A 44-year-oraHispanicwomancomes10meomceoecause01a , -week n,stol)Iorurinary lfequencyana01urreov,s,on. ::me sayssnell8Snot llaa pa,naunngunnat,on ana ,epons
no fever, chills, or shortnessof breath Medicalhistoryis remarl<ab le for hypothyroidismdiagnosed2 years agoandheronly medicationis levothyroxine. She is gravida5, para5,
andher lastmenstrualperiod 12 daysagowasnormal.Shedoesnotsmokecigarettes, drink alcoholic beverages, or useillicit drugs. Family history is significantfor diabetes
mellitusinherolderbrother; sheis estranged fromher parentsbu! reportsthat her mother hada below-the-kneeamputation111 her60s. She is marriedandworks as a housekeeper
in a hotel.She1s158cm(5 ft 2 in) tall andweighs86 kg (190 lb); BMIis35 kglm’. Vitalsigns aretemperature37 1•c (98.8.F) , pulse88/min, respirations 14/min, andblood
pressure 134178mmHg. Sheappears anxiousbutis in noacutedistress. Pupilsareequal, round, andreactiveto direct andconsensual light. Funduscopic examinationshowsno
abnormalities. Abdomenis obesewith awell-healed right uppe, quadrant scar. Theremainde<ot thephysicalexaminationshOIVSnoabnormalities. Resultsof laboratorystudiesare
shown:
Serum
Urea nilrogen
Creatinine
Na•
K•
Cl·
HCO,
Glucose
TSH
22 mgldL
1.5 mg/dL
137mEQIL
3.7mEq/L
103mE(IIL
24mEq/L
240mg/dL
4.9 µU/mL
Urinalysis
Glucose
Microalbumin
In addition to treatingherglucose, whichof the followingis the mostappropriate step in pharmacot herapy?
- , A) Beginaspirin therapy
- -. B) Beginbenazepriltherapy
- ., C) Beginmetoprolol therapy
- e D) Increasethe doseof levothyroxine
- O E) Nochange in pharmacotherapyis indicated at this time
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