CASE 34 - Fatigue

Question 1

I am drinking a lot of water, doctor. What do you think the reason is?

Answer 1

At this point I don’t know for sure, but I want to run some tests.

Drinking a lot of water could be the first sign of diabetes, and we will need to check for that.

Question 2

Specific Qs:

Answer 2

1. Being physically or emotionally hurt or abused by anybody?
2. Feeling safe/afraid at home.
3. Have you ever experienced any head trauma or accidents as a result of your husband?
4. Are the children being abused or threatened?
5. Suicidal thoughts/plans/attempts.
6. Feelings of blame/guilt?
7. Presence of guns at home?
8. Any family members who know about the abuse?
9. Sleeping problems.

Question 3

PEx:

Answer 3

1. Head and neck exam ==> Inspected conjunctivae, mouth and throat, lymph nodes, examined thyroid glands.
2. CV ==> A.
3. Chest ==> A.
4. Abdo ==> A + P + P.
5. Extr ==> I + motor exam + DTRs.

Question 4

DDx:

Answer 4

1. Domestic violence.
2. DM.
3. Anemia.

(……)

Question 5

Workup:

5

Answer 5

1. Serum glucose, HbA1c.
2. CBC.
3. Serum iron, ferritin, TIBC, B12.
4. UA.
5. Electrolytes.
6. MRI brain (pituitary protocol).
7. DDAVP nasal spray test (“vasopressin challenge test”).