Tiredness

Question 1

In the absence of clear underlying pathology (e.g. hypothyroidism), what is the most appropriate management of a patient presenting as TATT?

Answer 1

• watch and wait

- delay investigations for 1 month and review

Question 2

What are the 4 most important initial investigations to conduct in patients who are TATT, where underlying pathology is suspected?

Answer 2

1) TFTs
2) FBC
3) Random blood glucose
4) ESR

Question 3

Name 4 drugs that commonly cause fatigue

Answer 3

1) beta-blockers
2) opiates
3) anti-histamines
4) anti-depressants

Question 4

Give 5 common causes for being TATT

Answer 4

1) Hypothyroidism
2) Anaemia
3) Malignancy
4) Sleep apnoea
5) Depression

Question 5

What are the diagnostic criteria for chronic fatigue syndrome?

Answer 5

• debilitating fatigue
• triggered by minimal activity
• for 4 or more months
• other diagnoses excluded

Question 6

What is the most appropriate management of a patient with chronic fatigue syndrome?

Answer 6

• advice about diet, sleep, activity and relaxation
• alteration of education/work commitments
• signposting of self-help resources
• referral to chronic fatigue specialist

Question 7

What are the most common causes of:
Microcytic anaemia
Normocytic anaemia
Macrocytic anaemia

Answer 7

Microcytic = iron deficiency
Normocytic = chronic disease
Macrocytic = B12/folate deficiency

Question 8

What are the most common causes of iron deficiency anaemia?

Answer 8

• inadequate dietary intake (e.g. vegan)
• GI bleeding (e.g. NSAIDs, PUD, CRC)
• Malabsorption (e.g. coeliac disease)
• heavy menstruation
• regular blood donation

Question 9

What are the most common causes of anaemia of chronic disease?

Answer 9

• obesity
• malignancy
• chronic inflammatory disorders
• chronic infection

Question 10

What are the most common causes of B12 and folate deficiency?

Answer 10

• inadequate dietary intake (e.g. vegan)
• chronic alcoholism
• malabsorption (e.g. coeliac disease)