Fatigue Flashcards
(13 cards)
which ddx to include in pt complaining of fatigue
DEPRESSION - 18.5% of cases
Red Flags (6)
Recent onset in a well elderly person
Focal neuro deficits (CNS malignancy, MS)
Inflammatory signs or joint pain (autoimmune)
Lymphadenopathy, weight loss (Malignancy)
Chest pain/Dyspnea - anemia, heart failure
Fever - hidden infx or malignancy
fatigue that does not improve with rest is often associated with
psychological conditions,
medication side effects
or substance use
sleep apnea 3 quick qsts
i. Snoring
ii. Waking up from sleep
iii. Daytime sleepiness
Investigations
- CBC for hb
- ferritine
- Electrolytes including calcium
- A1C + fasting glu
- Renal and hepatic function tests
- TSH
Broad categories of ddx (9)
Psychiatric/Psychogenic (50%)
Pharmacologic
Endocrine-metabolic
Neoplastic
Infx
Cardiopulmonary
Rheumatological
Sleep disorder
Idiopathic (chronic fatigue, fibromyalgia)
Chronic Fatigue Syndrome (Systemic Exertion Intolerance Disease)
> 6 months duration, requires all of:
Impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities
- Accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
- Post-exertional malaise
- Unrefreshing sleep
- And at least one of: Cognitive impairment or Orthostatic intolerance
tx of Chronic Fatigue Syndrome
Treat comorbid (sleep disorder, mood)
Psychotherapy
Graded exercise therapy
ddx Psychiatric/Psychogenic (50%)
Depression
Anxiety
Somatization
Substance use
Malnutrition
ddx Pharmacologic
Antihypertensives, antidepressants, hypnotics
ddx Endocrine-metabolic
Hypothyroidism
Diabetes mellitus
Pitutiary insufficiency
Hypercalcemia
Adrenal insufficiency
Chronic renal failure
Hepatic failure
ddx infx
Endocarditis
Tuberculosis
Mononucleosis
Hepatitis
Parasitic disease
HIV
CMV
ddx cardiopulm
Anemia
CHF
COPD
