Fatigue

Question 1

Intro to fatigue

• -what diseases cause it?
• -how many cases?

Answer 1

• -virtually any disease

- -thorough Hx & Px = fatigue in 85% of cases

Question 2

acute fatigue - cause

Answer 2

MC = prodrome or sequela to an acute infection

Question 3

chronic fatigue - cause *

Answer 3

1) psychological (depression, anxiety, stress, etc)
2) chronic disorders (infection, rheumatologic, cardiopulmonary)
3) anemia
4) pharmacological (both prescription & OTC)

Question 4

Physiological fatigue

Answer 4

• -pt recognized the cause of fatigue
• -pt rarely seeks medical advise about the fatigue
• -usually assoc w. lack of sleep or too much work or both

Question 5

organic Vs psychological

Answer 5

Psychological
= depression, anxiety, stress
Organic
= an identifiable non-psychological cause

Question 6

historical nature of organic fatigue

Answer 6

• -short duration
• -worse w. exertion
• -not present in morning
• -more evident as day progresses
• -relieved by rest
• -progressive over time

Question 7

historical nature of psychological fatigue

Answer 7

• -usually longer
• -present/ often worse in morning
• -improves during day
• -not related to exertion

Question 8

associated problems with fatigue

Answer 8

1) anemia: breathlessness, anorexia, weight loss, pallor
2) anxiety: restless, irritable, sweating palps, paresthesias
3) cardiopulmonary: dyspnea
4) chronic pain syndromes

Question 9

precipitating or exacerbating factors

Answer 9

1) Psycho-social
- -suspect: anxiety or stress
2) Medications
- -suspect: pharmacology
3) Work load
- -suspect: work-related fatigue
4) Loss of job or family problems
- -suspect: psychological problems; consider referral to counselor

Question 10

ameliorating (present) factors

Answer 10

1) reduced by rest
- -suspect: physiologic
2) improves on weekends or on vaca
- -suspect: job related
3) improves w/ discontinuing meds
- -suspect: pharm

Question 11

specific populations:

pediatrics (acute Vs chronic)

Answer 11

1) acute = uncommon
- -assoc w/ acute infection
2) chronic = mc w…
- -cancer
- -cardiopulmonary disease
- -drug abuse
- -psychological issues (depression, anxiety)

Question 12

specific populations:

adult

Answer 12

• -acute fatigue = acute infections
• -depression & anxiety MC = chronic fatigue
• -anemia, cancer, endocrine disorders = MC = organic fatigue

Question 13

helpful Dx protocols

Answer 13

1) Hx
2) Vitals
3) Inspection
4) Eyes
5) Ears
6) Nose
7) Throat
8) Neck
9) Thorat
10) Heart & lungs
11) Abdomen
12) NMS–> DTR, sensory, motor

Question 14

helpful labs in Dx =

Answer 14

• -CBC w. differential
• -urinalysis
• -biochemistry profile
• -ESR
• -TSH & FT4 (if suspect hypothyroidism)

Question 15

what to ask: Hx

Answer 15

• -Onset
• -Relation to exertion
• -Fam & social circumstances —Meds
• -Full ROS

Question 16

what to do during: Inspection

Answer 16

Look at: hair, skin & mucous membrane

Question 17

what to look at during: eyes

Answer 17

• -ophthalmoscopic
• -ocular movement
• -peripheral vision

Question 18

what to look at during: ears

Answer 18

• -Otoscopic

- -Rinne & Webber