Case Published: September 2021
History of Present Illness (HPI) 
Mary is a 25-year-old graduate student who presents to the emergency department for chest pain. She first noticed the pain three days ago, when she was practicing with her church choir. The pain was sharp, substernal, and eased off whenever she leaned forward on her lab bench during an experiment. She has not had any trauma or new exercise regimens. She has not taken any medications for this pain. Her friends have noticed that she lost weight, but Mary attributed it to not having time to eat while conducting her studies in the lab. She describes worsening fatigue. In addition, she has developed pain in her bilateral hands and decreased dexterity with her fingers in the past two months or so.
Social History: Mary does not smoke, drinks 1-2 alcoholic beverages socially about once a month, and does not use illicit drugs. She used to exercise 3-5 times a week, but has been too tired to work out in the past 6 weeks. She tries to eat healthy but does not always succeed and lately her appetite has not been good. She has been in a monogamous relationship for the past three years.
Past Medical History: none
Family History: maternal aunt with rheumatoid arthritis, older sister with hypothyroidism
Surgical History: none
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