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Agnes Hopkins is coming in for tiredness and shortness of breath that she claims is unlike her normal

self. Currently in school, she also exercises and runs track. She states that the tiredness and shortness of
breath is affecting her ability to continue to function in her daily activities. She reports having heavy
menstrual bleeding and cramping, the last of which was two weeks ago. She takes ibuprofen for the
cramping. She says that her mother has the same condition, however her mother doesn’t get the
subsequent tiredness and shortness of breath. She has only been sexually active with her boyfriend, has
never had an STI, does not smoke, drinks about two glasses of wine a week, and has a very varied diet
that includes meat fish, and more. She doesn’t eat the same foods everyday. She says she hasn’t lost any
weight, nor is she depressed. She has not traveled outside the country. She says that the shortness of
breath and tiredness might be stress induced from school-related matters. She fears that she may have
to drop out of school of the symptoms persist, disappointing not only herself, but her mother as well.
Her mother works to support her and so Agnes doesn’t want to add any undue worries by telling her
mom about her recent signs and symptoms. As far as she knows she doesn’t have any allergies. She also
denies using drugs recreationally.