Approach to Fatigue Flashcards by Rebecca Lea

dry eyes

dry mouth

parotid gland dysfunction

schirmers test to test if eyes are watery

anti Ro and La Anti-Nuclear Antibodies

sjorgrens

How well did you know this?

Not at all

Perfectly

acute fatigue lasts

subacute fatigue lasts

chronic fatigue lasts

acute fatigue lasts less than 1 month

subacute fatigue lasts 1 to 6 months

chronic fatigue lasts more than 6 months

How well did you know this?

Not at all

Perfectly

3+ months of:

multi-site pain

fatigue

sleep disturbances

no evidence of inflammation

paresthesias

cognitive/psych sxs

fibromyalgia

How well did you know this?

Not at all

Perfectly

N/V

diffuse abdominal pain

polydipsia

polyuria

dehydration

DKA

How well did you know this?

Not at all

Perfectly

repetitive jerking movements of twitching of legs or arms during sleep

periodic limb movement disorder

How well did you know this?

Not at all

Perfectly

what are some infections that can cause fatigue

endocarditis

tuberculosis

PNA

EBV

parasite

hepatitis

HIV

CMV

How well did you know this?

Not at all

Perfectly

proximal aching and stiffness (pelvis, neck, shoulder)

worse in the morning for more than 1 hour

stiffness after long periods of inactivity (gel phenomenon)

associated w/ giant cell temporal arteritis (HA, vision changes, jaw pain)

rapidly improves w/ LD steroids

polymyalgia rheumatica

How well did you know this?

Not at all

Perfectly

prosthetic valves, IVDU, indwelling IV catheter, immunosuppressed, recent dental/ sx procedure

fever, chills, anorexia, WL

cardiac murmur

petechiae

splinter hemorrhages (red-brown lines under nail bed)

janeway lesions (NT red macules on palms and soles)

osler nodes (tender violet SQ nodules on fingers and toes

roth spots (exudate, edematous hemorrhagic retinal lesions)

BCX + echo

endocarditis

How well did you know this?

Not at all

Perfectly

Family Hx

polydipsia

polyphagia

polyuria

what do you always check

check eyes and feet

How well did you know this?

Not at all

Perfectly

what are some psych illnesses that can cause fatigue

depression

anxiety

somatization disorder

grief

substance abuse

How well did you know this?

Not at all

Perfectly

malar/ discoid rash

raynauds

photosensitivity

migratory symmetric joint pain

Anti Smith, Anti-DNA, Anti Phospholipid Anti-NuclearAntibodies

SLE

How well did you know this?

Not at all

Perfectly

black

dehydration, hypoxia, high altitude and exercise aggravates

HbS in RBC on electrophoresis

target cells, howell jolly bodies

sickle cell disease

How well did you know this?

Not at all

Perfectly

acrocyanosis (dark gray fingertips)

dark urine

(anemia)

autoimmune hemolytic anemia

How well did you know this?

Not at all

Perfectly

leukemia cutis, skin lesions

70 y/o

weakness and fatigue

infections

increased bleeding

organomegaly

LAD

> 30% lymphocytes

chronic lymphoblastic leukemia

How well did you know this?

Not at all

Perfectly

sick contacts

sore throat

posterior pharynx exudates

splenomegaly

EBV

How well did you know this?

Not at all

Perfectly

black, retired age

fatigue, weak, back pain, bone pain

hyperviscosity syndrome (bleeding mucous membranes, vision probs, neuro sxs)

rouleaux formation (stacked coins), anemia, M spike, Bence Jones proteins

CRAB: Calcium more than 10.5, Renal insufficiency, Anemia, Bone Lesions

multiple myeloma

How well did you know this?

Not at all

Perfectly

what are some Rheum/ inflammatory causes of fatigue

SLE

polymyalgia rheumatica

IBS

sarcoidosis

sjorgrens

How well did you know this?

Not at all

Perfectly

prox extremity weakness

myocarditis

raynauds

can’t get up, can’t reach

interstitial lung dz

plus

heliotrope rash/ shawl sign/ grottons papule

occult malignancy

dermatomyositis

How well did you know this?

Not at all

Perfectly

DOE

chest pain

cough

lupus pernio (hard purple lesion on the face)

erythema nodosum

uveitis

arthralgias

non caseating granulomas

lung biopsy required

sarcoidosis

How well did you know this?

Not at all

Perfectly

sleep walking

sleep talking

head banging

night terrors

parasomnias

How well did you know this?

Not at all

Perfectly

edema

SOB

productive cough- frothy pink sputum

orthopnea

PND

DOE

CHF

How well did you know this?

