Please answer the following disussion post/case study and give the appropriate diagnosis. I personally feel that this patient may be suffering from anemia and may require a blood transfusion, but please do the research to best attain the correct diagnosis and answer the 3 questions:
A 65-year-old African-American woman presented to the emergency room complaining of worsening shortness of breath and palpitations for about 1 week. She reports feeling “dizzy” on and off for the past year; the dizziness is associated with weakness that has been worsening for the past month. She has been feeling “too tired” to even walk to her backyard ad water her flower bed that she used to do “all the time”. She has been so dyspneic walking up the stairs at her home that she moved downstairs to the guest room about a week ago. Review of systems is significant for knee pain, for which she frequently takes aspirin or ibuprofen; otherwise, the review of systems is negative. She has no significant medical history and has not been to a doctor in several years. She had a well-woman examination and screening colonoscopy about 5 years ago. She occasionally has an alcoholic drink and denies tobacco or drug use. She is married and is a retired shopkeeper. On examination, her blood pressure is 150/88 mm Hg; her pulse is 98 bpm, her respiratory rate is 20 breaths/min; her temperature is 98.7° F (37.1°C), and her oxygen saturation is 99% on room air. Significant findings on examination include conjunctival pallor, mild tenderness with deep palpation in the epigastric and left upper quadrant (LUQ) region of the abdomen with normal bowel sounds, and no organomegaly but a positive stool guaiac test. The remainder of the examination, including respiratory, cardiovascular, musculoskeletal, and nervous systems were normal.
1. What is the most likely diagnosis?
2. What is your next diagnostic step?
3. What is the next step in therapy?
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