Mrs. Williams is a 54-year-old African American female who presents

Mrs. Williams is a 54-year-old African American female who presents for an annual physical as required by her employer for her work as a school bus driver. She has no complaints other than occasional (1 or 2 times per month) heartburn, which she attributes to overeating, and which is usually relieved by overthe-counter antacids. Past medical/surgical history Her past medical history is positive for: • Laparoscopic cholecystectomy 7 years ago • Gravida 3, para 3; Menopause at age 49 • GERD Medications • Multivitamin one tablet po daily • Calcium citrate/vitamin D 500 mg/400 IU one tablet po bid • Famotidine 20 mg po at bedtime Allergies-NKDA Tobacco history-Negative Alcohol history-Maximum 3 alcoholic drinks per week Drug abuse history-Negative Family history • Brother, living, age 48, with hypertension and dyslipidemia • Sister, living, age 45, with obesity • Father died at age 60 following emergency coronary artery bypass graft surgery subsequent to a first myocardial infarction • Mother, living, age 73, breast cancer survivor Social history Lives in a rural area with her husband of 23 years, and three children, ages 21, 19, and 17. She recently returned to work driving a school bus after her husband became unemployed. Review of systems (pertinent positives) • General/systemic: does not exercise regularly • Gastrointestinal: Reports occasional (1 or 2 times per week) heartburn and constipation, denies nausea, vomiting, and recent change in bowel habits Physical exam (pertinent findings) • General: Overweight female (central obesity) in no acute distress • Blood pressure (BP): 118/78; Height: 63 inches; Weight: 165 lbs; BMI: 29.2 • Neck: Thyroid not palpable, no tenderness or masses Physical exam (pertinent findings) cont. • Chest: Breasts symmetric, nontender, no masses; lungs clear with no wheezes • Heart: Clear S1 and S2, no audible S3 or S4; no murmurs heard • Abdomen: Soft, obese, nontender, normal bowel sounds, no bruits • All else in PE is WNL Laboratory findings (pertinent positives) • Hemoglobin (A1c): 5.0% • Fasting lipids – Triglycerides (TG): 238 mg/dL; HDL-C: 34 mg/dL; LDL-C: 165 mg/dL; Total cholesterol (TC): 244 mg/dL; Non-HDL: 210 mg/dL • Fasting plasma glucose (FPG): 100 mg/dL • Serum creatinine: 0.9 mg/dL QUESTIONS 1. What new diagnosis would you assign to this patient? Justify your answer 2. What pharmacotherapy would you advise for this diagnosis? Support your decision 3. What non-pharmacologic measures would benefit this patient? 4. What are the goals of therapy for the diagnosis in #1? 5. How would you follow-up her progress/response to therapy recommended in #2 and #3

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