Fever And Fatigue

Question 1

DDx of fatigue?

Answer 1

PIESAM

1. Psych: depression, anxiety, stress
2. Infection: hepatitis, mononucleosis
3. Endocrinology: DM, hypothiroismn
4. Sleep: OSA, RLS (PLMD)
5. Anemia: period, diet, drinking, meds
6. Malignancy

Question 2

DDx fever?

Answer 2

1. CNS
2. ENT
3. Cardiac
4. Lung
5. GIT
6. Urinary
7. MSK
8. Liver

Question 3

Fever: investigations?

Answer 3

1. Labs:
CBC/D, 
Electrolytes, Ca, Mg
BUN, Cr
TSH, T4
B12, Iron studies (Fe, TIBC, Ferritin, Transferrin)
ALT, AST, ALP, Bilirubin, total protein, Albumin
2. CXR, sleep study, EKG
3. Mammogram, colonoscopy

Question 4

Criteria for Depression

Answer 4

M-SIGECAPS >= 5
M depressed Mood**
S increased/decreased Sleep*
I decreased Interest** (anhedonia)
G Guilt*
E increased/decreased Energy* (fatigue)
C Concentration*
A increased/decreased Appetite* and weight
P Psychomotor agitation/retardation*
S Suicidal ideation*

Question 5

Fatigue: PS VINDICATE

Answer 5

P:
-Psychogenic: Depression, life stresses
-Physiologic: Pregnancy, caregiving demands (young/elderly)
S:
-Sleep: OSA, sleep disorder, shift work
-Sedentary
V: Vascular - Stroke
I: Infectious - Viral (Mono, Hep, HIV), TB
N:
-Neoplastic: Malignancy
-Nutrition: Anemia*
-Neurogenic: Miastenia, MS
D: Drugs - b-bloq, antihist
I: Idiopathic
C: Chronic illnesses - CHF, lung, renal, liver
A: Autoimmune - PMR, sle, ra
T: Toxin - Substance abuse*
E: Endocrine - Hypothiroidism, DM