A Woman with Extreme Fatigue

Her vitals on presentation follow: blood pressure 126/78 mm Hg, heart rate 82, respirations 16, and temperature 98.6. The patient appears her stated age, and is in no apparent distress. Sclerae are anicteric, and conjunctivae pink. No oropharyngeal exudates or apthous ulcers are seen, and there is no evidence of cervical, axillary, supraclavicular, or inguinal lymphadenopathy. Thyroid is not enlarged or tender. Cardiac exam is normal and her lungs are clear. Her abdomen is mildly obese, nontender and nondistended, with normoactive bowel sounds. There is no hepatosplenomegaly. No peripheral edema or joint abnormalities are appreciated, and she is neurologically intact.