Fatigue Flashcards
1
Q
Definition
A
- Feeling of exhaustion during or at end of activity
2. Feeling of inadequate energy to begin activities
2
Q
Most common 6 causes of fatigue
A
- Viral illness
- Upper respiratory illness
- Iron deficiency anemia
- Chronic bronchitis
- Medication
- Depression
3
Q
Classifying fatigue
A
- Origin
a. Central
b. Peripheral - Attributed to
a. Physical illness
b. Psychological
c. Social
d. Physiological
e. Occupational - Duration
a. Recent 1 month
c. Chronic >6 months
4
Q
Types of clinically evaluated chronic fatigue
A
- Chronic fatigue syndrome->Myalgic encaphalomyelitis
2. Idiopathic chronic fatige
5
Q
Common etiology (20)
A
Common 1. Psychiatric Insomnia disorder Depression 2. Endocrine Hyper/hypothyroid Diabetes melitus 3. Infection EMV Influenza HIV Tuberculosis Toxoplasmosis 4. Drugs Drug dependence Alcohol Medication induced 5. Neurological Stroke 5. Cardiovascular/Respiratory Chronic heart failure AF MI COPD 6. Metabolic Iron-deficiency anaemia Iron deficiency without anaemia
6
Q
Uncommon etiology to consider
A
1. Malignancy MDS CML NHL HL 2. Psychiatric Chronic fatigue Restless leg 3. Renal failure 4. GIT Celiac 5. Metabolic Vit B deficiency 6. Neurological Parkinson's 7. Infections CMV Brucelliosis 8. Autoimmune SLE Primary biliary cirrhosis
7
Q
The 7 step approach to diagnosis of fatigue
A
- Characterise the fatigue
- Elicit presence of complaints which may suggest an underlying organic illness
- Evaluate medication and substance use
- Psychiatric screening
- Ask about sleep
- Physical examination
- Investigations
8
Q
History (19)
A
1. Characteristics of fatigue Duration, onset, recovery period Impact of rest Impact on physical activity or mental activity Level of physical activity Seasonality and influenza outbreak 2. Risk factors Age, residence/travel (TB exposure) Work with cows, uncooked meat, kitten Immunosuppression Occupational, recreation (ticks) IVDU, unprotected sexual intercourse (HIV) Sleep deprivation/sedentary CV risk factors Steatorrhea, weight loss (celiac) Sore throat, lymphadenopathy Fever, cough, runny nose (influenza) Menomettorrhagia Polyuria, polydipsia Orthopnea, PND Visual field (MS) Heat/cold, diarrhea/constipation (thyroid) Arthralgia, rash Weight loss, blood in stool Neurological symptoms History of stroke 3. Evaluation of medication 4. Psychiatric Anxiety Depression Somatisation Substance 5. Drugs and alcohol CAGE AUDIT
9
Q
Physical examination
A
- General
- MSE
- Pallor, tachycardia, systolic ejection murmurs: anaemia
- Blue sclera: iron deficiency
- Jaundice, palmar erythema, Dupuytren’s contracture: chronic liver disease
- Goitre or thyroid nodule, dry skin, delayed deep tendon reflexes, peri-orbital puffiness, ophthalmological changes: hypothyroidism
- Weight loss, hyper-reflexia, tachycardia, atrial fibrillation, fine tremor, goitre: hyperthyroidism
- Hypotension, pigmentation in skin creases, scars, and buccal mucosa: Addison’s disease
- Increased central adiposity, dry skin, reduced muscle mass and strength, visual field defects, circulatory collapse (if acute presentation): hypopituitarism
- Lip pursing, prolonged expiration, wheezing, cyanosis: COPD
- Pulmonary stasis, elevated jugular venous pressure, ankle oedema: heart failure
- Lymphadenopathy and/or hepatosplenomegaly: malignancy, chronic liver disease, HIV infection, EBV, cytomegalovirus, brucellosis
- Decreased breath sounds and presence of rales (secondary bacterial pneumonia): influenza infection
- Pruritus, excoriations, xanthelasma: primary biliary cirrhosis
- Red butterfly rash on the face, joint deformity: SLE
- Tender points evaluation: fibromyalgia
- Tremor, rigidity, bradykinesia: Parkinson’s disease
- Loss of sensation to light touch and vibration: diabetes mellitus
- Babinski’s reflex, ataxic nystagmus: multiple sclerosis
- Erythema migrans, arthralgia: Lyme disease.
10
Q
Investigations
A
Initial: FBC w/ differential ESR if >65 UEC LFTs Fasting glucose CK CMP TSH and free T4
Other considerations:
ECG, cardiac enzymes, CXR
Consider further testing depending on history and examination
HIV/hepatitis/EBV serology
Anti-tissue transglutaminase and enomysial antibodies
