fatigue

Question 1

drug ass with fatigue

Answer 1

beta blockers, TCA, benzo, hyponotics, opoids, neuropathic pain medication, sedating antihitamine, antipsychotics, caffeine, alcohol

Question 2

precipitating factors of fatigue

Answer 2

briefment, infection,

Question 3

symptoms of fatigue

Answer 3

lack of energy
difficulty or inability to initiate activity 
reduced capacity to maintain activity 
exhaustion after usual activity 
difficulty with concentration and memory

Question 4

what does fatigue mean

Answer 4

excessive sleepiness
exertional dyspnoea
muscle weakness

Question 5

what sleep history to ask

Answer 5

 Sleep quantity and quality, sleep hygiene
 Insomnia, hypersomnia
 Snoring, apnoea, daytime sleepiness
 Risk factors for obstructive sleep apnoea

Question 6

some ddx for fatigue

Answer 6

Fevers, change in weight, night sweats, dyspnea
Bleeding (GIT, menstrual)
Anaemia, Hypothyoridism, Diabetes Mellitus
?undiagnosed cancer, cardiac, pulmonary, renal, liver,
rheumatologic, chronic infection

Question 7

investigation for fatigue

Answer 7

Full Blood Count
ESR or CRPRandom or fasting blood glucose
Thyroid Stimulating Hormone (TSH)
Biochemistry: electrolytes, liver function tests, renal function tests
especially if fatigue > 6 months
+/- Endomysial antibodies / tTGA
+/- Hepatitis/HIV serology

Question 8

classify causes of fatigue

Answer 8

psychiatric, sleep disorder, stress and high demand, physical disorders

Question 9

common cause of fatigue

Answer 9

Tiredness>Viral disease>Iron deficiency anaemia>Depressive disorder>Mental disorder>Infectious mononucleosis>Anaemia >Infectious disease

Question 10

Causes of fatigue present for ≥ 2 weeks

Answer 10

Depression>Other psychiatric disorders (mainly anxiety, dysthymia)> Boredom, overwork, other types of unhappiness>Alcohol misuse>
Obstructive sleep apnoea>Fibromyalgia> anaemia, DM, hypothyroidism, infection, cancer

Question 11

Management of fatigue < 6 months

Answer 11

 Treat underlying cause / co-morbidities
 Address underlying psychosocial stressors
 Sleep Hygiene
 Exercise and activity

Question 12

Chronic fatigue

Answer 12

Non-specific (idiopathic) chronic fatigue
> 90%

Chronic Fatigue Syndrome (systemic exertion intolerance disease)
< 10%

Question 13

chronic fatigue sydnrome dx

Answer 13

reduction in functinal compacity

post-exerional malaria, unfreshing sleep, cognitive impairment or osthostatic intolerance

Question 14

Chronic Fatigue Syndrome Management

Answer 14

 Cognitive behavioural therapy (CBT)

 Graded exercise therapy

Question 15

Manifestations of fatigue

Answer 15

 Impaired performance – increased risk of errors and accidents
 Increased probability of falling asleep / micro sleeps
 Subjective feelings of drowsiness or tiredness
 17 hrs awake: cognitive impairment ∞ BAC ̴0.05, 24 hrs – > ∞ BAC ̴0.1
 Psychological, social, cardiovascular, metabolic consequences

Question 16

Workplace factors predicting higher fatigue risk

Answer 16

> 70 hours worked in a seven day period
≥ 14 consecutive hours worked in a seven day period
One full shift of at least 24 hours
No short breaks taken on shift
Overtime > 20 hours
≥ 3 night shifts or extended hours into night shift during a seven day period
No stable shift direction
Job demands: sustained concentration for extended periods of time

Question 17

Rostering

Answer 17

Forward shift rotation
‘Fast rotation’
≥ 8 hours continuous sleep before
commencing next shift
Maximum 3-4 consecutive night shifts
Regular time (≥ 24 hours) free of work in a seven day period

Question 18

Individual measures for shift work

Answer 18

 Diet: low fat, high protein, avoid high sugar
 Ensure well hydrated
 Strategic use of caffeine
 Strategic napping e.g. 2am – 3am
 beware > 30 minutes (sleep inertia)
 Shield morning light exposure
 Avoid use of sedative hypnotics to facilitate sleep
 Avoid driving home if fatigued

Question 19

Sleep Hygiene

Answer 19

 Preparation for sleep
 Avoid light emitting screens
 Consistent sleep-wake schedule
 Avoid caffeinated beverages after lunch or 4-6 hours
prior to bedtime
 Avoid alcohol near bedtime
 Exercise > 4-5 hours before bedtime
 Air conditioning, block-out curtains, sound insulation