Anemia in a 42-year-old woman

Review of Systems

  • General: Patient says she felt fine until about 2 months ago when she had "the flu," which she describes as a low-grade fever, diffuse joint pain, malaise, and a non-pruritic rash primarily over her extremities. She took acetaminophen and her symptoms resolved after 4 days. Except for her fatigue and dyspnea, she has since felt well with normal appetite and no fever or chills.

  • Skin: No rash or lesions noted.

  • HEENT: Denies pain or swelling in her neck, no nasal discharge or bleeding.

  • Pulmonary: Dyspnea climbing stairs, worsening over the past 3 weeks to the point that she cannot climb a flight of steps without pausing to rest. No cough or wheezing.

  • Cardiovascular: No exertional chest pain, palpitations, orthopnea, or paroxysmal nocturnal dyspnea.

  • Gastrointestinal: No nausea, vomiting, diarrhea or abdominal pain.

  • Genitourinary: Menses normal, last period 2 weeks prior, normal amount of bleeding for her. No other vaginal bleeding. Urination normal, no visible blood.

  • Musculoskeletal: No swelling or pain in joints or extremities.

  • Neurologic: Unremarkable

  • Psychiatric: Unremarkable