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Clinical Problem Solving > 8 - Tired All the Time > Flashcards

8 - Tired All the Time Flashcards

1
Q

List 2 symptoms of obstructive sleep apnea.

A
  1. Snoring (usually snore-silence-snore)

2. Tiredness

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2
Q

How would heart failure lead to a swollen ankle?

A

Heart would be unable to pump effectively, causing a backlog of fluid in the ankles

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3
Q

How many globin chains does hemoglobin have?

A

4 (2 alpha, 2 beta)

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4
Q

Describe how diseased lungs in COPD put strain on the heart.

A

Diseased lungs ->
Less oxygen in the blood ->
Heart must pump faster to compensate

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5
Q

What is edema?

A

Swelling due to excessive fluid accumulation

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6
Q

Why would lung problems lower blood oxygen?

A

Lungs are the site where oxygen is transferred from the air to the blood

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7
Q

Which hormones control the overall metabolic rate of the body?

A

Thyroid hormones

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8
Q

NSAIDs can irritate the gastric mucosa, causing bleeding and ulcers. What would be the effect on stools?

A

Become black and tar-like

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9
Q

Compare lack of physical energy and lack of psychological motivation.

A

Lack of physical energy: want to do things but can’t
Lack of psychological motivation: can do things but don’t
Note: often interact

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10
Q

Define anemia.

A

Lack of RBC or hemoglobin

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11
Q

Older age of onset, obesity, and lack of exercise are indicative of which type of diabetes?

A

Type 2

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12
Q

A patient can’t make enough hemoglobin. List 3 nutritional deficiencies that could cause this.

A
  1. Lack of iron
  2. Lack of vitamin B9
  3. Lack of vitamin B12
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13
Q

List 3 risk factors for obstructive sleep apnea.

A
  1. Male
  2. Obese
  3. 40+
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14
Q

How may patients reduce orthopnea?

A

Sleeping propped up or sitting on a chair

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15
Q

Orthopnea (breathlessness when lying down) is a symptom of late stage heart failure. Describe its mechanism.

A

Lying flat ->
Blood rushing into the torso ->
Accumulation of fluid in the lungs ->
Breathlessness

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16
Q

Define menorrhagia.

A

Abnormally high menstrual bleeding

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17
Q

What is the result of untreated type 1 diabetes?

A

Death

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18
Q

What blood test would determine if a patient is anemic?

A

Full blood count (FBC)

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19
Q

Type 2 diabetes is mostly due to insulin ___.

A

Resistance

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20
Q

Describe how diseased lungs in COPD may increase blood pressure.

A

Diseased lungs ->
Less oxygen in the blood ->
Heart pumps faster to compensate->
High blood pressure

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21
Q

Why would a patient with sleep apnea exhibit a snore-silence-snore cycle?

A

The pharynx repeatedly collapses, blocking the airway each time

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22
Q

Which investigation method would you use to monitor COPD?

A

Spirometry

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23
Q

List 2 drugs that protect against GI bleeding by neutralizing stomach acid.

A
  1. Antacids

2. PPIs (proton pump inhibitors)

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24
Q

List 3 mechanisms by which COPD obstructs the airways.

A
  1. Swelling of airways
  2. Accumulation of mucus
  3. Destruction of lung parenchyma
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25
Q

Explain how high glucose levels in urine lead to dehydration and thirst.

A

Glucose drains cells of water via osmosis ->
Excessive urine production ->
Dehydration and thirst

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26
Q

List 2 reasons why foot ulceration occurs in diabetic patients.

A
  1. NEUROPATHY causes numbness to injury

2. BLOOD VESSEL DAMAGE prevents healing from injury

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27
Q

List 3 mechanisms that can damage lung alveoli.

A
  1. Edema
  2. Fibrosis
  3. Infection
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28
Q

What is the most common pulmonary function test?

A

Spirometry

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29
Q

How would upper GI bleeding cause tiredness?

A 
Blood loss -> 
Anemia -> 
Reduced oxygen levels in the body -> 
Slowed metabolism -> 
Tiredness
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30
Q

Why would iron deficiency cause anemia?

A

Iron is an integral component of hemoglobin

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31
Q

In COPD and asthma, which structure becomes swollen and filled with mucus?

A

Airways

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32
Q

List 2 long-term eye complications of type 2 diabetes.

A
  1. Retinopathy

2. Cataracts

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33
Q

At what stage of life do most cases of type 1 diabetes present?

A

Early

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34
Q

What is parenchyma?

A

FUNCTIONAL tissue (as opposed to connective or supporting tissue)

35
Q

List 3 conditions that slow cell metabolism via chemical disruption.

A
  1. Renal failure
  2. Malignancy
  3. Post viral fatigue
36
Q

What is the effect of hypothyroidism on metabolic rate?

A

Lowers it

37
Q

How does diabetes cause tiredness?

A

Blood glucose (source of fuel) cannot enter the cell due to insulin deficiency or resistance

38
Q

What is the most common cause of death in patients with type 2 diabetes?

A

Heart disease (75%)

39
Q

By what mechanism does type 1 diabetes deplete insulin levels?

A

Causes auto-immune destruction of beta cells, which produce insulin

40
Q

List 3 physical signs you would monitor in a type 2 diabetes patient.

A
  1. Weight (for increase)
  2. Eyes (for retinopathy or cataracts)
  3. Feet (for neuropathy)
41
Q

Which 2 mental illnesses are common causes of tiredness in primary care?

A
  1. Depression

2. Anxiety

42
Q

Air goes enters and exits the lungs through capillaries covering which structure?

A

Alveoli

43
Q

List 3 cellular disturbances that might cause a patient to present with lack of physical energy.

