Discussion Week 7

Carolyn Cross 41 years old female came to the clinic for a wellness visit, She also like to discuss a few concerns, especially her risk for breast cancer. She stated that recently both her mother who’s 63 and her first cousin on her mother’s side were diagnosed with breast cancer, then now she wants to know whether that increases her risk and if so how much.
Provide a reference for your treatment plan (in APA format). The reference may come from a journal, a book, etc.
Cite all sources using APA format.
Include three differential diagnoses and support your diagnoses with supporting literature.
diagnosis:
1- hyperlipidemia
2- type 2 diabetes mellitus
differential diagnosis:
1- breast cancer risk (based on first degree family member, early menses and late pregnancies)
1- diabetes (based on the patient is considered a prediabetic beased on labs results)
3- cardiovascular disease (based on lipid panel results)
The patient had an encounter a year before, this was the history:
Chief complaint:
Yearly physical
HPI:
Carolyn is an almost 40 y/o married female, G2P2 here for her yearly physical exam. She has no complaints.
PMH (previous medical history)
Other active problems:
None
Medical, surgical, obstetric, hospitalizations:
Medical: none
Surgical: G2P2; Bilateral tubal ligation following last delivery at age 35
OB/Gyn: NSVD x two; breast fed both for 3 months; premenopausal; menses regular since age 10.5
Allergies:
None
Medications:
None
Ibuprophen occasionally for headaches
Preventive Health:
Pap smears in the past are negative; last one 3-4 years ago
Diet: tries to eat a well-balanced diet
Exercise: Walks to and from the train 5 days a week; weekend gardening
Immunizations:
Up-to-date
FHx:
Father: hypertension, hyperlipidemia
Mother: Hx of type 2 diabetes
Sisters: no sisters
Brothers: healthy and very physically active
SHx:
Ethnicity: Hispanic-American
Occupation: Middle-school learning specialist
Marital status: married x ~13 years
Children: 2 sons (5ish and 7ish)
Tobacco: never
Recreational drugs: never
Alcohol: wine (one glass at dinner most days)
ROS (review of systems)
General/ Constitutional:
Normal energy level
No sleep concerns
Weight stable
Skin/Breast:
Negative except for lumpy breasts
HEENT & Neck:
Negative
Cardiovascular:
Negative
Respiratory:
Negative
Abdomen/ Gastrointestinal:
Negative
Genitourinary:
Negative
Musculoskeletal:
Negative
Allergic/Immunologic:
Negative
Lymphatic/Endocrine:
Negative
Hematologic:
Negative
Neurological:
Negative
Psychological:
Negative
Vitals
Temp: 98.6 F
Pulse: 72, rhythm: regular
BP: left: 130/72
Respiration: 14, effort: normal
Physical Exam
Weight:
148.0 pounds
Skin/Breast:
No pallor, jaundice, ecchymoses, or rash
Normal, symmetrical breast contour
No visible skin or nipple abnormalities
No spontaneous or expressed nipple discharge or blood
Irregular “lumpy bumpy” consistency through both breasts; no suspicious, discrete palpable lesions
Slight tenderness to exam reported
HEENT & Neck:
Good dentition
Thyroid within normal limits for size and consistency
No cervical lymphadenopathy or mass
Cardiovascular:
Regular rhythm and rate
No murmur or gallop
No peripheral edema
Respiratory:
Thorax normal to percussion
Breath sounds equal/clear bilaterally
Abdomen/ Gastrointestinal:
Abdomen mildly obese, nondistended
No hepatosplenomegaly, mass, or herniation
Soft, nontender throughout
Genitourinary:
Normal external genitalia
Parous introitus
Normal vaginal mucosa
Slight cervical eversion without friability; samples collected for Pap smear completed
No abnormal discharge
Musculoskeletal:
Normal muscle tone and bulk bilaterally
Allergic/Immunologic:
Normal
Lymphatic/Endocrine:
No adenopathy
Thyroid normal, no nodules
Hematologic:
No ecchymosis, no petechiae
Neurological:
Reflexes 2+ bilaterally throughout
CN II-XII intact
Management Plan
Ms. Cross is a healthy 40ish woman with no acute medical issues.
1) Preventative Health
Mammogram ordered
lipid panel ordered
Pap smear – pending results
Fasting blood sugar ordered
Then for this encounter this are the labs results, the ROS and PE are the same from the previous visit.
pap smear negative
mammogram pending
Name Value Units Reference Range
Hemoglobin A1c 6.4 % normal 4-5.6, elevated risk 5.7-6.4, diabetes >6.7
Name Value Units Reference Range
Glucose, 8 hour fasting 122 mg/dL <126 Name Value Units Reference Range Cholesterol 239 mg/dL low risk <200, moderate 200-239, high >239
High-density lipoprotein (HDL) 45 mg/dL maj risk <40, neg risk >59
Low-density lipoprotein (LDL) 159 units/L low risk <130, moderate 130-159, high >159
Triglycerides 40 mg/dL
(♀) 35-135, (♂) 40-160