Mrs. Cаrlisle is а 62-yeаr-оld white female whо presents tо your office as a follow up to review labs and diagnostics. She was a new patient at the previous visit. She had not had a primary care provider for 5 years but decided to make it her New Year’s resolution to take care of herself. At her initial office visit she stated that she was having some chronic tiredness and muscle aches. She also had complaints related to “upset stomach” at times. She knows she is overweight but can’t seem to lose the weight since she went through menopause 10 years ago. Medications: OTC Nexium PRN, OTC Motrin for muscle and joint achesAllergies: NKDA, no food, environmental or latex allergies PMH: GERDPSH: Negative Social History: Mrs. Carlisle is an accountant. She has been married for 30 years to the same man. She drinks 2 to 3 glasses of wine with dinner each week night. Some times more on the weekends. She has never smoked and denies use of illegal substances. She has not traveled outside the state of Florida in over 2 years. She walks with a neighbor on Monday and Wednesday mornings for 30 minutes. Her diet is “average” including all food groups. She and her husband order out for food 3 to 4 times per week for convenience. She tries to eat a salad for lunch most days to get vegetables into her diet. Family History: Father died in car accident at 46, mothers is 84 with diabetes type 2 for 20 years. No siblings. Vital Signs: Weight 220, Height 5’4”, B/P 152/92, Pulse 74, Resp. 20, BMI 37.8 The physical exam on her initial visit was unremarkable. You sent her for labs and diagnostics and instructed her to get daily B/P readings to bring in for today’s follow up appointment. Vital signs for today’s visit: Weight 221, Height 5’4”, B/P 158/92, Pulse 74, Resp. 20, BMI 37.8Patients B/P Log: 152/90, 170/89, 160/92Lab results for today’s office visit: CBC Ref. Range CMP Reference RBC 3.9 3.8-5.10M/ul Glucose 106 65-99mg/dL MCV 108 80-100 fL A1C 7.0 % < 5.7% MCH 35.4 27-33 pg Sodium 137 135-146mmol/L Hgb 10.3 12-17 g/dL Potassium 3.8 3.5-5.2mmol/L HCT 30.6 36-48% Creatinine 1.0 0.50-1.20mg/dL RDW 15.9 11-15% ALT 88 6-40 U/L AST 52 10-35 U/L Thyroid Reference Range Lipids Reference Range TSH 2.46 (0.4- 4.5mIU/L) Total Cholesterol 268 (125-200 mg/dL) Free T4 1.4 (0.8-1.8 ng.dL) LDL (Direct) 172 (< 130 mg/dL) Vitamin D 20 (30-100 ng/mL) Triglycerides 142 (< 150 mg/dL) HDL 36 (> 40 mg/dL) RF and ANA – Negative (Negative) Uric Acid 5.8 mg/d (3.4-7.0 mg/dL) Urine microalbumin 35mg/L (
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