VOLUME 1 ISSUE 3 CASE SW	SW is a 49-year-old man who presents for an employment physical. He has not seen a physician in the last 10 years, but considers himself healthy. He has had no hospitalizations as an adult.
PHYSICAL EXAM »  Height: 5 ft. 8 in. »  Weight: 200 lbs. »  Body mass index (BMI): 30 »  Waist circumference: 42 in. »  Pulse: 84 »  Blood pressure: 150/95 mm Hg »  Diminished pedal pulses »  Absent Achilles reflexes »  Remainder of examination is normal LABORATORY VALUES »  Fasting blood glucose: 118 mg/dL »  Uric acid: 9 mg/100 mL »  Remainder of chemistry panel is normal »  Lipid profile   --  Total cholesterol: 190 mg/dL   --  Triglycerides; 190 mg/dL   --  HDL: 19 mg/dL   --  Calculated LDL cholesterol: 133 mg/dL   --  hs CRP: 2.0 mg/dL (normal, <0.8)   --  Microalbumin/creatinine ratio: 40 µg/mg creatinine (normal, <30)	Please Note: This issue of The Bottom Line has expired and CE credit is no longer available. Q1: What findings are of concern to you at this visit? Q2: What other findings are suggestive of the Insulin Resistance Syndrome? Q3: How would you categorize SW’s blood pressure? Q4: What are the benefits of treating hypertension? Course of Treatment Q5: What is the recommended initial therapy for patients with hypertension? Q6: What other management strategies would you institute at this time? Follow-up Visit Q7: How do you explain SW’s worsening lipid profile and fasting glucose levels? 1 Year Later Q8: What is your diagnosis now? Q9: What are your treatment goals for SW? Q10: How should you modify SW’s antihypertensive regimen at this time?
	Issue Date: September 2003 Expiration Date: September 2004 Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.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