Tiredness and Fatigue

Question 1

The commonest cause of tiredness is______

Answer 1

psychological distress, including anxiety states, depression and somatisation disorder

Question 2

An Australian study showed that fatigue presents at

a rate of __________

Answer 2

1.4 per 100 encounters

Question 3

Prolonged or chronic tiredness is characterised

clinically by ________

Answer 3

disabling tiredness, typically lasting more than 2 weeks, associated with nonrestorative sleep, headaches and a range of other musculoskeletal and neuropsychiatric symptoms

Question 4

_______is defined as
debilitating fatigue, persisting or relapsing over 6
months, associated with a significant reduction in
activity levels of at least 50%, and for which no
other cause can be found

Answer 4

Chronic fatigue syndrome (CFS)

Question 5

What are the red flags for tiredness?

Answer 5

• Unexplained weight loss
• Sleep disturbance
• Symptoms of depression
• Drug and alcohol abuse
• Persistent fever

Question 6

T or F

Overweight children are likely to fatigue more
rapidly than children of normal weight

Answer 6

T

Question 7

_________causing
recurrent episodes of fever, pharyngitis, malaise and
adenopathy can occur, especially in teenagers, who
present with chronic exhaustion that is frequently
mistaken for malignancy

Answer 7

Chronic EBV infection

Question 8

When should the bereavement stage should have been compensated?

Answer 8

With
time, usually around 6 to 12 months, a compensated
stage is reached, fatigue gradually abates, and the
patient resumes normal activities

Question 9

Factors leading to ‘abnormal grief

reaction’,

Answer 9

• unexpected death
• high dependence upon the dead person
• guilt feelings, especially in a love/hate
relationship

Question 10

Burnout is a clinical syndrome with three components:
1
2
3

Answer 10

• long-term emotional exhaustion
• depersonalisation of others and
• lack of personal accomplishment

Question 11

How does burn out differ with stress-related depression

Answer 11

It is similar to stress-related depression but mood

lowering is temporary and work-specific

Question 12

ICD classifies burn out as?

Answer 12

‘problems related to life management’ as a

‘state of vital exhaustion’

Question 13

_______syndrome that arises when a person who has a
strong neurotic need to succeed in a particular task
becomes confronted with the impossibility of success
in that task

Answer 13

burnout

Question 14

Mx of burnout

Answer 14

Management involves appropriate counselling, which
aims to help the patient to identify life stressors, set
realistic personal goals and develop good support
mechanisms.

Question 15

This complex syndrome, which causes profound
and persistent tiredness, is also referred to as
myalgic encephalomyelitis, chronic neuromuscular
viral syndrome, postviral syndrome, chronic
EBV syndrome, viral fatigue state, epidemic
neuromyasthenia, neurasthenia, Icelandic disease,
Royal Free disease and Tapanui disease

Answer 15

Chronic fatigue syndrome

Question 16

What are the Typical features of CFS

Answer 16

• extreme exhaustion (with minimal physical effort)
• headache or a vague ‘fuzzy’ feeling in the head
• aching in the muscles and legs
• poor concentration and memory
• hypersomnia or other sleep disturbance
• waking feeling tired

Question 17

Other features of CFS

Answer 17

• emotional lability/anxiety
• depressive-type illness, mood swings
• arthralgia (without joint swelling)
• sore throat
• subjective feeling of fever (with a normal
temperature

Question 18

What virus is CFS related to?

Answer 18

Epidemiologically it has been related to Coxsackie

B virus infections

Question 19

Mechanism of CFS

Answer 19

Immune system dysfunction with
chronic overproduction of cytokines (e.g. interferon)
is a possible pathogenetic mechanism

Question 20

Duration of sx for CFS

Answer 20

6 mos

Question 21

PE findings for CFS

Answer 21

Apart from mild pharyngeal infection, cervical
lymphadenopathy or localised muscle tenderness, the
physical examination is normal

Question 22

What Tx may work for CFS

Answer 22

Cognitive behaviour therapy appears to help some
patients, as do relaxation therapy, meditation, stress
management and psychotherapy, where indicated

Question 23

What is the emphasis in the Mx of CFS?

Answer 23

The emphasis should be placed on caring, rather

than curing, until a scientific solution is found

Question 24

_________affects 5% of the American
population with a peak age of 35 years (range 20–60)
and a female:male ratio of 10:1. T

he management is similar to CFS but the prognosis less optimistic

Answer 24

Fibromyalgia