Tutor profile: Christopher S.
Subject: Health and Medicine
A 29-year-old woman with hypothyroidism comes to her primary care physician for advice on choosing a new health insurance plan. She works as a baker and owns a small bakery. The patient explains that her priority is affording her monthly premiums. She would be willing to make additional payments to be able to see providers outside her network and to get specialist care if referred by her primary care physician. Which of the following health insurance plans would be most appropriate for her?
Point of Service. In a point of service (POS) health insurance plan, patients require a referral from their primary care physician (PCP) for specialist care (a feature of health maintenance organizations). However, they can also see providers outside of the network (a feature of preferred provider organizations). Usually, patients have to pay extra to see providers outside of the network, which is aimed at keeping fixed monthly premiums moderate. The primary care physician still acts as a gatekeeper for access to specialists. Because this patient is self-employed as a baker and has a chronic medical condition requiring attention, the point of service plan would best suit her needs at this time.
A 44-year-old woman comes to the physician for a follow-up exam. She had a blood pressure recording of 142/90 mm Hg on her previous visit 1 week ago. Her home blood pressure log shows readings of 151/97 and 146/90 mm Hg in the past week. She has no history of serious illness and currently takes no medications. She is 5 ft 3 in tall and weighs 120 lbs; BMI is 21 kg/m2. Her pulse is 88/min and blood pressure is 160/96 mm Hg. Cardiopulmonary examination is unremarkable. Abdominal examination shows no abnormalities. The extremities are well perfused with strong/bounding peripheral pulses. Serum concentrations of electrolytes, creatinine, lipids, TSH, and fasting glucose are within reference range. A urinalysis is within normal limits. What is the most appropriate next step in management?
An electrocardiogram. Since hypertension is both an asymptomatic and insidious disease with several complications, an evaluation is necessary to assess the extent of end-organ damage once the diagnosis is made. Electrocardiogram (ECG) should be done in all newly diagnosed hypertensive patients to look for early electrical changes associated with hypertensive heart disease, such as left ventricular hypertrophy (LVH), left atrial enlarment, or concomitant heart diseases like coronary artery disease (CAD) and arrhythmias.
A 67-year-old man with hypertension and Type II diabetes mellitus is brought to the emergency department because of a 3-day history of shortness of breath. His temperature is 98.4°F, pulse is 102/min, respirations are 32/min, and blood pressure is 142/75 mm Hg. Pulmonary function testing shows decreased tidal volume and normal lung compliance. Which of the following best explains the results of this patient's pulmonary function testing?
A rib fracture. The chest wall pain due to a rib fracture limits the range of motion of the chest wall, which leads to the decrease in tidal volume seen in this patient. To compensate for the decreased tidal volume, this patient has increased his respiratory rate to maintain a normal minute ventilation. Since there is no damage to the lung parenchyma (and no underlying pulmonary disease mentioned), his lung compliance is normal. In a patient with an inability to increase the respiratory rate (e.g., due to sedation), minute ventilation would be impaired and could lead to hypoxia.
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