Mary T. is a 29 year old referred to you because of a routine screening test, which revealed markedly elevated cholesterol. ROS identified dry skin, 10 lb. Weight gain, regular but heavy menses, easy and frequent bruising, milky breast discharge and fatigue. Meds include multivitamin and oral contraceptives.
- What laboratory tests would you order for her?Mary further explains that she has had a stressful year. Her mother, whom she had cared for during the terminal phases of breast cancer died. She took several months off from work due to depression following her mother’s death. She now works full-time as a travel agent and discusses having difficulty concentrating. She works out of her home and cares for her 4-year-old daughter.
- Discuss the normal grieving process in view of her symptoms?PE: BP 120/72, Weight 145, pounds Height 61 inchesSkin: dry, scaly, slight loss of scalp hair, several bruises on arms and legs, diminished DTRs, thyroid slightly enlarged.Labs: glucose and electrolytes WNL, Total Cholesterol 267/LDL 178/HDL 40/Triglycerides 167, HGB 11, HCT 33.4, TSH 20.
- List 5 differential diagnoses based on the available data.
- How would you explain your findings to her? What will you tell her about her labs?
- What follow-up labs will you order and when?
- How do you plan to treat her cholesterol? Her fatigue?