Fatigue

Question 1

46 yo male presents with feeling tired with no energy. 1. What questions to ask? 2. DDx? 3. Test?

Answer 1

1. Onset, Associated events, progression of fatigue, Affecting job/performance, appetite changes, weight changes, feelings of depression, Suicidial ideation, plan, intent, feelings of blame and guilt, sleeping problems, snoring, loss of concentration, cold intolerance, hair/nails/skin changes. 2. Depression, Adjustment Disorder with depressed mood, Hypothyroidism, OSA, PTSD, HIV infeciton. 3. CBC, TSH, Ambulatory nocturnal pulse oximetry, Polysomnography, HIV antibody, MRI -brain

Question 2

32 yo female presenting with fatigue, thirst and bruising on arm. 1. What questions to ask? 2. DDx? 3. Test?

Answer 2

1. Onset, Progression of fatigue, change in vision during day, Affecting job performance, Appetite, Weight changes, Feelings of depression, SIGE CAPS Suicidal ideation, thoughts plan, causes of bruises, physical or emotional abuse, feelings of safety, safety plan, children, feelings of blame or guilt, sleeping issues, Loss of concentration, LNMP, urinary complaints/polydipsia/polyuria/polyphagia/yeast infections/urinary tract infections, Diet, sexual activity. 2. Domestic Violence, Depression, Hypothyroidism, DM, DI, Anemia, Myasthenia gravis. 3. CBC, Iron level, TIBC, Ferritin, B12, BMP, Glucose AIC, UA, TSH, MRI, DDAVP Nasal Spray Test.

Question 3

61 yo male complaining of fatigue and epigastric abdominal pain. 1. What questions to ask? 2. DDx? 3. Test?

Answer 3

1. Onset, progression, Affecting job, Appetite, Weight, SIGE-CAPS, SI/IN/P. NVD/Constipation/Blood, Relation to food, OLDCARTS, radiation, for abdominal pain. Past psychiatric, Diet. 2. Depression, Pancreatic Cancer, Chronic Pancreatitis, Peptic Ulcer Disease, Hypothyroidism. 3. CBC, Stool sample, BMP/Glucose/AIC, Amylase, Lipase, AST/ALT/Bili/Alk phos, TSH, AXR, US or CT abdomen/pelvis, Upper endoscopy.