A 50-year-old woman presents to your clinic for routine
follow-up. She has a history of diabetes mellitus and hypertension for ~ 20
years. She mentions that she has noted fatigue and increased swelling in her
lower extremities during the past several weeks.
On exam she appears to be in no apparent distress. Height 5’3”
tall and 240 pounds. Blood pressure 190/125 mmHg, pulse 85/minute and
respirations 20/minute. Funduscopic exam reveals diabetic retinopathy. There
were no visible hemorrhages or papilledema. Cardiac exam was remarkable for an
S1, S2 and S4. Lungs were clear to auscultation and percussion. Abdomen was
obese, nontender and without masses or bruits. Lower extremities had good pulses
with 3+ pitting edema. Neurological exam is remarkable for decreased sensation
in a stocking-glove distribution, otherwise intact.