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45yo Singaporean man presents with lethargy for last few months. FBC shows…

- - - - Hx: poor exercise tolerance; features of secondary hypoparathyroidism: muscle cramps, bone pain
      - PE: pallor, fatigue, dyspnoea; signs of renal failure: jaundice, skin bruising, lung rales, pericardial rub, edema, poor concentration or memory, myoclonus; positive Chvostek's sign or Trousseau's sign in associated hyperparathyroidism
  - - - Hx: Hx of hepatitis, HIV, benzene exposure, medications, radiation exposure, paroxysmal nocturnal haemoglobinuria; malaise, fatigue, easy bruising or bleeding, recurrent infections, fever
      - PE: pallor, petechiae, purpura, dyspnea, tachycardia
    - - Hx & PE: Self-limiting: medications, clinical features of causative infections (parvovirus B19, infectious mononucleosis, viral hepatitis, malaria, respiratory infections, gastroenteritis, primary atypical pneumonia, mumps); chronic disease: hx of autoimmune disease (SLE, rheumatoid arthritis, dermatomyositis, scleroderma, polyarteritis nodosa), persistent infection, or thymoma
    - - Hx: weight loss, malaise, fevers, fatigue, dyspnoea, easy bleeding or bruising
      - PE: pallor, petechiae, purpura, tachycardia, abnormal lung examination (if lung cancer), breast mass (if breast cancer), bruising, cachexia
- - - - Hx: hx of chronic high alcohol intake
      - PE: Increased prominence of superficial cutaneous vasculature, peripheral neuropathy, hepatomegaly or small liver, jaundice, ascites
    - - Hx: weakness, lethargy, slow speech, feeling cold, forgetfulness, constipation, weight gain, poor exercise tolerance
      - PE: Pallor; dyspnoea; coarse, dry skin; eyelid edema; thick tongue; facial edema; bradycardia
    - - Hx: hx of chronic liver disease, poor exercise tolerance; may be asymptomatic or with fatigue, weakness, weight loss, recurrent infections, decreased libido; altered mental status in hepatic encephalopathy
      - PE: pallor, fatigue, dyspnea, jaundice, lower-extremity swelling; hand and nail features: leukonychia, palmar erythema, finger clubbing, spider angiomata; facial features: telangiectasia, bruising, rhinophyma, parotid gland swelling, paper-dollar appearance of skin, seborrhoeic dermatitis, xanthelasma; abdominal features: caput medusae, bruising, hepatomegaly, splenomegaly, abdominal distension; in males, loss of secondary sexual hair and testicular atrophy
  - - - ↓Dietary intake (Vegans/Vegetarians, ~mths-yrs), Gastric Surgery, Celiac, Crohn's disease. Pernicious anemia (Anti-IF Abs, family hx, autoimmune disorder).
      - Hx: Trouble walking, Confusion, Memory loss, Depression.
      - PE: Pallor, Jaundice, Hepatosplenomegaly. Loss of reflexes, Unsteady gait, Loss of balance, Atrophic glossitis with loss of tongue papillae, Impaired vibration sense, Extremity numbness, Vitiligo, Tachycardia.
    - - Hx: ↓Dietary intake (~4-5mths), Alcohol/drug abuse. Gastric Surgery, Celiac, Crohn's disease, Haemodialysis.
      - PE: Patchy hyperpigmentation of skin & mucosal membrane (esp. dorsum of fingers, toes, creases of palms/soles), Angular stomatitis, Atrophic glossitis with loss of tongue papillae, Mild persistent pyrexia, Tachycardia, Pallor, Hepatosplenomegaly.
    - - Hx: Exposure to petroleum distillates (especially benzene), chemotherapy, radiotherapy; Fever, chills, fatigue, weakness, recurrent infection, anorexia, night sweats, dyspnea, easy bruising
      - PE: pallor, petechiae, purpura
    - - Hx: Ingestion of causative drug prior to onset, Exercise intolerance
      - PE: pallor, jaundice (with haemolytic anaemia only), dyspnea
- - - - Hx: Hx of GI bleed, Gastritis, NSAIDs/corticosteriod, Alcohol, Cirrhosis, Anticoagulants
      - PE: Abdominal pain, Hepatomegaly, Splenomegaly, Caput medusae, Bright red blood on rectal exam
  - - - TTP
        
        Hx: Hx of autoimmune disorders (e.g SLE); fatigue; dyspnea; petechiae; other bleeding (nose, gums), weakness; dizziness; N/V; GI symptoms; Major neurologic findings (e.g coma, stroke, seizure, transient focal abnormalities), minor neurologic findings (e.g headache, confusion)
        
        PE: pallor, lethargy, dyspnoea, purpura, ecchymoses
      - Hemolytic uremic syndrome (HUS)
        
        Hx: acute renal failure usually following an enteric bacterial infection (Escherichia coli 0157:H7) with bloody diarrhoea, or Streptococcus pneumoniae
        
        PE: pallor, lethargy, dyspnoea, petechiae, purpura, bloody diarrhoea