38. Fatigue

Question 1

Give an overview of the Assessment in Tiredness/fatigue?

Answer 1

• Onset/duration
• pattern of fatigue- on exertion (organic cause), worst in morning and never goes (depression)
• associated symptoms- breathlessness, weight, anorexia, appetite, chronic pain
• sleep patterns- early waking?snoring?unrefreshed in mornings?daytime sleepiness?
• psych hx
• alcohol/smoke/drugs/meds
• patient worries/social/relationships

Question 2

common organic causes of fatigue?

Answer 2

Anemia, 
DM, 
Asthma, 
Infections (EBV, CMV, hepatitis), 
perimenopausal, 
hyper-hypo thyroidism
sleep apnoea

Question 3

investigations for fatigue?

what if symptoms last longer than 6 weeks and no organic cause?

Answer 3

Urine (dipstick for protein, glucose and blood)
Blood- FBC, ESR, CRP, U&E, LFT, RFT, Ca, TFT, random glucose, coeliac, CK

if no organic cause, and symptoms last longer than 6-12 weeks- psychogenic….

Question 4

Give 2 examples of psychologic fatigue?

Answer 4

depression, anxiety, bereavement, lifestyle factors

Question 5

Give 2 examples of pharmacologic fatigue?

Answer 5

alcohol, antidepressants, antihypertensives, hypnotics, drug withdrawl

Question 6

Give 2 examples of endocrine fatigue?

Answer 6

hypothyroid,
DM,
Adrenal disease (addisons and cushings),
chronic renal & kidney failure, hypercalcemia,
hypolkalemia,
hypomagnesia,
perimenopausal

Question 7

Give 2 reasons for hypercalcemia?

Answer 7

primary hyperparathyroidism (adenoma) (Stones, bones, groans and psych overtones)

secondary hyperparathyroidism (in early its hypocalcemia, late stage kidney disease hypercalcemia)

malignancy (solid tumours and leukemias)

Increased absorbtion of Ca due to hypervitaminosis D (increased calcium absorbtion due to intake of vit D in hypoparathydism)

Question 8

Give 2 examples of infectious fatigue?

Answer 8

• -TB and other chronic infections
• -Viral (EBV, infectious mono, hepatitis, CMV, influenza)
• -Bacterial endocarditis

Question 9

Give 2 examples of sleep disturbances causing fatigue?

Answer 9

sleep apnea, GERD, chronic pain

Question 10

Give 2 examples of neuromuscular reasons for fatigue?

Answer 10

PArkinsons, MS, MND, MGravis

Question 11

Give 2 examples of connective tissue diseases causing fatigue?

Answer 11

RA, Polymyalgia

Question 12

Give 2 examples of Cardiac causes of fatigue?

Answer 12

Chronic CHF, Ischemic heart disease

Question 13

give reasons for hypokalemia?

Answer 13

increased entry into cells if there is increased availability of insulin

diuretic use

Question 14

give examples of idiopathic fatigue?

Answer 14

‘fibromyalgia’
chronic fatigue syndrome
idiopathic chronic fatigue