Not at all

Perfectly

kid

fever

fatigue

pallor

hepatosplenomegaly

LAD

lymphoblasts on BM bx and peripheral smear

acute lymphoblastic leukemia

How well did you know this?

Not at all

Perfectly

N/V, constipation

polydipsia

polyuria

bone pain, muscle weakness

depression, confusion, lethargy

palpitations, syncope, arrhythmia

hypercalcemia

How well did you know this?

Not at all

Perfectly

what are some malignant causes of fatigue

anemia

leukemia

lymphoma

hodgkins

How well did you know this?

Not at all

Perfectly

prox extremity weakness **myocarditis** raynauds **can't get up, can't reach** **interstitial lung dz**

increased CK and aldolase ## Footnote **polymyositis**

irresistable urges to move legs when falling asleep crawling/ burning/ painful sensations in the legs

restless leg syndrome

amnesia slow speech confusion, repetitive questions dizziness HA emotional volatility decreased focus and attention sleep disturbance

TBI ent msk respiratory

what are some neurologic causes of fatigue

MS myasthenia gravis myositis myasthenia gravis myositis parkinsons dementia TBI migraine CVA

hx of HTN, DM, a-fib, smoking, dyslipidemia hypotension pallor sweating tachycardia/ severe bradycardia bilateral neuro sxs

CVA

dyspnea chronic cough sputum cyanosis, tripoding, accessory muscle usage tobacco stained fingers JVD, S3 gallop decreased breath sounds, wheezes, increased resonance on percussion, crackles at base

PFTs COPD- chronic bronchitis vs emyphysema

AIDs pt + visual disturbances perivascular hemorrhages, white fluffy exudates

cytomegalovirus

aching, heaviness, burning sensation in legs that is worse with standing, relieved by elevation edema, dry, hyperpigmented, red skin restless legs pink/yellow ulcers on bones arterial pulses present telangiectasias, visbile variscosities fatigue

venous insufficiency

rest tremor rigidity (lead pipe/ cog wheel) akinesia-bradykinesia (mask face, loss of movement) postural instability fatigue

parkinsons

fluctuating muscle weakness ptosis, diplopia dysarthria (difficulty speaking), difficulty chewing, dysphagia) arm \> leg weakness aggravated by stress thymoma/ thymic hyperplasia

dx by electrophysiology (NCS/ EMG) ⇒ worsens fatigue **myasthenia gravis**

what are idiopathic causes of fatigue

chronic fatigue syndrome fibromyalgia

immunocompetent pt- pulm infection immunocompromised pt- night sweats, WL, abdominal pain, diarrhea, anemia

sputum cx ⇒ acid fast strain

what are some 'other' physical conditions that cause fatigue

obstructive sleep apnea insomnia pregnancy obesity malnutrition eating disorders chronic pain

3 most common causes of chronic fatigue

**major depressive disorder** panic disorder somatic symptom disorder

what are some cardio/pulmonary causes of fatigue

CHF COPD, emphsema peripheral vascular disease coronary artery disease

foreign travel night sweats SOB pleuritic retrosternal CP post-tussive crackles decreased fremitus weight loss LAD

CXR- apical cavitary lesions, military pattern sputum CX x 3 **TB**

excessive daytime sleepiness episodic spells of suddenly falling asleep sleep paralysis vivid dreams sudden, transient episode of muscle weakness triggered by laughing, crying, or terror (cataplexy)

narcolepsy

HA vision changes hemiopsia (decreased peripheral vision)

pituitary adenoma

what are some meds that cause fatigue

hypnotics anti-hypertensives muscle relaxants anti-depressants 1st generation antihistamines opioids

hx of EBV painless cervical LAD mediastinal mass hepatosplenomegaly drinking ETOH ⇒ extreme pain

reed sternberg (multi-nucleated B cells on lymph bx) ⇒ ann arbor staging **hodgkins lymphoma**

6 + months of intense fatigue not improved with rest worse with activity and or exertion cognitive impairment orthostatic intolerance

chronic fatigue syndrome | (diagnosis of exclusion)

glossitis, GI sxs ETOH, pregnant, anticonvulsants

elevated homocysteine **normal** MMA **megaloblastic macrocytic anemia- folate deficiency**

pruritis icterus jaundice abdominal swelling confusion RUQ pain

liver failure

glossitis GI sxs neuro sxs (ataxia, confusion, stocking glove paresthesia) hx of metformin, PPIs, H2 blockers, elderly, vegan

positive shilling test increased MMA **and** homocysteine **megaloblastic macrocytic anemia- B12 deficiency**

diarrhea gas fatigue

IBS

atherosclerosis pain w/ elevation claudication- calf/ thigh/ buttock skin changes (blue/ pallor w/ elevation, dependent rubor, ulcers, necrosis) atrophied, shiny, taut, hairless, cool skin delayed cap refil, absent arterial pulses dry pale/ necrotic ulcers fatigue

peripheral artery disease

cold weak, lethargic, depressed weight gain dry skin thick tongue eyelid edema bradycardia