A
  1. Lack of FUEL
  2. Lack of OXYGEN
  3. Disrupted METABOLISM
44
Q

Define melena.

A

Black, tar-like stool associated with upper GI bleeding

45
Q

How would heart failure lead to pulmonary edema?

A

Heart would be unable to pump effectively, causing a backlog of fluid in the lungs

46
Q

What is the term used to describe breathlessness in a patient when lying flat?

A

Orthopnea

47
Q

What is the term used to describe fluid accumulating in the lungs?

A

Pulmonary edema

48
Q

A patient is losing hemoglobin faster than they can make it. List 2 possible mechanisms.

A
  1. Blood loss

2. Hemolysis

49
Q

What is the preferred fuel for cells?

A

Glucose

50
Q

Which part of hemoglobin is attached to a ferrous ion?

A

Heme molecule

51
Q

What is a long-term foot complication of type 2 diabetes?

A

Ulceration

52
Q

A patient with a long history of smoking presents with chronic cough, shortness of breath, and recurrent infections. Which of the following is the most likely diagnosis:

a) COPD
b) Asthma
c) Obstructive sleep apnea
d) Anemia

A

COPD

53
Q

What is the effect of excess insulin on blood glucose levels?

A

Blood glucose lowered

54
Q

How does heart failure lower the amount of oxygen in the tissues?

A

Decreased pumping activity ->

Blood not carrying enough oxygen to the tissues

55
Q

What is the pharynx?

A

Passageway leading from the mouth and nose to the esophagus and larynx

56
Q

Define hemorrhage.

A

Bleeding from a ruptured vessel

57
Q

What is the underlying pathology of sleep apnea?

A

Recurrent collapse of the pharynx

58
Q

List 3 symptoms of peripheral neuropathy.

A
  1. Numbness
  2. Tingling
  3. Pain
59
Q

Spirometry screens for lung function. Which 2 metrics does it test?

A
  1. VOLUME of exhalation or inhalation

2. SPEED of exhalation or inhalation

60
Q

Which two clinical conditions are the most common causes of heart failure in the UK?

A
  1. Coronary heart disease

2. Hypertension

61
Q

List 3 causes of COPD.

A
  1. Smoking
  2. Pollution
  3. Occupation (involving exposure to biomass fuels)
62
Q

Why would a patient with heart failure feel breathless?

A

Heart’s inability to pump blood causes a backlog of fluid in the lungs (i.e., pulmonary edema), leading to breathlessness

63
Q

How might a full blood count (FBC) indicate anemia?

A

By showing reduced RBC or hemoglobin levels

64
Q

CO is a colorless, odorless gas produced by burning organic fuels. List 3 situations that can lead to CO poisoning.

A
  1. House fires
  2. Faulty domestic appliances
  3. Exhaust fumes (e.g., from vehicles)
65
Q

List 5 ways to manage COPD.

A
  1. Quit smoking
  2. Reduced exposure to pollution
  3. Physiotherapy
  4. Inhalers
  5. Steroids
66
Q

List 2 reasons why patients with COPD develop a lot of sputum.

A
  1. Increased number of GOBLET CELLS

2. Enlargement of AIRWAY MUCOSA

67
Q

Compare CO and O2’s affinity for hemoglobin.

A

CO: higher
O2: lower

68
Q

List 4 long-term complications of diabetes.

A
  1. Blood vessel damage
  2. Nerve damage
  3. Eye damage
  4. Kidney damage
69
Q

What is the impact of sickle cell disease on the lifespan of red blood cells?

A

Shorter lifespan due to weakness caused by repeated cycles of sickling and de-sickling

70
Q

What is the most common cause of peripheral neuropathy?

A

Type 2 diabetes

71
Q

What is the normal lifespan of RBC?

A

120 days

72
Q

List 4 factors of particular importance when taking a history for anemia.

A
  1. Blood loss (e.g., GI conditions, menorrhagia)
  2. Diet (i.e., iron, vitamin B9, vitamin B12)
  3. PMH (e.g., rheumatoid arthritis, stomach resection, bowel resection)
  4. FH (e.g., hemolytic anemia)
73
Q

What is the effect of insulin deficiency or resistance on blood glucose levels?

A

Raised blood glucose

74
Q

What is the effect of insulin resistance on the amount of glucose entering the cell?

A

Decreased glucose entering the cell

75
Q

Describe how diabetes leads to osmotic diuresis.

A

Glucose drains cells of water via osmosis ->

Excessive urine production

76
Q

List 2 conditions that decrease the blood’s capacity to CARRY oxygen.

A
  1. Anemia

2. CO poisoning

77
Q

How does CO poisoning lower blood oxygen?

A

Inhibits O2 from binding by binding with hemoglobin in its place

78
Q

Define diuresis.

A

Excessive urine production

79
Q

A patient was diagnosed with type 2 diabetes. They are struggling to maintain their blood glucose. List 3 tests you should order.

A
  1. HbA1c (monitors long-term glucose control)
  2. Renal function test (checks for kidney failure)
  3. Cholesterol (checks for CVD risk)
80
Q

What is peripheral neuropathy?

A

Damage to the peripheral nerves, causing numbness, tingling, and pain

81
Q

List 4 dietary recommendations you would make to a diabetic patient.

A
  1. Reduce sugar intake
  2. Reduce fat intake
  3. Eat food with a LOW GLYCEMIC INDEX
  4. Increase fibre intake
82
Q

How does anemia lower blood oxygen?

A

Fewer RBC or hemoglobin molecules ->

Fewer binding sites for oxygen

83
Q

What is a long-term kidney complication of type 2 diabetes?

A

Renal failure

Clinical Problem Solving (10 decks)

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