Constitutional: reports weight loss of 2-3 pounds, no fever, chills, or weakness reported
Heent: Eyes: No visual loss, blurred vision, double vision or yellow sclera. Ears, Nose, Throat: No hearing loss, sneezing, congestion, runny nose or sore throat.
Cardiovascular: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
Respiratory: No shortness of breath, cough or sputum.
GastrointestinaL: Reports decreased appetite for about 3 months. No nausea, vomiting or diarrhea. No abdominal pain or blood.
NEurological: No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.
Genitourinary: no burning on urination. Last menstrual period 4 years ago.
Psychiatric: No history of diagnosed depression or anxiety. Reports great anxiety due to verbal and concern for physical abuse, reports feeling very sad and anxious when divorcing and leaving her son in France. Did not seek treatment. She started to feel better after about 4 months.
Endocrinologic: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia
Allergies: No history of asthma, hives, eczema or rhinitis.
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