Marian is a 43-year-old Asian female who presents to your outpatient clinic with complaints of fever and productive cough.

Denies tobacco and drug use Negative medical history Family history positive for cardiovascular disease in her father

Reports a fever (max temp 101 F), fatigue, generalized muscle aches, and productive cough of green sputum x 5 days Starting today, Marian has developed shortness of breath with minimal activity. Review of systems:

VS: Temp 101.1 F, HR 94 bpm, RR 32 breaths/min, BP 92/48 mm Hg, SaO2 91% on room air General: Appears stated age; speech clear Skin: warm to touch; pallor present HEENT: Nasal congestion present Respiratory: crackles (rales) auscultated bilaterlly in lower lobes, positive use of accessory muscles at rest, tachypnea, dyspnea with exertion Cardiovascular: S1 and S2 auscultated, no murmurs present. Denies chest pain. Gastrointestinal: bowel sounds auscultated in all quadrants; abdomen soft and nontender Genitourinary: Denies dyruria Musculoskeletal: No edema of extremeties. Strength 5/5 in bilateral upper and lower extremities. Neurological: alert and oriented x 4; PERRLA