Donelson is to further evaluate her for a diagnosis of PAD using the ankle-brachial index (ABI). ABI is an accurate measure (ABI less than 0.9 has a sensitivity of 95% and specificity of 100% in detecting PAD) that is noninvasive, inexpensive, and office-based. The first line of treatment for Mrs. Donelson will be aimed at lifestyle changes including smoking cessation, supervised exercise therapy, and weight loss. The patient’s uncontrolled hypertension, which is likely contributing to her PAD, will also need to be addressed. Currently, Mrs. Donelson is taking Hydrochlorothiazide (25mg/day), this dose should be increased initially to 50mg/day and HTN will be reevaluated at next visit. If necessary a second drug will be added, such as lisinopril (ACE inhibitor). Bilateral xanthelasma’s suggest dyslipidemia and warrant obtaining a lipid panel to assess the need for intervention. If needed, Lipitor (10mg/day) will be prescribed. A pulsatile, fixed mass was observed in the abdomen upon physical exam, possibly an abdominal aortic aneurysm. To investigate this finding further, an abdominal ultrasound will be ordered. A chest x-ray will also be ordered to address patient concerns as well as physical exam findings suggesting possible pulmonary congestion. Lastly, the patient reported drinking ‘3-4 beers per night’. We discussed the potential detrimental affects of this on her health and the possibility of her cutting back to one beer a night. An 8 week…