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PCM III Final > Fatigue > Flashcards

Fatigue Flashcards

1
Q

what is the broad differential for fatigue?

A

DEAD TIRED

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2
Q

Fatigue:

A

sensation of exhaustion after usual activities OR
insufficient energy to begin usual activities.

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3
Q

what is some pt terminology for fatigue?

A

fatigue = tired = lack of
energy = excessive sleepiness = weakness =dyspnea on exertion
= depressed = and so on. A

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4
Q

whats a good way to get clarification for fatigue?

A

“What does your [fatigue] keep you from doing?” or some
other description of impact on life.

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5
Q

whats a high yield question for fatigue?

A

Is there anything in your life that
changed around the onset of your [fatigue] that might account
for your symptoms?

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6
Q

-Fatigue accounts for (BLANK) of patients seeking care in
primary care.

A

21-33%

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7
Q

-An estimated cost to employers exceeding (BLANK) in lost
productivity

A

$136 billion

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8
Q
  • Multiple studies indicate that (BLANK) of patients in primary care
    have an organic cause for their fatigue.
  • Laboratory tests identify as few as (BLANK) of patients source of
    fatigue.
A

~15%

5%

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9
Q

what is the stepwise approach to fatigue?

A
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10
Q

what is there are no new stressors, meds, or symptoms of bleeding?

A
  1. Ask about anxiety & depression
  2. Obtain a sleep history
  3. Perform complete ROS & PE

Obtain CBC, TSH, CMP,UA, other testing depending on risk
factors. May include HCV (see below).

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11
Q

what are the components of sleep history?

A
  1. What time do you go to bed?
  2. How long does it take to you fall asleep?
  3. How often do you get up during the night?
  4. Do you nap during the day?
  5. Do you drink alcohol in the evening?
  6. Do you feel rested when you wake in the morning?
  7. Do you exercise? What time of day?
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12
Q

social history for fatigue

A

-Inquire about work and life stressors as well as support
system.
- Be vigilant for signs of abuse (partner/spouse) or neglect.
- Alcohol and/or drug use/abuse
- Other social determinant of health such as poverty, food
insecurity, homelessness, etc.

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13
Q

special pops for fatigue

A

Hepatitis C (HCV) screening is recommended for men who have
sex with men, anyone with a history of injection drug use or
persons born between 1945 – 1965.

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14
Q

what are some endocrine ROS for fatigue?

A

unintentional weight change (do you wear the same size
clothes?); constipation or other changes in bowel habits,
polyuria, polydipsia, polyphagia, palpitations; hair or skin
changes; cold intolerance; anorexia; etc.

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15
Q

what are some PE for fatigue?

A

VS—tachycardia or bradycardia; objective weight change
from previous visits
General: temporal or muscular wasting?
Neck: palpate thyroid
Skin: assess turgor, flaking/dryness

Hair: tug test, alopecia;
Nails for brittleness/dryness
Neuro: DTR & muscle strength

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16
Q

what should you look for in FH with fatigue?

A

DM or thyroid dysfunction

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17
Q

anemia PMH

A

renal disease

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18
Q

anemia ROS

A

Pica; Blood loss (menstrual, stool, urine); heartburn or
indigestion symptoms (peptic ulcer or esophagitis?); dental
problems (painful or difficult chewing); dizziness or syncope;
weakness; unintentional weight loss,

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19
Q

anemia meds

A

supplements that interfere with iron absorption
(H2 blockers,

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20
Q

anemia diet

A

vegan or vegetarian–plant sources of heme are less
absorbable

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21
Q

wellness exams to do for anemia

A

colonoscopy (age dependent); pelvic exam

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22
Q

what SH questions should you ask for anemia?

A

alcohol use? Poverty or isolation?

23
Q

what should you look for in FH with anemia?

A

colon CA or other cancer

24
Q

what should you do for PE for anemia?

A

VS –tachycardia, hypotension or orthostatic hypotension
General: general pallor or palmar pallor;
HEENT: glossitis, angular chelitis
CV: auscultate for new murmurs;
Nails: cyanosis, cap refill
Abd: complete exam to assess for masses, changes in organ
size, etc.
Rectal: fecal occult blood test
Symptoms or signs of bleeding: Obtain CBC

