[Answered]: Cindy Alaniz, aged 25, has come to the health…

Cindy Alaniz, aged 25, has come to the health center for her routine annual pap and pelvic examination. During her interviews, she tells you that her menstrual periods have been heavier than normal for the past 6 months and that she has been passing clots about the size of a nickel on the first day of each cycle. She denies any cramping with her menses. She’s thinking about trying to become pregnant. Her medical history is negative for serious illnesses or surgery. Ms. Alaniz is currently taking no medications. She exercised but says that she has recently stopped this practice because she feels “tired all the time.” Her diet is high in pasta foods, some fruits, and vegetables, and she only eats meat once each month in an attempt to limit her fat content. She has episodes of dizziness, which is also described as “feeling very weak.’ She also says she has been having some heart palpitations. The healthcare provider completes a physical examination and orders a complete blood count and differential.