Fatigue and Sleepiness Flashcards
What history is key when a patient complains of fatigue and sleepiness?
Duration Sleep Hygeine Snoring Waking up choking/gasping Witnessed apnea Overexertion/stress Depression Diet/Weight changes Symptoms of thyroid disease History of bleeding or anemia Medication Alcohol or drug use
What key physical exams would be performed if a patient complained of fatigue or sleepiness?
Vital signs Head and neck exam (conjunctival pallor, oropharynx/palate, lymphadenopathy, thyroid exam) Heart exam Lung exam Abdominal exam Neurological exam Rectal exam/occult blood testing
40 yo F complains of feeling tired, hopeless and worthless and of having suicidal thoughts. She recently discovered that her husband was a homosexual. Differentials?
Depression
Adjustment disorder
Hypothyroidism
Anemia
40 yo F complains of feeling tired, hopeless and worthless and of having suicidal thoughts. She recently discovered that her husband was a homosexual. Differentials: depression, adjustment disorder, hypothyroidism, anemia. Workup?
CBC
TSH
HIV/STD testing (given husband’s possible risk factors)
PHQ-2/PHQ-9
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night. Differentials?
Post-traumatic stress disorder (PTSD) Depression Generalized anxiety disorder Psychotic or delusional disorder Hypothyroidism
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night. Differentials: Post-traumatic stress disorder, depression, generalized anxiety disorder, psychotic or delusional disorder, hypothyroidism. Workup?
CBC
TSH
Calcium
Urine toxicology
55 yo M presents with fatigue, weight loss and constipation. He has a family history of colon cancer. Differentials?
Colon cancer Hypothyroidism Renal failure Hypercalcemia Other malignancy Depression
55 yo M presents with fatigue, weight loss and constipation. He has a family history of colon cancer. Differentials: colon cancer, hypothyroidism, renal failure, hypercalcemia, other malignancy, depression. Workup?
Rectal exam Stool for occult blood CBC, electrolytes, calcium BUN/Cr, AST/ALT TSH Colonoscopy Barium enema
40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation and dry skin. Differentials?
Hypothyroidism
Depression
Diabetes
Anemia
40 yo F presents with fatigue, weight gain, sleepiness, cold intolerance, constipation and dry skin. Differentials: hypothyroidism, depression, diabetes, anemia. Workup?
TSH
CBC
Glucose
50 yo obese F present with fatigue and daytime sleepiness. She snores heavily and naps 3-4 times per day but never feels refreshed. She also has hypertension. Differentials?
Obstructive sleep apnea
Hypothyroidism
Chronic fatigue syndrome
Narcolepsy
50 yo obese F present with fatigue and daytime sleepiness. She snores heavily and naps 3-4 times per day but never feels refreshed. She also has hypertension. Differentials: obstructive sleep apnea, hypothyroidism, chronic fatigue syndrome, narcolepsy. Workup?
CBC TSH Nocturnal pulse oximetry Polysomnography ECG
20 yo M presents with fatigue, thirst, increased appetite and polyuria. Differentials?
DM
Atypical depression
Primary polydipsia
Diabetes insipidus
20 yo M presents with fatigue, thirst, increased appetite and polyuria. Differentials: DM, atypical depression, primary polydipsia, diabetes insipidus. Workup?
Glucose
Urine analysis
CBC, electrolytes
BUN/Cr
35 yo M policeman complains of feeling tired and sleepy during the day. He changed to the night shift last week. Differentials?
Sleep deprivation
Sleep apnea
Depression
Anemia
