Question

E.W. is a 40-year-old African American male, who is is visiting his primary care provider for a thorough physical examination. He has a history of Chronic sinus infections, Pneumonia 6 years ago that resolved with antibiotic therapy, One major episode of major depressive illness caused by the suicide of his wife of 15 years, 5 years ago

Family History: Father died at age 49 from AMI; had HTN;Mother has DM and HTN,Brother died at age 20 from complications of CF;Two younger sisters are A&W

The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal aunt. He has not spoken with his son for four years. The patient is an air traffic controller at the local airport. He smoked cigarettes for approximately 10 years but stopped smoking recently. He drinks "several beers every evening to relax" and does not pay particular attention to the sodium, fat, or carbohydrate content of the foods that he eats. He admits to "salting almost everything he eats, sometimes even before tasting it." He denies ever having dieted. He takes an occasional walk but has no regular daily exercise program.

Physical Exam: Vital signs are as follows:  B/P 155/96, RR 22,HR 73 and afebrile. Weight: 235.  States that he gained ten pounds since he stopped smoking. The physical exam was normal except for rales at the base of the lungs.  He also complained of SOB when 2 flights climbing stairs but not when walking his dog.

Based on the above symptoms what other assessments, tests or procedures would the MD order or perform to help diagnosis the problem?

What results would you expect to find and why?

Based on your results what is the cause and pathology?

What are the patient’s risk factors?

Answer 1

1. Tests for cardiac function: ECG, x ray chest, cardiac stress analysis, echo cardiogram, lipid profile (Total cholesterol, LDL, HDL, triglycerides and their ratio), serum urea and serum creatine, liver function tests.

Test for diabetes: Fasting/postprandial blood sugar and HbA1c.

2. Hypertension based on physical examination (SoB, BP and febrile), Hypercholesterolemia, Hypertriglyceridemia and Hyperglycemia due to other risk factors such as families history and unhealthy lifestyle.

3. Depression, unhealthy diet (high salt intake, fat and carbohydrates), alcohol use, past smoking and lack of physical activity are the causes that lead to obesity, high VDL and HLDL, impaired live function); further weakens arteries and increased blood pressure. Also, the causes lead to impaired insulin secretion that lead to hyperglycemia.

4. Risk factors

Family history of hypertension, AMI and diabetes mellitus,

Depression

Poor diet

Lack of physical activity

Overweight

Alcohol use

Lifestyle (staying alone)