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 woman with the same patient characteristics. She reports that “I’ve noticed that I’m kind of swollen all over.”
HPI: The patient states that over the last 6 months she has noticed that she has become progressively swollen “all over her body.” She states that at first she thought she was just “getting fat,” but thinks this doesn’t make sense because since her husband died 1 year ago, she has been feeling “pretty down” and doesn’t eat much. When asked about her diet, she reports that she mainly eats toast with butter for breakfast, has some tea at lunch, and usually skips dinner unless her daughter comes over and cooks for her. She reports that she feels quite fatigued and weak as well, but she thought this was just “getting old.”
PMH: Same as in the long case, except she takes hydrochlorothiazide x 30 years.
FMH and SH: same as in the long case, except she lives at home alone since her husband died 1 year ago.
ROS: General: Fatigue, weight gain of 15 lbs over last 6 months. Skin: Has been really dry over the last few months. MSK: Feels weak all the time.
PE: Vitals: Same except heart rate 110. General: Appears thin and frail, but has noticeable generalized edema. Skin: Skin is dry to the touch, evident patches of dermatitis over the forearms and legs. CV: tachycardic with an S3. Extremities: 2+ pitting edema to bilateral lower extremities up to the thigh, 2+ edema also in bilateral arms. Rest of PE is the same as in the long case.
Labs: CBC shows microcytic anemia (low Hgb, low MCV). CMP shows an Albumin level of 1.2 (low).