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1、Eric E. Gish, D.O. Associate Dean of Clinical Education Liberty University College of osteopathic Medicine (Proposed),The Many Faces of Hyperlipidemia,Case #1,43 year old male presents because of a tan discoloration of his eyelids. He states that they started off as small “spots” and have enlarged o
2、ver the last year. They do not affect his vision and he denies any trauma to the area. He states that his father had similar “spots” on his eyelids as well.,43岁男性，因为眼睑有黄褐色样变来诊所看病。 开始为小点, 在过去的一年开始扩大。 不影视力,否认任何损伤。 他父亲的眼睑有相似的“斑点”。,Case #1 Continued,Past Medical History Type II diabetes diagnosed 2003 H
3、ypertension diagnosed 2007Past Surgical History: NoneMedications Lisinopril奈落普利 40 mg orally daily Metformin 1000 mg orally twice daily,Case #1 Continued,Family History Father: Type II Diabetes, MI, HTN Mother: Hypercholesterolemia Social History Smokes 1pack of cigarettes per day for 25 years Denie
4、s illicit非法 drug use Drinks 2 to 3 alcoholic beverages a day on average Allergies: No known drug or food allergies,Case #1 Continued,Review of Systems Constitution: Denies fever, chills, or weakness. Admits to fatigue. Endocrine: States glucose is well controlled, Last Hg A1C was 6.8% approximately
5、9 months ago Rheumatology: Denies any joint aches, swelling, inflammation, or morning stiffness. Hematology: Denies any unusual bleeding, bruising, noticeably enlarged lymph nodes.,系统回顾 否认发热，寒颤，虚弱。但有疲乏感。 内分泌：血糖控制好，9月前HBA1C6.8% 风湿学：无关节痛，肿胀，炎症，晨僵 血液学：无出血，外伤，无淋巴结肿大,Case # 1 Continued,Review of Systems
6、(Continued) Cardiovascular: Denies chest tightness, cyanosis of the extremities, diaphoresis, dyspnea on exertion, claudication symptoms Pulmonary: Denies coughing, wheezing, hemoptysis Gastrointestinal: Denies dyspepsia, stomachache, hematemesis, melena, hematochezia, or diarrhea. Admits to intermi
7、ttent constipation which is becoming more frequent.,心血管系统：否认胸闷、脸色惨白、出汗、呼吸困难,跛行症状 呼吸系统：无开始，气喘、咳血 胃肠道：否认消化不良、腹痛、呕血、黑粪症,便血,或腹泻。承认间歇便秘，而且正变得越来越频繁。,Case #1 Continued,Review of Systems (Continued) Musculoskeletal: Denies any muscular weakness, stumbling, backache. Admits to feeling a mass in the front of
8、his neck just above his breastbone. Neurologic: Admits to occasional numbness and tingling in toes bilaterally. Denies radicular symptoms, incontinence of bowel/bladder, vertigo, or loss of consicousness. Integument: Admits to easily chipping fingernails, skin feels dry.,肌肉骨骼系统：否认有任何肌肉无力,步履蹒跚,背痛。感觉脖
9、子前面略高于他的胸骨处有压迫感。 神经系统：承认偶尔脚趾双边麻木和刺痛。否认神经性症状,尿失禁肠/膀胱,眩晕,或者意识损失。体表：术容易指甲脱屑，皮肤干燥,Case #1 Continued,Physical Examination Vital Signs: BP 127/83 Pulse 81 RR 10 Afebrile Wt. 84.82 kg (187#) Ht. 172.72 cm (5 8”) BMI 28.4 Skin: well circumscribed tan colored plaques measuring 2 mm in diameter OD and 3 mm di
10、ameter OS noted at the inner canthus of the eyelids. Hair is course and dry, eyebrows appear somewhat sparse, finger and toe nails with multiple cracks and chips.,PE: BP 127/83 Pulse 81 RR 10 Afebrile Wt. 84.82 kg (187#) Ht. 172.72 cm (5 8”) BMI 28.4 皮肤：明显的棕褐色彩色斑块，测量2毫米X 3毫米，在眼角的内部。头发干燥,眉毛看起来有些稀疏,手指
11、和脚趾的指甲见多个裂缝和增厚。,Case #1 Continued,Physical Examination Continued HEENT: Dense nodular mass anterior neck at the level of the thyroid, no bruits to auscultation over thyroid or carotid arteries. PEERLA, EOMI, Visual Acuity is 20/20 with corrective lenses, peripheral vision approximately 85 degrees bi
12、laterally. Bilateral plaques on inner canthus of eyelids as noted on integument exam. Fundiscopic examination is negative.,五官:可触及颈前部甲状腺结节，甲状腺听诊无杂音。 视力是20/20，矫正镜片,周边视觉大约85度双边。Fundiscopic（内窥镜）检测正常。,Case #1 Questions,What is/are the patients likely diagnosis/diagnoses? Are there any potentially confoun
13、ding comorbidities? What additional studies you would like to perform? What additional information from the patient would you obtain? How would you medically manage this patient?,If the patients hypertension became uncontrolled and necessitated a second medication, what class would you consider? Wha
14、t education would you provide to the patient for self care and prevention? What comorbidities are likely with this patient and how would you refine your future examinations?,Question #1,What is/are the patients likely diagnosis/diagnoses?Answer: The patients presenting diagnosis is xanthoma of the e
15、yelids. However, this diagnosis is likely a symptom of another underlying disease, hyperlipidemia. 病人的初步诊断是眼睑的黄色瘤。但是不能忽视背后隐藏的另一个潜在疾病，高血脂。,Question #2,Are there any potentially confounding comorbidities?Answer: There is likely an underlying comorbidity of hypothyroidism as evidenced by the nodular an
16、terior neck mass, dry skin and fingernails, course hair, sparse eyebrows, and constipation. Additionally, there is likely an underlying comorbidity of hyperlipidemia. Along with the history of hypertension and diabetes, the patient may have metabolic syndrome.,可能有其他易混淆的合并症吗？答:有可能存在潜在的甲状腺功能减退，如前颈部肿瘤结节,干性皮肤和指甲,头发,稀疏的眉毛和便秘。 此外,有可能是潜在疾病的高脂血症。由于有高血压和糖尿病病史,患者可能有代谢综合征。,Question #3,What additional studies you would like to perform? 你需要哪些其他的检查?Answer: Comprehensive Metabolic Profile (CMP), serum creatine kinase, lipid profile, TSH CMP综合代谢指标，血肌酐，血脂，TSH(促甲状腺激素),
