PCC Biochemistry Case #2
Dr. Blazyk
March 9, 2004
Presenting Complaint
Mazie visits her family practitioner complaining of another yeast infection.
History of Chief Complaint
Over the years, Mazie, a 58-year-old female, has experienced recurring yeast infections. This
is her fourth this year. She states she has been thirsty lately and urinates frequently. She says
that she is hungry all the time. Recently, she has noticed that she gets dizzy when she stands
up quickly.
Medication
Mazie takes no prescription or over-the-counter medication on a regular basis.
Habits
Mazie has smoked two packs of cigarettes a day for over 30 years. She admits to an
occasional beer. Her lifestyle is totally sedentary.
Social History
Mazie is a housewife with six children, ages 28 to 42. She lives in Nelsonville with her
husband, who is unemployed. She has never been outside of Athens County in her life, and
has only been to Athens twice. She worries whether Medicaid will cover her doctor bills.
Past Medical History
Mazie had gall bladder problems 23 years ago.
Past Surgical History
Mazie had her gall bladder removed at age 35.
PCC Biochemistry Case #2
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Family Medical History
Mazie's maternal grandmother had “sugar” and died at age 64. Her mother, age 73, also has
“sugar” and has had two heart attacks, the most recent last year. Her father died in an
accident at the coal mine when she was 2. Her only sibling, a 57-year-old sister, has sugar
and kidney problems.
Systems review
•
Cardiovascular
Mazie admits dyspnea on exertion, but denies any recurrent chest discomfort,
palpitations, orthopnea, paroxysmal nocturnal dyspnea, hypertension, edema, cyanosis,
cardiac murmurs, phlebitis, varicosities or claudication.
•
Respiratory
Mazie often has "coughing spells" upon waking in the morning, but denies any history of
pain in or unusual drainage from the ears, nose or throat. She does not suffer frequent
nosebleeds. She denies recurrent chest pain, wheezing, hemoptysis, pneumonia,
tuberculosis, fever or night sweats.
•
Gastrointestinal
Mazie admits to increased appetite recently. She denies any history of recurrent
abdominal pain, chronic indigestion, pyrosis, food dyscrasias, anorexia, recurrent nausea,
vomiting, diarrhea, constipation, hematemesis, abnormal stools, jaundice, hemorrhoids or
recent change in bowel habits.
•
Genital/Reproductive
Mazie has experienced repeated yeast infections accompanied by cheesy white discharge.
•
Urinary
Mazie admits to a burning sensation on the "outside" while urinating. She admits to
polyuria, and has to get up three or four times at night to urinate. She denies any
problems with urinary urgency, dysuria, hematuria, facial edema, oliguria, recurrent
kidney or bladder infections, difficulty starting urinary stream, change in size or force of
urinary stream, kidney stones, incontinence or urinary retention.
PCC Biochemistry Case #2
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Endocrine
Mazie admits to dry skin and increased thirst and urination recently. Over the past two
years, she has gained about 20 pounds.
Physical Examination
General Appearance
Height: 64 inches
Weight: 180 pounds
Alert
Oriented to time, person and place
Vital Signs
Temperature: 98.6°F
Pulse: 80/min supine, 95/min upright
Respirations: 15/min
Blood Pressure: 120/80 supine, 100/60 upright
Head/Neck
Mucous membranes dry and pink.
Dentition is poor, with numerous caries noted.
Gingiva are inflamed.
Genitals
White cheesy discharge (KOH positive) is noted.
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Diagnostic Studies
Normals
Acetone
Moderate
Negative
Alcohol
< 10 mg/dL
< 10 mg/dL
Arterial Blood Gases
Cardiac Monitor
P O2
PCO2
100 torr (mm Hg)
32 torr (mm Hg)
pH
7.34
HCO3-
17 meq/L
80 - 100
35 - 45
7.35 - 7.45
21 - 28
Sinus tachycardia
Electrolytes
Glucose
Na+
K+
Cl-
140 meq/L
4.2 meq/L
136 - 145
3.5 - 5.0
100 meq/L
90 - 110
HCO3-
14 meq/L
23 - 30
Anion gap
30 meq/L
10 - 25
Random:
325 mg/dL
70 - 120
2-hour Postprandial:
560 mg/dL
HbA1c (Glycosylated Hb)
13%
2-5
250 mg/dL
38 mg/dL
205 mg/dL
160 mg/dL
<200
>40
<130
<250
Lipid Profile
Total Cholesterol
HDL Cholesterol
LDL Cholesterol
Triglycerides
Liver Profile
SGOT (AST)
SGPT (ALT)
Bilirubin
12 U/L
15 U/L
0.4 mg/dL
8 - 20
5 - 35
0.1 - 1
Urinalysis
Glucose
Positive
Negative