25
insomnia
Difficulty falling asleep or staying asleep or early awakening despite the opportunity for sleep.
26
acute insomnia
often stress related; consider new medications and/or medication side-effects
27
chronic insomnia
at least 3 nights/week for 3 months; irregular sleep cycle (shift workers, travel, etc.)
28
what are some components of sleep hygiene?
x Establish a sleep pattern-go to bed and rise at the same time every DAY x AVOID lying in bed sleepless. After 20-30 minutes, get out of bed; engage in mundane activities until you feel sleepy. x The bedroom ONLY is for sleep and sex. x Avoid naps \> 30 minutes long x Avoid eating 3 hours before lying down x Avoid drinking 1 hour before lying down
29
Treatment of Acute Insomnia
Review Sleep Hygiene Aerobic exercise improves sleep quality Limit Caffeine, alcohol and stimulants
30
Secondary treatment insomnia:
pharmacologic - Titrate lowest effective dose with short half-life - Limit use to 2-4 times/week
31
pharmocologic treatment insomnia
Benzodiazepines Benzodiazepine receptor agonists Tricyclic Antidepressants Trazodone Diphenhydramine
32
Primary Prevention of sleep disorder:
Healthy lifestyle that includes exercise, stress reduction and proper sleep habits
33
Obstructive Sleep Apnea (OSA):
Temporarily stop or decrease breathing during sleep for at least 10 seconds. Incidence increases with age, obesity, M \> W. ≥15 events/hour is diagnostic for OSA.
34
Apnea:
Complete obstruction of airflow.
35
Hypopnea:
oxygen desaturation of ≥3% or arousal from sleep.
36
Gold standard for diagnosis: of sleep apnea
Polysomnography (aka sleep study): Combined evaluation of sleep, breathing and movement. -Electroencephalography (EEG) assesses brain activity associated with stages of sleep (non-REM and REM). -Breathing is assess by sensors that detect nasal airflow, pulse oximetry and respiratory effort. -ECG monitors for rate and rhythm -Limb EMG leads analyze periodic limb movements
37
Treatment OSA:
-risk factor modification: weight loss, smoking cessation, avoid alcohol or hypnotics prior to sleep -Continuous Positive airway pressure (CPAP): pneumatically splints upper airway throughout sleep cycle
38
less common treatments OSA
oral appliances that advance the mandible and open the pharyngeal airway -Surgery: considered second line unless there are anatomic abnormalities -Tracheostomy for life-threatening disease that fails other treatments.
39
complications of untreated OSA
- increase of motor vehicle accidents - hypertension - heart failure - impaired glucose tolerance - increase risk of CVA
40
Periodic Limb Movement Disorder: aka Restless Legs
-Urge to move the legs, accompanied by the uncomfortable or unpleasant sensation of ‘crawling’ on legs. -Legs twitch or move every 20-24 seconds during non-rem sleep. -bed partner complains of kicking or restlessness -more common after age 30 -primary cause of insomnia in 17% of patients
41
periodic limb movement disorder Diagnosed
during Polysomnography (sleep study)
42
treatment periodic limb movement disorder
``` dopamine agonists (pramipexole or ropinirole) OR anti-epileptics (gabapentin, pregabalin or carbamazepine) ```
43
managment of fatigue
Identification of acute stressors that may interfere with sleep Identification of lifestyle or behaviors that disrupt sleep cycle Screen for depression, anxiety
44
what are some things you must not miss with fatigue?
Anemia, Hypothyroid or Diabetes Depression or Anxiety Obstructive Sleep Apnea
45
anterior chapmans points for hypothyroid
46
biomechanical model hypothyroid
-Thoracic Somatic, OA, and Rib somatic dysfunctions related to somatovisceral reflexes
47
Respiratory-Circulatory Model hypothyroid:
- Lymphatic Restrictions - Mesenteric Lift (if constipated)
48
Neurological Model hypothyroid:
-Sympathetic innervations for head and neck: T1-4 -Sympathetic innervations for distal transverse colon to rectum: T12-L2 -Parasympathetic innervations head and neck as well as GI tract until proximal transverse colon: CN X-Vagus -Parasympathetic innervations to distal transverse colon to rectum: S2-4 -Chapman’s Points
49
Metabolic Model hypothyroid:
- \*Hormone treatment\* - Rule out related auto immune disorders - Consider iodine intake if needed
50
Behavioral Model hypothyroid:
Exercise Proper nutrition Therapy/psychiatric referral(depression)
51
posterior chapmans points for hypothyroid
52
Anterior Chapmans for Thyroid:
Second intercostal space
53
General Treatment of Chapman’s Point for Thyroid:
Firm but gentle rotary movement over anterior and/or posterior Champan’s Point.
54
Visceral Somatics for Thyroid:
Sympathetic: T1-4 Parasympathetic: CN X(Vagus)

PCM III Final (11 decks)

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