AKT Clinical Flashcards
A 31-year-old female retail manager comes to your morning surgery complaining of tiredness for about six weeks. She says she has been promoted in her job and reports no stress in her family life. She used to smoke 2–3 cigarettes a day for ten years, but gave up two years ago. She does not think she has lost weight and cannot recall any recent infection, abnormal bleeding, regular periods, cough or dyspnoea. She considers herself fit and healthy but this continued fatigue is bothering her. Her physical examination is unremarkable: temperature 36.4°C, blood pressure 128/72 mmHg, pulse 76 beats/min and regular.
What is the SINGLE MOST appropriate next step? Select ONE option only.
Select one:
A.
Perform further investigations in primary care

B.
Arrange review in 2–3 weeks and investigate further if no better
C.
Tell the patient to come back in a month if no better
D.
Do not investigate further and reassure the patient
E.
Refer the patient to the local chronic fatigue specialist service.
Answer justification and feedback:It would be advisable to offer first-line investigation in this case to exclude any underlying causes especially as this woman’s symptoms have been present for more than a month. First-line tests would include blood tests for full blood count, erythrocyte sedimentation rate or C-reactive protein, liver function tests, renal function tests, thyroid function, random blood glucose/glycosylated haemoglobin (HbA1c) andimmunoglobulin A (IgA) tissue transglutaminase.
Depending on additional factors and the individual presentation, it may also be worthwhile to consider checking bone biochemistry, ferritin, vitamin D level,human immunodeficiency virus(HIV),hepatitis serology and a chest X-ray.
Resource:
NICE.Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (or Encephalopathy): diagnosis and management(CG53).2007.
The correct answer is: Perform further investigations in primary care
