagnosed at age 24. She began metformin 5 months ago. She monitors her blood sugar once daily in the morning with average readings being around 90. She has a history of hypertension which normalized when she initiated diet and exercise. No surgeries. OB/GYN: Menarche, age 11. Never pregnant. Last menstrual period 2 weeks ago. Diagnosed with PCOS four months ago. For the past four months (after initiating Yaz) cycles regular (every 4 weeks) with moderate bleeding lasting 5 days.
Past Medical History: Type II diabetes, asthma, HTN, PCOS
Medications: Flovent 110 mcg 2 puffs BID, albuterol 90 mcg/spray MDI 2 puffs q4h PRN, metformin 850 mg PO BID, drospirenone/ ethinyl estradiol PO QD, acetaminophen 500 -1000mg PO PRN.
HT- 170cm WT- 84kg BMI- 29.0 Blood glucose- 100 T- 99.0 BP-128/82 HR- 78 RR- 15 O2- 99%
Head is normocephalic, atraumatic. Bilateral eyes with equal hair distribution on lashes and eyebrows, lids without lesions, no ptosis or edema. Conjunctiva pink, no lesions, white sclera. PERRLA bilaterally. Mild retinopathic changes on right. no hemorrhages. Snellen: 20/20 right eye, 20/20 left eye with corrective lenses. TMs intact and pearly gray bilaterally, positive light reflex. Nasal mucosa moist and pink, septum midline. Oral mucosa moist and pink. Gag reflex intact. Respirations CTA without cough or wheeze. Resonant to percussion throughout. In office spirometry: FVC 3.91 L, FEV1/FVC ratio 80.56%. Heart rate is regular, S1, S2, without murmurs, gallops, or rubs. Bilateral peripheral pulses equal bilaterally. capillary refill less than 3 seconds. No peripheral edema. Abdomen symmetric, no visible masses, scars, or lesions, coarse hair from pubis to umbilicus. Bowel sounds are normoactive in all four quadrants. Tympanic throughout to percussion. No tenderness or guarding to palpation. No CVA tenderness. Strength 5/5 bilateral upper and lower extremities with full range of motion. No pain with movement. Normal graphesthesia, stereognosis, and rapid alternating movements bilaterally. Decreased sensation to monofilament in bilateral plantar surfaces. Scattered pustules on face and facial hair on upper lip, acanthosis nigricans on posterior neck.
Based on these findings, what diagnosis and differential diagnosis would you give this patient?