Part I - Mary Smith
Mary is a 40-year-old female. Mary works for a pharmaceutical sales company and sits behind a desk for the majority of her day. Mary has not been feeling like herself lately and she's concerned. Mary has noticed a handful of symptoms: she has been tired and a little depressed, she's gained weight – especially around her belly, and she's noticed that her face feels fuller than usual. Additionally, her menstrual cycles have become irregular, at first she thought she was going through menopause, but then thought she's too young for that. And, she was embarrassed to mention this to her doctor, but she's noticed increased facial hair growth that she's been dealing with via waxing. Mary saw her primary care physician, and after running some tests, she sent Mary to Dr. Gupta for follow-up. Some blood work and patient info is in her chart and details are listed below.
Test | Result | Normal Range
BMI (weight: 215 lbs; Height: 5'7") | 33.7 | 18.5–24.9
Triglycerides (mg/dl) | 165 | < 150
High-density Lipoprotein (mg/dl) | 41 | ≥ 40
Low-density Lipoprotein (mg/dl) | 82 | < 100
Blood Pressure (mm Hg) | 135/97 | 90–120/60–80
Pulse | 88 | 60–100
Hematocrit (%) | 42 | 36–50
Hemoglobin (g/100 ml blood) | 13.6 | 11–14
Glucose (mg/dl) | 115 | 75–105
Sodium (mmol/L) | 147 | 135–145
Potassium (mmol/L) | 3.3 | 3.5–5.0
Questions
1. What symptoms is Mary experiencing?
2. Are any of her values on her chart outside normal ranges? If yes, which ones?
3. What additional information about Mary's history would be useful in understanding her situation? Explain your answer.
4. What additional tests might assist in your understanding of your patient's situation? Explain your rationale for your choice(s).