39. Fatigue

Question 1

Name redflags : Fatigue (6)

Answer 1

• Recent onset in a well elderly person
• Focal neuro deficits (CNS malignancy, MS)
• Inflammatory signs or joint pain (autoimmune)
• Lymphadenopathy, weight loss (Malignancy)
• Chest pain/Dyspnea
• Fever

Question 2

Name DDX categories of fatigue (9)

Answer 2

• Psychiatric/Psychogenic (50%)
• Pharmacologic
• Endocrine-metabolic
• Neoplastic
• Infectious
• Cardiopulmonary
• Rheumatological
• Sleep disorder
• Idiopathic (chronic fatigue, fibromyalgia)

Question 3

Name DDX Fatigue : Psy/Psychogenic

Answer 3

• Depression
• Anxiety
• Somatization
• Substance use
• Malnutrition

Question 4

Name DDX Fatigue : Pharmaco

Answer 4

Antihypertensives, antidepressants, hypnotics

Question 5

Name DDX Fatigue : Endocrine-metabolic (7)

Answer 5

• Hypothyroidism
• Diabetes mellitus
• Pitutiary insufficiency
• Hypercalcemia
• Adrenal insufficiency
• Chronic renal failure
• Hepatic failure

Question 6

Name DDX Fatigue : Infectious (7)

Answer 6

• Endocarditis
• Tuberculosis
• Mononucleosis
• Hepatitis
• Parasitic disease
• HIV
• CMV

Question 7

Name DDX Fatigue : Cardiopulmonary (3)

Answer 7

• Anemia
• CHF
• COPD

Question 8

Describe physical exam : Fatigue

Answer 8

• General appearance
• Lymphadenopathy
• Thyroid (Goiter, nodule, ophthalmologic changes)
• Cardiopulmonary (CHF, lung disease)
• Neurologic (Muscle bulk, tone, strength, reflex, sensory, cranial nerve)

Question 9

When to do investigations for fatigue

Answer 9

Consider delaying 4w unless fatigue >3mo

Question 10

Name labs for fatigue

Answer 10

• CBC
• Electrolytes (glucose, creatinine)
• LFT
• TSH
• Pregnancy test
• ESR/CRP
• UA
  ___
  Consider
• Celiac screen (Anti-TTG, IgA)
• CK if pain or muscle weakness
• Tuberculosis, HIV, Hepatitis C (born 1945-1965)

Question 11

Describe : Chronic Fatigue Syndrome (Systemic Exertion Intolerance Disease) (4)

Answer 11

6 months duration, consider Chronic fatigue syndrome, requires all of:

• Impairment in the ability to engage in pre-illness levels of occupational, educational, social, or personal activities -> Accompanied by fatigue, which is often profound, is of new or definite onset (not lifelong), is not the result of ongoing excessive exertion, and is not substantially alleviated by rest;
• Post-exertional malaise
• Unrefreshing sleep
• And at least one of: Cognitive impairment or Orthostatic intolerance

Question 12

Describe tx : Chronic Fatigue Syndrome (Systemic Exertion Intolerance Disease) (4)

Answer 12

• Treat comorbid (sleep disorder, mood)
• Psychotherapy
• Graded exercise therapy