Case 34 - 32 yo F with fatigue

Question 1

Gathering information

Answer 1

SIG E CAPS
Hypothyroidism - cold intolerance, weight gain, hair loss, constipation
Menstrual period
Urinary symptoms (polyuria, pain during urination or change of urine color, polydipsia)

For domestic violence, ask:
Physically or emotionally hurt or abused by anyone
Feeling safe or afraid at home
Any head trauma or accidents as a result of your husband
Children being abused or threatened
Suicidal thoughts/plans/attempts
Feelings of blame or guilt
Presence of guns in the home
Have you told anyone about the abuse, including family members?
Emergency plan
Sexual activity

Question 2

Physical examination

Answer 2

Head and neck exam (conjunctivae, mouth and throat, lymphadenopathy, thyroid exam)
Neurologic (DTRs, motor exam)

Question 3

Closure

Answer 3

Domestic violence counseling:
I care about your safety and am available for help and support. Everything we discuss is confidential, but I must involve CPS if your children are being harmed.
Support group information and safety planning

Question 4

Differential diagnosis

Answer 4

Domestic violence (admits to physical abuse, self-blame, attempts to defend husband, abuse of child, bruises on extremities)
Diabetes mellitus (polyuria, polydipsia, obesity, family history)
Iron deficiency anemia (fatigue/weakness, heavy menstrual flow, conjunctival pallor)

Question 5

Diagnostic work-up

Answer 5

HbA1c
Serum glucose
Serum iron, ferritin, TIBC, serum B12
UA
Electrolytes