Please help. Thank you. While seeing patients in your preceptor\'s clinic, you h
ID: 242631 • Letter: P
Question
Please help. Thank you.
While seeing patients in your preceptor's clinic, you have the opportu nity to meet and examine one of her long-time patients, a 46-year-old woman who presents for her yearly physical examination. She has been fine and has no complaints today. Her medical history is notable only for borderline hypertension and moderate obesity. Last year her fasting lipid profile was acceptable for someone without known risk factors for coro- nary artery disease. Her mother and older brother have diabetes and hypertension. At prior visits, you see that your preceptor has counseled her on a low-calorie, low-fat diet and recommended that she start an exercise program. However, the patient says she has not made any of these recommended changes. With her full-time job and three children, she finds it difficult to exercise, and she admits that her family eats out frequently. Today her blood pressure is 140/92 mm Hg. Her body mass index (BMI) is 27 kg/m2. Her examination is notable for acanthosis nigricans at the neck but otherwise is normal. A Papanicolaou (Pap) smear is performed, and a mammogram is offered. The patient has not eaten yet today, so on your preceptor's recommendation, a fasting plasma glucose test is performed, and the result is 140 mg/dl. > What is your diagnosis?
Explanation / Answer
Diabetes. As she has the plasma glucose level at fasting is of 140mg/dl and also has the family history of diabetes and moreover she is hypertensive. Acanthosis nigricans present in neck also insists the same as it is more common in diabetic overweight patients. Acanthosis nigricans usually occur due to the higher levels of insulin in the blood.