TSH **hypothyroidism**

N/V yawning, mood changes, constipation, fluid retention visual/ auditory/ sensory/ motor + and - sxs HA confusion and exhaustion

migraine

male: decreased energy, libido, muscle mass, body hair hot flashes gynecomastia infertilitiy low testosterone

**male hypogonadism** primary- testes prob (high FSH, LH) secondary- pituitary prob (low/ normal FSH, LH)

what 5 things are often mistaken for fatigue but are NOT

weakness somnolence DOE drowsiness apathy

what are lifestyle factors that you should ask about w/ a pt who presents with fatigue

physical activity- not enough/ too much lack of effective sleep unhealthy eating habits alcohol or drugs medications jet lag shift work

paresthesias neck flexion ⇒ electric shock down back/ limbs optic neuritis defective pupillary reaction to light (Marcus Gunn Pupil) waxing waning/ recurring pattern (separated by time and space) hyper reflexive DTRs, + babinski, clonus nystagmus, inccordination, tremor, gait and balance probs, vertigo uhthoff phenomenon- transient worsening due to elevated body temp

MRI w/ and w/out ⇒ hardened plaques in myelin of brain/ spinal cord/ optic nerve CSF ⇒ oligoclonal band **Multiple Sclerosis**

fatigue malaise RUQ pain N/V +/- arthralgias +/- jaundice/ dark urine/ pruritis/ light colored stool/ organomegaly

hepatitis

fatigue, malaise anorexia, N/V pruritis, ecchymosis metallic taste in mouth SOB DOE restless legs hx of pericarditis, encepalopathy, seizures

GFR **chronic kidney disease**

exhuasting after usual activities difficulty concentrating and remembering lack of motivation and emotional stability insufficienct energy to initiate and/or maintain usual activities

fatigue

hx of HIV/ autoimmune dz fam hx exposure to pesticides/ hair dye painless diffuse/isolated LAD mediastinal mass abdominal fullness night sweats, fever, WL (B sxs)

BX, CT/PET lugano staging **non-hodgkins lymphoma** (No Reed Sternberg cells!!!!)

LAD fever, HA upper trunk, neck, face rash mucotaneous ulcers myalgia, arthralgia N/V/D

HIV

hypoglycemia N/V WL orthostatic hypotension muscle weakness and pain hyperkalemia hypotension salt craving bronze skin

low cortisol ⇒ cosyntropin stimulation test **adrenal insufficiency** (decrease of androgens and cortisol) **primary- adrenal prob** (addisons disease... also low aldosterone) **secondary- anterior pituitary/ hypothalamic prob**

weakness and fatigue infections increased bleeding hemorrhages and white plaques in eye male chemical/radiation/chemo exposure tobacco MDS downs

\> 20% myeloid blasts (BM and CBC) auer rods **Acute Myeloid Leukemia**

jaundice gallstones dark urine (anemia)

immature, nucleated RBCs, schistocytes **hemolytic anemia**

what are some endocrine/ metabolic causes of fatigue

hypothyroidism- primary vs secondary DM pituitary insufficiency adrenal insufficiency hypercalcemia renal failure hepatic failure

weakness and fatigue infections increased bleeding (anemia)

aplastic anemia

productive cough fever SOB pleuritic CP chills

PNA

glossitis angular cheilitis koilonychia pica dysphagia restless legs

CBC and iron studies IDA

chronic fatigue syndrome triggers

immune destruction infections nutrition deficiency neurally mediated hypotension stress

fever WL night sweats 3 phase: 1. \<10% blasts 2. 10-19% blasts 3. \>20% blasts

philly chromosome/ BCR-ABL **chronic myeloid leukemia**

daytime sleeping snoring, gasping, choking increased risk of HTN, CVA, MI overweight

measure neck circumference **obstructive sleep apnea**

symmetric joint pain AM stiffness for more than 1 hour movement improves bakers cyst MCP and PIP stiffness/ swelling that **spares DIP**

see joint space narrowing and erosions on XRay **Rheumatoid Arthritis**

fatigue is a possible exacerbation of (3)

exertion acute illness nonproductive sleep

Approach to Fatigue Flashcards

(73 cards)