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PCM IV Final > 3. HYHO: Fatigue > Flashcards

3. HYHO: Fatigue Flashcards

1
Q

What is fatigue CLINICALLY?

A
  1. Exhausted after usual activities
  2. Not enough NRG to begin usual activities
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2
Q

Fatigue can mean many things, what is a good way to diagnose if it is clinical?

A
  • What does your fatigue keep you from doing? (how does it impact life)
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3
Q

HIGH YEILD QUESTION for FATIGUE

A

Is there anything in your life that changed around the onset of your fatigue?

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4
Q

DEAD TIRED MNEUMONIC

A

Differential for Fatigue

  1. D = depression
  2. E = environment/lifestyle
  3. A = anxiety/anemia
  4. D = DB/endocrine
  5. T = tired, tumors
  6. I = infection
  7. R = rheumatologic
  8. E = endocarditiis/ CV
  9. D = drugs
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5
Q

____ only ID 5% of sources of fatigue.

A

Lab tests = only 5%.

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6
Q

Fatigue: what do we do next?

  1. Recent stressor is ID’d =>
  2. New meds/substance abuse =>
  3. Sign/sx of bleeding =>
A
  1. Recent stressor is ID’d => give support, discuss sleep and re-eval in 1 month
  2. New meds/substance abuse => adjust or stop substance and re-eval in 1 month
  3. Sign/sx of bleeding => get CBC
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7
Q

If we cannot ID new stressor, pt is not on new meds/no substance abuse, bleeding, then what do we do?

A
  1. Ask about anxiety/depression
  2. Get sleep history
  3. Perform complete ROS and PE
  4. Get labs: CBC, TSH, CMP, UA, other tests
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8
Q

What to ask in sleep history?

A
  1. What time do you go to bed
  2. How long does it take to go to bed
  3. How often do you wake up at night
  4. Do you nap during day?
  5. Drink alcohol in evening?
  6. Do you feel rested in morning
  7. Do you exercise? What time?
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9
Q

__________ = better sleep patterns

A

regular sleep cycle (going to bed and waking up at same time)

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10
Q
  • restorative sleep = _________ quality of sleep
  • ___________ can be stimulating and delay onset of sleep
A
  • high quality of sleep
  • exercise in evening
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11
Q

What should be asked in social history of fatigue?

A
  1. Work/life stressors and support system
  2. Look for signs of abuse/neglect
  3. Alcohol/drugs
  4. Poverty, food insecurity, homeless
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12
Q

When should HepC screenings be done?

A
  1. MSM
  2. HX of injection drug
  3. Born in between 1945-65
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13
Q

ROS for endocrine causes of fatigue

A
  1. Unintentional weight change
  2. Changes in bowel habits
  3. Polyuria/dipsia
  4. Polyphagia
  5. Palpitations
  6. Hair/skin changes
  7. Cold intolerance
  8. Anorexia
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14
Q

Anemia (=> Fatigue)

  1. PMH
  2. ROS
  3. Medications
  4. Diet
A
  1. PMH = renal dx
  2. ROS = PICA, blood loss, heart burn/indigestion (PUD/esophagitis), dental problems, dizziness/syncope; weakness
  3. Meds = drugs that interfere with iron absorption (H2 blockers)
  4. Diet = vegan/vegetarian
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15
Q

Anemia (=> Fatigue)

  • Wellness
  • SH
  • FH
A
  • Wellness = colonoscopy and pelvic exam
  • SH = alcohol, poverty or siolation
  • FH = colon CA/cancer
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16
Q

Anemia

  • VS
  • General
  • HEENT
  • CV
A
  • VS = tachycardia, hypotension, orthostatic hypotension
  • General = pallor
  • HEENT = glossitis, angular chelitis
  • CV = auscultate for new murmurs
17
Q

Anemia

  • Nails
  • Abdominal
  • Rectal
  • If bleeding present =
A
  • Nails = cyanosis, cap refill
  • Abdominal = complete exam to look for massess/ changes
  • Rectal = fecal occult blood test
  • If bleeding present = get CBC
18
Q

What is insomnia?

