Case 6

A 74 yo woman was admitted to the hospital because of low blood counts. She has felt weak and tired for 3 weeks, and more recently noticed palpitations and lightheadedness. She was hospitalized following a brief syncopal episode. Evaluation at a local hospital showed pancytopenia and so she was transferred here.

Past Medical History

Hypothyroidism
Breast Cancer, T1 N0 M0, ER/PR positive, treated with lumpectomy in 2005. Given a short course of Arimidex, which was stopped because of a rash.
Diabetes type 2
Hypertension
History of excision of malignant scalp lesion of uncertain type in 2002

Medications

Levothyroxine
Metformin
Enalapril
Baby aspirin
Clarinex
Azithromycin

Allergies

Penicillin
Sulfa
Arimidex

Family Hx

Mother had hypothyroidism
Niece had breast CA at age 41

Social Hx: No tobacco, alcohol, illicit drugs. Widowed, lives with son and daughter-in-law.

ROS: Unintentional 20# wt loss in past 6 mo. Good appetite. No fever/chills/sweats. No focal neurologic symptoms. No bleeding. No change in urine color.

Physical Examination: Alert and oriented, in NAD. Temp 99.7 F, pulse 100, resp 20, BP 126/58, Sa02 94% on 2L. Mild scleral icterus. No lymphadenopathy. Lungs clear. 2/6 systolic murmur radiating to carotids. Abdomen normal. Skin normal. Neuro exam normal except for diffuse hyporeflexia.