Given these changes from the original case, what is your diagnosis?
What is your diagnostic explanation?
As compared to the long case, this patient is a 35 year old G2P1 female at 30 weeks gestation who presents to the clinic with the chief complaint: “My feet are swelling and I have felt horrible the past few weeks with headaches and fatigue.”
HPI: The patient reports the fatigue and edema started when she was around 22 weeks gestation and have since worsened. She reports she sleeps 7 – 8 hours per night and takes one nap in the afternoon. She reports edema in her legs bilaterally that is worse at the end of the day. She denies leg warmth or redness or recent immobilization. She also reports headaches that occur daily. She reports the headaches feel as if a tight band is placed around her head. She denies any changes in vision, flashes of light, or loss of vision. She denies any changes in hearing. She has received limited pre-natal care. She gave birth to her first child 3 years prior; there were no complications during this pregnancy or birth. She has a 10 pack year history of tobacco use but no longer smokes.
Vital signs: BP 150/95, P 62, RR 18, BMI 30, T 99F.
2+ edema present bilaterally in the lower extremities. Fundus present 32 cm from pubic symphysis. Fetal heart tones heard at 145 bpm.
Repeat BP: 150/100
UA(dipstick): 2+ proteinuria
24 hour urine: >300 mg / 24 hours
CMP: Protein: 4 gm/dL (low); Creatinine: 2.5 (elevated)