Fatigue Flashcards
A 45-year-old divorced female presents with fatigue for the past nine months In addition, she has muscle aches, insomnia, sleep that is not refreshing and poor concentration. On examination, there are no abnormal findings. CBC, CMP, TFTs, FOB and ESR are normal.
Chronic fatigue syndrome
A 54-year-old male presents with progressive weakness, vomiting and weight loss. On examination, BP is low and the skin is hyperpigmented, especially in skin creases. CMP shows hyperkalemia and hyponatremia. Serum cortisol levels fail to rise after administration of ACTH.
Addison’s disease
A 46-year-old female presents with fatigue and excessive weight gain. She also complains of menstrual irregularity. On examination, her BP is 160/100. She is hirsute. Her face is round and she has a fatty hump just below her neck. There are purple striae on her abdomen. CMP reveals hyperglycemia, hypernatremia and hypokalemia. Her ACTH levels are markedly elevated. CT scan shows small adenoma in the pituitary gland.
Cushing’s disease (menstrual issues, weight gain and hirsutism indicate polycystic ovarian disease, but she is older than reproductive age; would need further imaging to confirm enlarged ovaries as well)
A 42-year-old male complains of fatigue for the past month. On further inquiry, his appetite is poor. He has trouble sleeping and can’t concentrate at his job. He is sad and has lost his sex drive. There is nothing worthy of note on examination. CBC, CMP and thyroid function tests are normal.
Depression
A 79-year-old female presents with fatigue and orthopnea. She complains that her ankles are swollen, especially towards the end of the day. On examination, there is bilateral pitting ankle edema, a positive hepatojugular reflex and distended jugular veins. Her B-type Natriuretic Peptide level is elevated over 500 pg/dL. Chest x-ray shows cardiomegaly, prominent pulmonary vessels and Kerley B lines.
Congestive heart failure
An overweight 51-year-old female complains of fatigue and vulvar itching. She also complains of increased urinary frequency, increased thirst and eating too much. On examination, a red inflamed vulva with a cheesy white discharge is revealed. CMP shows a glucose level of 325 mg/dL and there is glycosuria in the urinalysis. Analysis of the vaginal discharge shows fungal organisms with buds and branching hyphae.
Type II diabetes mellitus with accompanying vulvovaginal candidiasis
A 35-year-old female presents with fatigue. She complains of weight loss in spite of a good appetite. On examination, BP is 150/96. There is bilateral exophthalmos and a diffuse goiter. Her DTRs are brisk (3+) and she has a fine tremor in both hands. Thyroid function test show and elevated T3 and low TSH.
Graves disease (hyperthyroidism)
A 67-year-old female presents with lack of energy and constipation for the past two months. Her hair has been falling out and her voice has deepened also. On examination, there is loss of the outer third of her eyebrows and her DTRs are slow to relax. TFT reveals low T3 and T4 with an elevated TSH.
Primary hypothyroidism (secondary hypothyroidism would have low TSH as well)
A 35-year-old female presents with fatigue and diplopia. She says that her arms get tired easily, especially when she has to brush her daughter’s long hair. She also complains that her jaw gets tired when she chews. On examination, there is bilateral ptosis and increasing muscle fatigue of the deltoid muscle with repetitive contraction. Chest x-ray shows a mass in the anterior mediatinum. Tensilon test is positive.
Myasthenia gravis
A 35-year old African male presents with raised purplish bumps on his legs and arms, and currently has a sore throat. He reports having several previous infections, but the most recent felt like the flu. On examination, his temperature is 101 and slight muscle pain. Labs indicate the presence of p24 antigens. ELISA antibody test is positive.
HIV
A 75-year-old vegan female complains of fatigue, weight loss and a sore tongue. On examination, her tongue has a beef-red color. CBC shows an elevated MCV with a normal MCHC. There are numerous hypersegmented neutrophils present.
B12 deficiency
A 6-year-old boy presents with constipation and his mother reports his behavior as “difficult.” The mother also reports her child has lost weight and is lethargic. On examination, the child has a blue gum line has some muscle pain. CBC indicates a low RBC and low iron.
Lead poisoning
A 69-year-old black man presents with fatigue and bone pain, predominantly in his back. He reports unintended weight loss and has had recurrent infections in the past. On examination, he has weakness and numbness in both legs. Kidney function test reveals beginning stages of renal failure. Urinalysis showed an M-spike and the presence of Bence-Jones proteins. Bone marrow biopsy revealed rapid beta-2 microglobin cell division.
Multiple myeloma (beta-2 microglobin cells are also called myeloma cells)
A 45-year-old Scot walks in complaining of back pain and fatigue. He also says his hearing and vision “aren’t what they used to be.” He reports that he just had to buy a new hat because his old one didn’t fit anymore. On examination, his legs are numb and tingling. X-ray revealed both femurs are bowed and the L4 and L5 IVFs are encroached. CBC revealed elevated alkaline phosphatase.
Paget’s disease
A 35-year-old female presents with fatigue and diplopia. She says that her arms feel tired, but she feels stronger as she uses them. On examination, there is bilateral ptosis and decreasing muscle fatigue of the bicep muscle with repetitive contraction. Chest x-ray shows a mass in the anterior mediatinum. Tensilon test is negative.
Lambert-Eaton syndrome
