042815 fatigue

Question 1

hyponatremia can cause fatigue: true or false

Answer 1

true

Question 2

essential ques to ask pt w fatigue

Answer 2

what do you mean by fatigue/tired

sleep?
meds?
psych/mood?
these 3 are the most common causes

PMH
alcohol (won’t sleep soundly)

Question 3

what tests do you want to do on someone w fatigue

Answer 3

BMP
CBC
glucose
thyroid
polysomnography

Question 4

grief resolves by

Answer 4

1 yr

Question 5

meds to tx depression

Answer 5

SSRIs (onset of action can take 4-6 wks)
SNRIs
TCAs
MAOIs
bupropion (inhibits dopamine and NE reuptake)-no sexual side effects

mirtazapine (alpha 2 blocker, 5HT2 and 5HT3 receptor antagonist)

Question 6

list SSRIs

Answer 6

fluoxtine, sertraline, paroxetine, citalopram, escitalopram, fluvoxamine

Question 7

list SNRIs

Answer 7

venlafaxine, desvalafaxine, duloxetine, milnacipran, sibutramine

Question 8

list TCAs

Answer 8

amitriptyline, nortriptyline, imipramine, desipraimne, clomipramine, doxepin, amoxapine

Question 9

list MAOIs

Answer 9

tranylcypromine, phenelzine, isocarboxazid, selegiline

eating tyramine foods can cause HTN crisis

Question 10

serotonin syndrome

Answer 10

high fever, autonomic instability, seizures, confusion, myoclonus, flushing

can be caused by combining SSRI with MAOI or TCA or SNRI or meperidine or tramadol or St John’s Wort

Question 11

risk of seizures esp in eating disorder pts

Answer 11

bupropion

Question 12

list 3 possible endocrine causes for fatigue and the order in which you would evaluate them

Answer 12

adrenal insufficiency
hypothyroidism
hypercalcemia

Question 13

how would you evaluate for adrenal insufficency

Answer 13

do ACTH stimulation

if cortisol low, then get lab ACTH

Question 14

how would you evaluate for hypothyroidism

Answer 14

lab TSH

Question 15

how would you evaluate for hypercalcemia

Answer 15

get serum Ca
look at possible causes:
albumin level
vit D
phosphorous
urine Ca (rules out familial hypocalciuric hypercalcemia)
PTH (if LOW, PTHrP)
abd XR (kidneys)
bone mineral density study

Question 16

where is Ca absorbed in gut

Answer 16

duodenum

jejunum

Question 17

signs and symptoms of hypercalcemia

Answer 17

fatigue and weakness

constipation, nausea/vomiting, abd pain/ulcers

osteoporosis

renal stones, polyuria and polydipsia

neuro/cogn: impaired memory, drowsiness, coma, etc

Question 18

PTH dependent causes of hypercalcemia

Answer 18

primary hyperPTH (common, could also be due to MENs)
FHH (mutation in Ca sensing receptor of parathyroid)
parathyroid carcinoma (EXTREMELY RARE)

Question 19

PTH independent causes of hypercalcemia

Answer 19

sarcoidosis
lytic lesions
vit D toxicity (extremely hard)
PTHrP
MALIGNANCY (PTHrP, osteolytic mets)

Question 20

tx for hyperparathyroidism

Answer 20

surgery if symptomatic

medical management: hydration, avoid Ca sparing diuretics, normal Ca intake, optimize vit D, use calcimimeitc like cinacalcet