His only complaints are fatigue and diffuse muscle aches. He is a seventy pack year smoker who quit within the past few weeks.
Past history reveals degenerative arthritis, chronic neck and back pain.
He has multiple tick bites in the recent past, however, he tested negative for Lyme disease. He has no history of chronic lung disease. He works as a livestock farmer in southern Iowa. On examination, the patient was in no acute distress. Vital signs were normal.