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 65 year old female presenting to the clinic with bilateral swelling of the legs and hands. She reports the swelling has been gradual and progressive over the past few weeks. She has not had any recent periods of immobilization and she has kept her usual level of physical activity. She denies any erythema or pain associated with the swelling. She does not report increased vascularity of her legs or hands. She does not report a difference in the swelling at night as compared to the mornings. She follows a low-salt diet since being diagnosed with HTN 5 years prior. She has reports leg swelling in the past, but she has noticed the swelling has been worse since her last visit with her primary care physician 1 month ago. She reports her blood pressure was slightly elevated during the visit and she was started on a new medication, amlodipine. She denies any allergies. She denies any recent illness, fever, or chills.
Past Medical History –
Illnesses: HTN, HLD, Hypothyroidism
Medications: Amlodipine 10mg qd, Simvastatin 40mg qd, Levothyroxine 0.125mg qd
Surgeries: Hysterectomy at age 50, Cholecystectomy at age 45
Family Medical History: Mother, died at age 82 of breast cancer; Father, died at age 75 of lung cancer; Son, age 45, diagnosed with HTN and HLD; Daughter, age 42, diagnosed with HTN
Social History: Noncontributory
Review of Systems: Noncontributory
Physical Exam –
General: Female patient with appearance consistent with stated age. Patient is in no distress.
Vital Signs: BP:130/85, P:75, RR:18, BMI:34, T:99
HEENT: Normocephalic, atrumatic, PEERLA bilaterally.
Neck: Non-tender to palpation. No thyromegaly or lymphadenopathy present. No JVD.
Respiratory: Normal respirations, no accessory muscle use. Vesicular breath sounds present bilaterally. No wheezes, rales, or rhonchi present.
Cardiovascular: Regular rate and rhythm. S1 and S2 of normal intensity. No murmurs, rubs, or gallops.
Abdominal: Soft, non-distended. Non-tender to palpation in any quadrant. Bowel sounds present in all quadrants. No hepatosplenomegaly.
Skin: Warm, dry, pink. No lesions or scars present.
Musculoskeletal/Extremities: Visible swelling present in hands and legs bilaterally. 2+ pitting edema present bilaterally in the lower extremities extending to the knees. 1+ pitting edema present bilaterally in the hands and arms, extending to the distal forearm. No increased vascularity noted in the extremities. Full ROM of extremities. No weakness noted in upper or lower extremities.
LFT: normal AST and ALT