University  |   Hospital  |   Pulse  |   JeffNet   |   RAP

Find People  |   JeffMail  |   JeffCal  |   JeffShare

VOLUME 1 ISSUE 1 CASE KM	KM is a 43-year-old woman, who was originally born in India but has lived in the US since she was 19 years old.
CHIEF COMPLAINT KM complains of heel pain, especially bad with first step in morning and gradually improving throughout the day. MEDICAL HISTORY Patient states she last saw a physician 3 years ago. You have no records of past visits at your practice. PHYSICAL EXAMINATION »  Height: 5 ft. 1 in. »  Weight: 185 lbs. »  Slight heel tenderness and discomfort stretching the foot. »  Blood pressure: 135/88 mm Hg (average of two measurements). »  Waist circumference: 39 in. FAMILY HISTORY »  Both parents living. »  Grandparents deceased from heart disease and cancer. »  Mother has type 2 diabetes. SOCIAL HISTORY »  KM does not exercise. »  Rare alcohol use. »  Never smoked. PROBLEMS »  Plantar fasciitis »  Obesity »  Other? TREATMENT »  Heel cushion »  Arch support »  Stretches NAVIGATION »  Q1: What else would you do at this visit? »  Q2: What is KM’s body mass index (BMI) and weight classification? »  Q3: Is KM a candidate for diabetes screening? »  Q4: What blood tests would you order? »  Q5: What do you do now? »  Q6: How would you confirm or rule out a diagnosis of diabetes? »  Q7: What is your diagnosis now? »  Q8: What is your initial treatment plan? »  Q9: What are your initial treatment goals for KM? »  Q10: What other interventions should you suggest at your next visit(s)? When should you see this patient again?	Q: What do you do now? A: KM certainly has an abnormally elevated glucose, but she may in fact have type 2 diabetes. Population studies have shown that some patients with type 2 diabetes by glucose tolerance test criteria have a FBS <126 mg/dL, but sufficiently abnormal glucose tolerance to demonstrate high glucose excursions after a glucose load. While relatively inconvenient, the oral glucose tolerance test remains as the gold standard for making the diagnosis of diabetes mellitus. You should have a high degree of suspicion and either confirm or rule out diabetes.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.tju.edu/jeffcme
The Thomas Jefferson University web site, its contents and programs, is provided for informational and educational purposes only and is not intended as medical advice nor is it intended to create any physician-patient relationship. Please remember that this information should not substitute for a visit or a consultation with a health care provider. The views or opinions expressed in the resources provided do not necessarily reflect those of Thomas Jefferson University, Thomas Jefferson University Hospital, or the Jefferson Health System or staff. Return to Thomas Jefferson University Home Page