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• Corazon Padua-Uy is a 54/F, married, unemployed, from Tondo Manila • Hypertensive since 1989 • Diagnosed with diabetes mellitus in 2008 History of Present Illness • 2 yrs prior to visit – Non-healing wound of 2 months duration on her right ankle prompted consult at a private doctor in Cavite – Capillary blood glucose taken, diagnosed with diabetes – No medications given, lost to follow-up – Several non-healing wounds, no consult done – No other symptoms History of Present Illness • 1 year prior to visit – nocturia • 10 months prior to visit – Woke up with heaviness of left leg – Rushed to Ospital ng Maynila where she was diagnosed with mild stroke – Sent home with medications and lab orders but she was non-compliant – Had 3 sessions of physical therapy, which she claimed helped her to walk with less difficulty History of Present Illness • 7 months prior to visit – Four episodes of chills precipitated by hunger – Polyphagia – Consulted at Canossa Health Center where capillary blood glucose was measured – Diagnosed with DM – Given meds: • • • • Metformin 500mg BID Glicazide 80mg BID Enalapril 10mg OD Amlodipine – Joined DM club • Regular checkups at the Canossa Health center • Helped the patient become more compliant with her medications • Financial constraints prevent her from being compliant History of Present Illness • 3 months prior to visit – Frothy urine – Polydypsia • 2 months prior to visit – Chest pain described as “kirot”, usually felt in the afternoon, no known aggravating or relieving factors, duration of 5-10 minutes – Episodes of feeling of pins and needles on the left hand History of Present Illness • 1 month prior to visit – Episodes of dyspnea at rest – 2-pillow orthopnea – Edema of left leg which resolved after 2 wks Review of Systems • • • • • • • • • • • (-) weight loss, fever (+) BOV since 2002 (+) hearing loss (-) cough, colds (+) Left abdominal pain Bowel movement of once/week since 2000 (-) melena/hematochezia (-) frothy urine (-) gross hematuria (-) loss of sensation (+) weakness of left leg Past Medical History • Hypertension: 1989, currently taking aspirin 80mg OD and enalapril 10mg OD • (-) thyroid disease, TB, asthma, drug and food allergies Family Medical History • • • • • Hypertension: mother and siblings Cardiovascular disease: father and siblings Asthma: sibling Stroke: sibling Leukemia: child Menstrual and Gynecologic History • • • • Menarche: 17 yrs old, RMI Menopause: 48 yrs old, (-) HRT Coitarche: 18 yrs old w/ 1 NPSP (+) OCP use for 3 years (1981-1984) OB History • G8P6(6024) Year Outcome 1976 M, FT, SVD at local hospital, currently alive 1977 F, FT, SVD at local hospital, died at 11 mos due to leukemia 1979 M, FT, SVD at local hospital, currently alive 1980 Abortion at 4mos 1981 M, FT, SVD at local hospital, currently alive 1984 F, FT, SVD at home assisted by midwife, currently alive 1985 abortion 1988 F, FT, SVD at local hospital, died at 11 mos due to measles Personal and Social • Elementary school graduate • Previously worked as a vendor in a canteen until 1989 when the canteen closed • Husband is a carpenter, and still does minimal contractual work • Smoker for 27 years (13.5 pack/yr), stopped when diagnosed with diabetes • Occasional alcohol drinker, stopped in 2009 due to diabetes Timeline Diagnosed with hypertension 1973 Got married, moved from Paho to Tondo, worked in a canteen 1987 Moved to Block 2 1989 Lost employment due to closure of canteen 2000 Moved from block 2 to current home Timeline Non-healing wound 2008 Diagnosed w/DM in Cavite nocturia Stroke Polyphagia, chills diagnosed w/ DM 2009 Frothy urine,polydypsia, edema, chest pain present Physical Exam • General: conscious, coherent, NICRD • Ht:150cm, wt: 94kg, waist-hip ratio: 0.86 • Vital signs: BP:180/100 HR: 70 RR: 24 Physical Exam • HEENT: pupils 2-3mm EBRTL, anicteric sclerae, pink conjunctivae, (-)nasal/ear disharge, (-) CLAD, normal JVP • Chest: distinct heart sounds, (-) murmurs, PMI at L 5th ICS • Lungs: equal chest expansion, clear breath sounds, normal tactile fremiti, resonant on percussion • Abdomen: (-) lesions, normoactive bowel sounds (+) tenderness on LUQ, tympanitic on percussion, normal liver span, intact Traube’s space • Extremties: (-) cyanosis, (-) clubbing, (+) pitting edema on L leg, good capillary refill Physical Exam • Neurologic exam CN: intact (CN I not tested) Sensory: intact Motor: weakness of left leg