82-year-old Korean patient presents to the office for annual-check up with her daughter. Her last check-up was two years ago.

Vitals: 186/77
HR: 61.
O2 sat 97%
Wt: 47.0kg

PMHx: hypertension (6 years), osteoporosis (10 years), CKD3 (3 years), and hypothyroidism (2 years).

She brought her medication for review.

  • Losartan 100 mg Q day
  • Carvedilol 25 mg PO BID

White coat syndrome has been ruled out. Based on patient home blood pressure records.

Office records indicate:

  1. Amlodipine 10 mg Qday
  2. Carvedilol 25 mg BID
  3. Clonidine 0.1 mg TID
  4. Hydralazine 100 mg TID
  5. Leverthyroxin 125 mcg Qday
  6. Pantoprazole 40 mg Q day
  7. Cholecalciferol 800u Qday

All other medication was last taken five months ago (unconfirmed).

1. What is your potential diagnosis?

2. What initial labs or procedures are you running to confirm your diagnosis?

3. What are your recommendations for the patient?

4. If there is a language or age-related cognitive barrier what is the best way to ensure your instructions are understood?

 
 
 
 

5. If labs revealed a TSH of 10.0. What dose of Levothyroxine is appropriate?

 
 
 
 

6. Which other blood pressure medication should be added to the patient’s treatment?

 
 
 
 

7. Her Vitamin D level is 19.0. What is your best course of action?

 
 
 
 

8. When should the patient return for a check-up?

 
 
 
 

9. When should you re-draw labs?

 
 
 
 

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