Discussion Question – Heme or Endocrine
Discussion Prompt
Select one of the following discussion questions (Writers Choice):
55-year-old female presents to your office with fatigue. She states she has felt tired for many months and thinks “something is wrong” with her. She denies any rectal bleeding, nausea, vomiting, abdominal pain. What else do you need to ask her about?
PMH- HTN controlled on lisinopril 20mg PO QD
Family Hx- No family history known as she is adopted
VSS and Physical Exam is WNL
Hgb- 10.9g/dL (13-18)
RBC- 3.53 m/mm3 (4.3-6)
MCV- 76 fL (78-100)
MCH- 24 pg (27-34)
RDW 19% (12.1-18.2)
Serum ferritin- 16 ng/mL (18-370)
Serum iron- 23 ug/dL (40-190)
TIBC- 391ug/dL (250-400)
Vitamin B12- 450pg/mL (>200)
What is your Assessment and Plan? Please include specific instructions on any medication and education.
OR
A 42-year-old woman has noticed dry skin, fatigue, and weight gain over the past 3 months. Her blood pressure is 110/70 mm Hg, pulse 60/min, and heart and lungs are normal. Her skin feels rough and dry, but the rest of her examination is normal. Her biochemistry is normal, but the TSH is 39 mU/L. Provide at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.
Expectations
• Length: A minimum of 250 words, not including references
• Citations: At least 2 high-level scholarly reference in APA from within the last 5 years
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