Case 26 - 55 yo with fatigue

Question 1

Causes of fatigue

Answer 1

1. primary fatigue
2. secondary physical causes - meds, diabetes, anemia, cv disease, thyroid disease, pregnancy
3. Physiologic - decreased sleep, shift work
4. Psych

Question 2

USPTF cancer screening recommendations

Answer 2

1. Breast cancer - mammographies every 2 years in 50 or older, BRCA in patients with family history
2. Cervical cancer - all women sexually active who have a cervix
3. Colorectal cancer - FOBT, sigmoidoscopy or colonoscopy in adults 50 and older until 75

Question 3

cancer screenings NOT recommended by the USPTF

Answer 3

PSA, cxr, total body skin exam, pancreatic cancer screening, testicular cancer screening

Question 4

Colorectal cancer epi and risk factors

Answer 4

Epi: third most common cancer and second most common cause of cancer-related deaths
Risk factors: age, hereditary conditions, personal history of colon cancer or adenomas, fam hx, personal history of ovarian, endometrial or breast cancer, UC or chrons, diabetes

Question 5

Patient centered medical home

Answer 5

a set of principles for primary care: the patient’s primary care physician should be a leader of a team of other providers and should ensure well coordinated care

Question 6

SPIKES

Answer 6

Setting up the interview
Perception: before you tell, ask
Invitation
Knowledge
Emotions
Strategy
Summary

Question 7

Differential diagnosis of fatigue

Answer 7

1. Depression
2. Obstructive sleep apnea
3. Anemia - rectal bleeding/pallor, can be from GI/GU blood loss or poor dietary intake
4. Occult malignancy
5. Coronary artery disease - fatigue with exertion
   Less likely: diabetes, sleep restriction, hypothyroidism, chronic fatigue syndrome

Question 8

Studies for evaluation of fatigue

Answer 8

• blood tests: CBC, ESR, TSH, diabetes
• sleep study
• anoscopy, colonoscopy, upper GI for male with anemia

Question 9

Management of iron deficiency anemia in an adult male

Answer 9

• ferrous sulfate 325 mg three times daily
• docusate sodium 100 mg twice daily for constipation
• colonoscopy if concern for GI cause

Question 10

Management of invasive adenocarcinoma of the colon

Answer 10

1. Referral to surg and med onc
2. Staging: surgical removal and pathologic staging, CT scan
3. Treatment modalities include chemo, surgery, radiation