    • Causes of acute insomnia?
    • Definition and causes of chronic insomnia?
A
  • [Difficulty falling asleep/ staying asleep] or [waking up early despite opportunity for sleep].
  • Acute insomnia => stress, new meds or side effects
  • Chronic insomnia => at least 3 nights/week/ 3months = irregular sleep cycle (shift workers)
19
Q

Sleep hygiene

  1. If cant fall asleep for 20-30 min =>
  2. Avoid naps ____ long
  3. Avoid eating _____ before lying down
  4. Avoid drinking ____ before lying down
A
  1. Do mundane activities till sleepy
  2. > 30 min
  3. 3 hrs
  4. 1 hr
20
Q

Tx of acute insomnia

A
  1. Review sleep hygeine
  2. Aerobic exercise
  3. Decrease caffeine, alcohol, stimulants
21
Q

Secondary treatment of insomnia

A

Secondary treatment => pharmacologic (benzos AGO, tricyclic antidepress, trazodone, diphenhydramine)

  1. @ lowest dose with short 1/2 life only 2-4 times/week
22
Q

Primary prevention of sleep disorders

A
  • Healthy lifestyle (exercise, stress reduction, good sleep habits)
23
Q

Obstructive sleep apnea (OSA)

  1. ​What is it?
  2. RF?
  3. __ events/hr = diagnostic
  4. Gold standard for dx
A
  • Temporarily stop or decrease breathing during sleep for at least 10 seconds.
  • Increase age, obesity, men
  • >15 events/hr
  • Polysomnography (sleep study) = assess sleep, breathing and movement
24
Q

Difference between apnea and hypopnea

A
  • Apnea = Complete obstruction of airflow.
  • Hypopnea = oxygen desaturation of ≥3% or arousal from sleep
25
Q
  1. _____ = dx tool used to assess brain activity associated with nREM and REM sleep
  2. ________ = monitors rate and rhythm of breathing
  3. ________ = analyzes period limb movements
A
  1. EEG
  2. ECG
  3. Limb EMG
26
Q

Treatment of OSA

A
  1. Modify RF: lose weight, stop smoking, do not take alcohol/hypnotics before bed
  2. Continous CPAP
  3. 2nd line: surgery
  4. Life threatening: tracheostomy
27
Q

Complications of untreated OSA

A
  1. MVA
  2. HTN
  3. HF
  4. Impaired glucose tolerance
  5. Increase risk of CVA
28
Q

A common cause of insomnia where legs twitch/moveq20-24 secondsduringnon-remsleep +crawling on legs

A

Periodic Limb Movement Disorder

29
Q

Periodic Limb Movement Disorder

  1. More common after ___YO
  2. Diagnose
  3. Treatment
A
  1. 30YO
  2. Polysomnography
  3. DA AGO (pramipexole or ropinirole) or ANTI-EPILEPTICS (gabapentin, pregbalin, carbamazepine)
30
Q

Management of fatigue

A
  1. ID acute stressors, lifestyle or behaviors that disrupt sleep
  2. Screen for depression/anxiety
31
Q

When dx fatigue, what must we make sure NOT to miss?

A
  1. Anemia, Hypothyroid, DB
  2. Depression/anxierty
  3. OSA
32
Q

OSE for Hypothyroid

  • Anterior Chapmans Pt:
  • Viscerosomatic (parasympsthetic/sympathetic):
A
  • 2nd ICS (firm, gentle movement)
  • VS
    • Sympathetic = T1-4
    • Parasympathetic = CN 10 (Vagus)
33
Q

OSE for Hypothryoid

  1. Biomechanical
  2. Respiratory-Criculatory
  3. Neurologic
A
  1. OA, thoracic and rib SD
  2. Lymphatics and mesenteric lift if constipated
  3. Viscerosomatics
    1. Sympathetic
      1. head and neck = T1-4
      2. Distal transverse colon - rectum: T12-L2
    2. Parasympathetics
      1. CN X (vagus)
      2. S2-4 (distal transverse colon => rectum)
    3. Chapmans
34
Q

OSE for Hypothryoid

  • Metabolic
  • Behavioral
A
  • Metabolic = hormone treatment; R/O AI disorders, take iodine
  • Behavorial = exercise, nutrition, therapy and psychiatrist if depressed

PCM IV Final (12 decks)

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