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Case HPI: VP is a 53 y/o Asian woman presenting to the clinic today to establish primary care. She recently moved to Philadelphia from Dallas, Texas. She tells you her medical conditions are hypertension, dyslipidemia, and type 2 diabetes mellitus and is able to list her medications for these conditions. She has no complaints today, PMH: Hypertension (diagnosed 10 years ago), dyslipidemia (diagnosed 2 years ago), and T2DM (diagnosed 3 years ago) Medications: Metformin 1000 mg PO BID Liraglutide 1.2 mg sucbut daily Insulin glargine 40 units daily Rosuvastatin 20 mg PO daily Chlorthalidone 100 mg PO daily Allergies: NKDA SH: – tobacco, ) EtOH – 3-4 drinks of liquor/week: (-) illicit drug use FH: Mother alive with T2DM; father passed away at age 65 from MI PE: VS: BP 120/80 mmHg, HR 88 bpm, RR 14 breaths per min, T 38,2 C, Wt 104 kg. Ht 160 in Gen: No acute distress; A&Ox3 HEENT: EOMI, PERRLA, LI TM intact & reactive to light Neck: supple.() JVD. (-) LAD.) carotid bruit CV: RRR, S1/S2, no m/r/g Pulm: CTAB: (-) // Abd: soft, NTND, normal BS Ext: c/cle Lipid Panel (obtained today): TC 210 mg/dL, LDL 122 mg/dL, HDL, 50 mg/dl., TG 190 mg/dl. Lipid Panel (obtained today): TC 210 mg/dL, LDL 122 mg/dL, HDL 50 mg/dL, TG 190 mg/dL. Alc (obtained today): 7.5% CMP (obtained today): Albumin 3.2 g/dL, alkaline phosphatase 70 IU/L, ALT 16 IU/L, AST 16 IU/L, BUN 18 mg/dL, Ca 9.8 mg/dL, CI 102 mmol/L, CO2 18 mmol/L, SCr 1.1 mg/dL, Gluc 140 mg/dL, K 4.2 mEq/L, Na 142 mEq/L A/P: pending 1. Is this patient’s lipid lowering therapy appropriate? Why or why not? 2. What changes would you make, if any, to his lipid lowering therapy? What monitoring parameters you will monitor for this patient?
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