Chronic fatigue

Question 2

What is chronic fatigue syndrome

Answer 2

Myalgic encephalomyelitis
Long standing fatigue

Question 3

Criteria for fatigue NICE

Answer 3

> 4 months
New or clear onset
Not explained by else eg BMI >40
Significant reduction in activity level
Classically post exertional, delayed onset, lasts >24 hrs

Question 4

What criteria does CFS have to be associated with

Answer 4

Difficulty sleeping
Widespread muscle/joint pain
Cognitive impairment ie poor memory, word finding difficulties, poor concentration
Ongoing flu like symptoms: malaise, painful lymph nodes, sore throat, headahces
Dizziness/nausea/palpitations/orthostatic intolerance

Question 5

Fatigue vs depression

Answer 5

Fatigue - reduced energy, subjective feeling of tiredness or exhaustion
Depression - reduced motivation and enjoyment. Down/weepy/upset. Concomitant fatigue

Question 6

Baseline tests for chronic fatigue

Answer 6

FBC
U&Es
LFTs
TFTs
CRP/ESR
HbA1c
IgA anti-tissue transglutaminse (anti-ttg) - coeliac disease can cause fatigue without GI symptoms

Question 7

What investigations consider in chronic fatigue symptoms if suggestive history

Answer 7

Bone panel/myeloma screen
Vitamin D
EBV/CMV
Lyme serology
HIV/Hepatitis

Question 8

What can be a triggering event for chronic fatigue

Answer 8

Infection w EBV, other viruses, vaccination at a time of stress/exertion

Question 9

Principles of management of chronic fatigue

Answer 9

Coping therapies - educate a patient on condition
Pascing techniques - avoid over exertion, track activity and symptoms

Question 10

What is complex regional pain syndrome

Answer 10

Distal limb affecetd after injury, fracture, surgery or trauma
Chronic severe and debilitating pain within 1 month

Question 11

What causes complex regional pain syndrome

Answer 11

Damage to 1 major nerve or to small sensory and autonoic nerves in area

Question 12

Criteria for complex regional pain syndrome

Answer 12

at least 1 symptom from 3/4 categories:
Sensory -
-allodynia - pain from non painful stimuli
-hyperalgesia - increased/disproportionate pain from painful stimuli eg pinprick

Vasomotor - temp changes, colour changes

Sudomotor - oedema, reduced/increased sweating

Motor/trophic - reduced motor function, nail, skin, hair changes

Question 13

What can be seen on investigation with CRPS

Answer 13

Nerve conduction stidues and MRI can show nerve damage
Normal scan does not rule out CRPS

Question 14

CRPS amputation as management problem

Answer 14

Development of phantom limb syndrome