An 80 year old woman living in a retirement home presents with generalized weakness. She says she can't get out of bed because she's just too tired every morning. It's been going on for several months. The onset has been gradual and she can't recall any inciting factors. At the nursing home, she has her own room and says that she goes days without talking to anyone. Her husband passed away several years ago. At that time, she had an MI. Currently, she has severe arthritis which gives her chronic uncontrolled pain. She is on high dose anti-inflammatories, a statin, a beta-blocker, an ACE-inhibitor, and alendronate.
The nursing home attendant also says that the patient has not been eating very much, been losing significant weight, and has stopped doing her daily crossword puzzle. She's been sleeping excessively and moves a lot slower than usual.
Challenge: What's on the top of your differential?