Mrs. G, a 55 year old Hispanic female, presents to the office for her annual exam. She reports that lately she has been very fatigued and just does not seem to have any energy. This has been occurring for 3 months. She is also gaining weight since menopause last year. She joined a gym and forces herself to go twice a week, where she walks on the treadmill at least 30 minutes but she has not lost any weight, in fact she has gained 3 pounds. She doesn’t understand what she is doing wrong. She states that exercise seems to make her even more hungry and thirsty, which is not helping her weight loss. She wants get a complete physical and to discuss why she is so tired and get some weight loss advice. She also states she thinks her bladder has fallen because she has to go to the bathroom more often, recently she is waking up twice a night to urinate and seems to be urinating more frequently during the day. This has been occurring for about 3 months too. This is irritating to her, but she is able to fall immediately back to sleep. Current medications: Tylenol 500 mg 2 tabs daily for knee pain. Daily multivitamin PMH: Has left knee arthritis. Had chick pox and mumps as a child. Vaccinations up to date. GYN hx: G2 P1. 1 SAB, 1 living child, full term, wt 9lbs 2 oz. LMP 15months ago. No history of abnormal Pap smear. FH: parents alive, well, child alive, well. No siblings. Mother has HTN and father has high cholesterol. SH: works from home part time as a planning coordinator. Married. No tobacco history, 1-2 glasses wine on weekends. No illicit drug use Allergies : NKDA, allergic to cats and pollen. No latex allergy Vital signs : BP 129/80; pulse 76, regular; respiration 16, regular Height 5’2.5”, weight 185 pounds General: obese female in no acute distress. Alert, oriented and cooperative. Skin : warm dry and intact. No lesions noted HEENT: head normocephalic. Hair thick and distribution throughout scalp. Eyes without exudate, sclera white. Wears contacts. Tympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender. Nares patent without exudate. Oropharynx moist without erythema. Teeth in good repair, no cavities noted. Neck supple. Anterior cervical lymph nontender to palpation. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. CV : S1 and S2 RRR without murmurs or rubs Lungs : Clear to auscultation bilaterally, respirations unlabored. Abdomen - soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits. No CVAT. Labwork: CBC : WBC 6,000/mm3 Hgb 12.5 gm/dl Hct 41% RBC 4.6 million MCV 88 fl MCHC 34 g/dl RDW 13.8% UA: pH 5, SpGr 1.013, Leukocyte esterase negative, nitrites negative, 1+ glucose; small protein; negative for ketones CMP: Sodium 139 Potassium 4.3 Chloride 100 CO2 29 Glucose 95 BUN 12 Creatinine 0.7 GFR est non-AA 92 mL/min/1.73 GFR est AA 101 mL/min/1.73 Calcium 9.5 Total protein 7.6 Bilirubin, total 0.6 Alkaline.