Dealing With Diagnostic Uncertainty- Fatigue

Question 1

Answer 1

3 months history
Crying
Started after a flu - Post viral? Sore throat
Medical hx - no real hx, Asthma?
Medication: Iron tablets 
Gynae- heavy menses
Vegan
Full time student, works part time at law firm
S- Poor sleep, cannot get out of bed 
N:
A:
P: Can do ADLs, but finding normal excercise difficult 

DDX:

V:
I:
N:
D:
I:
C:
A:
T:
E:
Fhx: Mother Rheumatoid arthritis

Question 2

Answer 2

Differential diagnosis

Probability
Red flags
Often missed
Masquerades 
Patient? Do they want to tell you something 
Tell

Question 3

What specific examination will you undertake in this patient:

Answer 3

Point of care tests:

1) BSL
2) Urinalysis + beta HCG
3) Investigations: HBA1C , FBC-looking at Hb, and elevated, iron studies, looking at microcytic/macrocytic anaemia, TSH-T3,T4, Inflammatory markers (CRP, RA, ESR- screening for chronic inflammatory conditions, e/lfts

Question 4

What are you going to do with your patient? (Fatigue)

Answer 4

Hx, Physical, office based, consider further investigations

Question 5

Answer 5