Case #3:

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 53 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.