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LMCC Part II > Fatigue > Flashcards

Fatigue Flashcards

1
Q

What is a good approach to evaluating fagtigue

A

systems based approach

elicit what the patient actually means by fatigue

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2
Q

define fatigue

A
  1. perceived generalized weakness causing inability to initiate some activities
  2. increased fatiguability reducing the ability to maintain activity
  3. mental fatigue causing poor concentration, memory impairment and emotional instability
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3
Q

define somnolence

A

abnormal sleepiness

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4
Q

define muscle weakness

A

true muscular weakness, wherein the strength of muscles is less than expected

must differentiate this from perceived muscular weakness where the patient feels more effort is required than normal but muscle power itself is normal

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5
Q

cardiopulmonary causes of fatigue

A

*post MI
*OSA
CHF
COPD
angina
critical aortic stenosis

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6
Q

endocrine causes of fatigue

A

*DM
*hypothyroidism
addisons disease

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7
Q

GI causes of fatigue

A

malignancy
celiac disease
chronic liver disease

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8
Q

renal causes of fatigue

A

chronic kidney disease

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9
Q

hematologic causes of fatigue

A

*anemia
lymphoma
leukemia
autoimmune disease

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10
Q

infectious causes of fatigue

A 
*viral illness
HIV
viral hepatitis
subacute bacterial endocarditis 
TB
EBV
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11
Q

MSK causes of fatigue

A

rheumatoid arthritis

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12
Q

neurological causes of fatigue

A 
cerebrovascular disease
MS
ALS
myasthenia gravis
parkinsons disease
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13
Q

psychiatric causes of fatigue

A

*depression
*anxiety
*dementia
chronic fatigue syndrome
fibromyalgia
chronic pain syndrome

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14
Q

“other” causes of fatigue

A

*disordered sleep
*medication
malignancy
lupus
pregnancy

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15
Q

what are the COMMON causes of fatigue

A 
post MI
OSA
DM
hypothyroid
anemia
viral illness
depression
dementia
anxiety
disordered sleep
medications
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16
Q

what are the LIFE THREATENING causes of fatigue

A 
CHF
COPD
angina
malignancy
HIV
17
Q

some things to ask specifically on HPI for fatigue

A

impact on daily life

constitutional symptoms –weight loss, fevers, night sweats

18
Q

what meds are associated with fatigue

A

beta blockers
benzodiazepines
*also ask about OTC, herbals, CAM

19
Q

what to ask on social history for fatigue

A 
substances
social stressors
intimate partner violence, abuse
recent travel or emigration  
sexual history (HIV, viral hep)
20
Q

what to ask on ROS specifically for fatigue in the following system:
CV/RESP

A 
chest pain
SOB
syncope
daytime sleepiness
snoring
21
Q

what to ask on ROS specifically for fatigue in the following system:
ENDO

A 
polyuria
polydipsia
dry skin
goiter
hyperpigmentation
22
Q

what to ask on ROS specifically for fatigue in the following system:
GI

A

changes in bowel pattern
black or bloody stool
abdo pain
ascites

23
Q

what to ask on ROS specifically for fatigue in the following system:
renal

A 
edema
nausea
emesis
anorexia
pruritis
24
Q

what to ask on ROS specifically for fatigue in the following system:
heme

A

SOBOE
petechial rash
LAD

25
Q

what to ask on ROS specifically for fatigue in the following system:
infectious

A

constitutional
travel
social risk factors

26
Q

what to ask on ROS specifically for fatigue in the following system:
MSK

A

joint pain

swelling

27
Q

what to ask on ROS specifically for fatigue in the following system:
neuro

A 
vision changes
weakness
paresthesias
vertigo
ptosis
atrophy
fasciculations
28
Q

what to ask on ROS specifically for fatigue in the following system:
psych

A 
SIGECAPS
excessive worry
panic
anxiety
memory changes
SI/HI
29
Q

what to ask on ROS specifically for fatigue in the following system:
other

A

CAGE
sleep habits
rash
menstrual history

30
Q

in which patients should you order a colonoscopy

A

in iron deficiency anemia in women over 50 and in any man

31
Q

how to manage fatigue if no underlying cause is found

A

BATHE approach to patient counselling

ensure frequent follow up i.e monthly to monitor symptoms–continue to screen for red flags

consider alternate diagnoses if its chronic and no other causes IDed ie fibromyalgia, CFS

lifestyle changes

pharmacologic options

referral

32
Q

what is the BATHE approach to patient counselling

A

Background factors
how is this Affecting you
what is it about this that Troubles you most
how are you Handling this
Empathize and Empower –elicit patients resources and coping mechanisms

33
Q

what are some lifestyle changes that can help with fatigue

A
  1. sleep hygiene–> ensure adequate sleep duration, consistent sleep/wake times, dark room, no TV/electronics in bedroom, no caffeine after noon, avoid food or exercise late in the day, avoid naps
  2. stress reduction–> mindfulness exercises, reduction of work hours, hobbies, counselling
  3. exercise–> regular, structured exercise i.e daily 30 min walk
  4. reduce or eliminate substances
34
Q

what pharmacologic therapy may be offered for fatigue

A

a 6 week trial of SSRI may be offered if diagnosis of depression is being considered

short course of treatment with hypnotic like zopiclone may be appropriate for insomnia

LMCC Part II (52 decks)

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