A primary care physician is evaluating several patients in an outpatient clinic. Match each patient's clinical presentation with the most appropriate initial management step.
- A 45-year-old man with a BMI of 34 kg/m², asymptomatic, with two separate fasting plasma glucose readings of 135 mg/dL and a hemoglobin A1c of 7.2%.Initiate metformin and recommend comprehensive lifestyle modifications
- A 32-year-old woman with a 6-month history of intermittent lower abdominal cramping relieved by defecation, alternating diarrhea and constipation, and unremarkable basic laboratory tests.Recommend a low-FODMAP diet and trial of symptom-based therapies
- A 60-year-old man with newly diagnosed essential hypertension (blood pressure consistently 145/90 mmHg) and no other medical comorbidities.Initiate lifestyle modifications and begin monotherapy with a thiazide diuretic, calcium channel blocker, or ACE inhibitor
- A 50-year-old woman presenting with progressive fatigue, unexpected weight gain, cold intolerance, a markedly elevated TSH, and low free T4.Initiate oral levothyroxine replacement therapy and recheck thyroid function in 6 weeks
Answer
Match the diabetes presentation with metformin, IBS with low-FODMAP diet, essential hypertension with primary antihypertensives, and hypothyroidism with levothyroxine.
Each clinical vignette provides a classic, straightforward presentation of a very common primary care condition. The first-line management for type 2 diabetes is metformin; for IBS is dietary modification; for uncomplicated hypertension is a thiazide, CCB, or ACE inhibitor; and for primary hypothyroidism is levothyroxine.
Step-by-Step Solution
Key Concept
First-line outpatient management of common internal medicine conditions (Type 2 Diabetes Mellitus, IBS, Essential Hypertension, Primary Hypothyroidism).
Estimated Time:1m 0s