PC: Tiredness

Question 1

when exploring tiredness what other questions do you need to be asking

Answer 1

timing: when it started, acute/gradual onset, duration, progression and is it intermittent or continuous
tiredness: what do they actually mean, their sleep pattern, how it affects the patient

associated symptoms;

• anaemia: breathlessness on exertion
• hypothyroidism: constipation, weight gain, cold intolerance
• depression
• diabetes

Question 2

what are the main differentials for tiredness

Answer 2

anaemia
hypothyroidism
diabetes
depression

others to consider

stress
post viral fatigue 
organ failure 
drugs (illegal, beta blockers, diuretics) 
malignancy 
chronic inflammatory diseases 
chronic infection (TB)
Addisons disease

Question 3

what clues would help differentiate anaemia

Answer 3

breathlessness on exertion
weakness
may get palpitations, worsening angina, worsening claudication

Question 4

what clues would help differentiate hypothyroidism

Answer 4

constipation
cold intolerance
weight gain

Question 5

what clues would help differentiate diabetes

Answer 5

polydipsia/ thirst
polyuria
weight loss
visual disturbance

Question 6

what clues would help differentiate depression

Answer 6

core: low mood, anhedonia
biological: poor sleep, lack of energy
future: hopelessness, suicidal thoughts

Question 7

what differential are you thinking of if you here these symptoms;
breathlessness on exertion
weakness
may get palpitations, worsening angina, worsening claudication

Answer 7

anaemia

Question 8

what differential are you thinking of if you here these symptoms;
constipation
cold intolerance
weight gain

Answer 8

hypothyroidism

Question 9

what differential are you thinking of if you here these symptoms;
polydipsia/ thirst
polyuria 
weight loss 
visual disturbance

Answer 9

diabetes

Question 10

what differential are you thinking of if you here these symptoms;

core: low mood, anhedonia
biological: poor sleep, lack of energy
future: hopelessness, suicidal thoughts

Answer 10

depression