Grace is a 26 year-old woman with a three month history of cough.

Symptoms worsening over three months Cough productive of white sputum 'Hotness of body' (fever) Nausea and dyspnea for several weeks. Anorxia and malaise. Does not smoke or drink. Three uncomplicated pregnancies.

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Physical exam

• Vital signs: Temp = 38.4°C, Pulse = 120, BP = 110/70, Resp = 28
• Pale conjunctiva and mucus membranes, no thrush.
• No cervical adenopathy, no JVD, neck is supple.
• Heart is regular, tachycardia and there is a 2/6 early systolic ejection murmur.
• Decreased breath sounds in the apices bilaterally.
• Abdominal, neurological and extremity exams are unremarkable.
• Blood smear shows 'scanty' malarial parasites.

Grace is admitted with a diagnosis of malaria and started on quinine.