2010 Fatigue Flashcards
Features of nonpathologic fatigue includes all the following except:
A. Lasts fewer than 3 months
B. Does not have an identifiable cause
C. is self limiting
D. Is related to lifestyle or situational factors
B.
Fatigue is considered nonpathologic if it lasts fewer than 3 months and has an identifiable cause. It is often a consequence of lifestyle and situational factors such as lack of sleep or stress. Nonpathological fatigue is self-limited or treatable by treating the underlying condition or illness.
Features of pathologic fatigue include all of the following EXCEPT: A. mild functional impairment B. Higher incidence in rural settings C. Association with chronic illness D. Duration of greater than 6 months
A.
Pathologic fatigue is associated with severe impairment of functional activity, is associated with chronic illness and has a higher incidence in rural settings. It is considered prolonged if lasts 1-5 months and chronic if lasting 6 months or longer
Fatigue associated with Chronic Fatigue Syndrome is characterized by: A. improvement with mild exertion B. slow insidious onset C. no improvement with rest D. decrease in mRNA post exercise
C.
Fatigue associated with Chronic Fatigue Syndrome tends to be exacerbated after even mild exertion. It often occurs over a few hours or days and is to alleviated by rest. Postexercise fatigue is associated with increase in mRNA of the genes
Which of the following four models of cognitive fatigue has the best supportive evidence for decrease in behavioral performance?
A. Decrease in cognitive performance over prolonged period of time
B. Impaired performance during sustained mental exertion
D. Cognitive fatigue after challenging physical exertion
D.
The conceptualization of cognitive fatigue resulting in impaired performance during sustained (i.e. maintaining cognitive vigilance) rather than prolonged mental effort provides the best explanation for decrease in behavioral performance. There is limited evidence to support the other models.
Which of the following is true when studying fatigue in persons with multiple sclerosis?
A. The Fatigue Severity Scale is reliably correlated with performance on the neuropsychologic testing.
B. There is a good correlation between cognitive impairment and self-reported fatigue
C. Performance differences on tests are usually attributed to fatigue
D. Subjective fatigue did not correlate with performance accuracy.
D.
Subjective fatigue did not correlate with performance accuracy over the course of a continuous working memory task. There is no significant correlation between fatigue reported on the fatigue severity scale and performance on a variety of neuropsychologic measures. There is also no association between cognitive impairment and self-reported fatigue and multiple sclerosis. Performance differences on tests cannot be attributed to fatigue in the same MS subject.
Basal ganglia involvement in central fatigue is strongly correlated in all of the following disorders EXCEPT: A. fibromyalgia B. Parkinson disease C. Multiple sclerosis D. Postpolio syndrome
A.
A number of disorders that are characterized by central fatigue as a symptom of a strong association to basal ganglia disease and/or involve disconnection between the prefrontal cortex and the thalamus. These disorders include Parkinson disease, multiple sclerosis, postpolio syndrome, and depression. The evidence for basal ganglia involvement in central fatigue appears to be quite compelling. Fibromyalgia is not discussed in this context.
What is fMRI able to demonstrate when measuring cognitive fatigue in persons with multiple sclerosis compared to healthy controls?
A. There is no difference in brain activity across time between the two groups.
B. Subjective fatigue closely correlates with cognitive fatigue in patients with MS but not controls.
C. Healthy controls demonstrate decreased brain activity over time
D. Performance accuracy highly correlates with greater increase in brain activity.
C. When trials of sustained attention task were administered during fMRI in persons with MS and healthy controls, performance accuracy did not differ between MS and control groups. Subjects with MS showed greater increase in brain activity across time relative to who demonstrated decreased brain activity over time. Subjective fatigue was not assessed in these trials.
In the neural model of primary and secondary fatigue, which of the following can be considered a factor that initiates primary fatigue? A. sleep disturbance B. Depression C. Parkinson D. Pain
C.
There are factors that initiate fatigue (systemic disease), and these are distinct from those that perpetuate or exacerbate it, such as sleep disturbance, depression, and pain. This distinction has been described as primary fatigue (those that initiate fatigue) versus secondary fatigue.
Which aspect of dysregulation of the hypothalamic pituitary-adreal axis is described as a biologic feature of Chronic Fatigue Syndrome?
A. decreased glucocorticoid sensitivity of immune cells
B. Exaggerated cortisol diurnal secretion
C. Higher than normal basal cortisol secretion
D. Excessive glucocorticoid signaling
A.
Dysfunction of the HPA axis is characterized by decreased glucocorticoid sensitivity of immune cells, flattened cortisol diurnal secretion, lower than normal cortisol secretion and insufficient glucocorticoid signaling.
Which of the following is NOT associated with the chronic symptoms of Chronic Fatigue Syndrome? A. Elevated pro-inflammatory cytokines B. Hypoactivity of the HPA axis C. elevated plasma C reactive protein D. Active viral load
D
The chronic symptoms of the syndrome are unlikely to co-exist with active infection. Acute viral infection studies found that intial infection severity was the single best predictor of persistent fatigue. Pro-inflammatory cytokine levels and C-reative proteins have been shown to be elevated in patients with CFS. Chronic fatigue has also been attributed to the hypoactivity of HPA axis.
