Reference no: EM133772805

Assignment

A 34-year-old obese woman presents to your office with a chief complaint of recurrent yeast infections and increased thirst. She also has noticed increased urinary frequency, but she believes this is related to her yeast infection. Over the last several years, she has gained more than 40 lb despite having tried numerous diets, most recently a low-carbohydrate, high-protein and fat diet. The patient's only other pertinent history is that she was told to "watch her diet" during pregnancy because of excessive weight gain. Her baby had to be delivered at 38 weeks via cesarean section 2 years ago because he weighed more than 10 lb (> 4500 g). Her family history is unknown, as she is adopted. On physical examination, her blood pressure is 155/94 mm Hg, her pulse is 72 beats/min, and her respiratory rate is 16 breaths/min. Her height is 65 inches, and her weight is 223 lb (body mass index [BMI] = 37.1 kg/m2). On examination, she has darkened skin that appears to be thickened on the back of her neck and moist, reddened skin beneath her breasts. Her pelvic examination reveals a thick, white vaginal discharge. A wet preparation from the vaginal discharge shows branching hyphae consistent with Candida species. A urinalysis is negative for leukocyte esterase, nitrites, protein, and glucose.

Required

A. What is the most likely primary diagnosis for this patient?
B. What physical findings are suggestive of the diagnosis and have implications for management?
C. What diagnostic studies should be ordered at this time?