Fatigue

Question 1

What are common malignant causes of fatigue?

Answer 1

Leukemia, lymphoma, plasma cell disorders, metastatic solid tumors, paraneoplastic disorders, secondary hematologic causes

Question 2

What are some history q’s to ask for a possible hematology pt w fatigue?

Answer 2

Fever or night sweats?
Bleeding (GI, GU, etc)
LN swelling?
Early satiety or weight loss
Prior hx of tx for cancer?

Question 3

What are some possible causes of SOB in hematologic fatigue pt?

Answer 3

Pleural effusion, pericardial effusion, anemia, constrictive pericardial sx, LAD

Question 4

What should you look for on PE for evidence of hematologic dz?

Answer 4

petechiae, purpura, ecchymoses, hematoma, hemarthrosis, telangiectasis

Question 5

What is the ONE TEST you should always order if suspecting anemia?

Answer 5

The reticulocyte count!

Question 6

Labs and clinical features of iron deficiency

Answer 6

microcytic hypochromic anemia presenting w constitutional symptoms
Have decreased serum iron and ferritin, but increased TBIC

Question 7

What is one way to know if a pt has anemia of chronic disease?

Answer 7

doesn’t respond to iron supplementation

Question 8

What is factitious anemia?

Answer 8

Anemia due to autophlebotomy - could have underlying psychiatric disease

Question 9

Mechanical anemia

Answer 9

feet striking ground repeatedly causes damaged of RBCs in capillaries on plantar surface of feet.
common in marathon runners. tx w padded footwear

Question 10

Cardiac anemia

Answer 10

usually mild but found in pt w severe aortic stenosis and pt w prosthetic valves and ongoing lysis of RBCs

Question 11

Enzyme deficiency

Answer 11

Has heinz bodies, collections of denatured Hb.
found early in G6PD pt. also have bite cells once Hb is removed by macrophages.
normocytic normochromic anemia

Question 12

Lead anemia

Answer 12

hemolytic anemia interfering w cation pump and shortening RBC tine line

slows production of RBCs in marrow

Question 13

Malaria

Answer 13

MC cause of hemolytic anemia in the world

can have severe hemolysis w dark urine bc of hemoglobinuria

Question 14

Tx of warm ab hemolytic anemia

Answer 14

most aren’t in danger but transfusions can be helpful - watch for cross matching hemolysis
steroids in high doses can cause long-lasting remission
Immunosuppressives can also be of benefit
sometimes need splenectomy if pt requires chronic steroid use

Question 15

clinical signs of polycythemia vera

Answer 15

facial rubor, pruritis w hot water, and signs of hyper viscosity.
Splenomegaly in 70%

Question 16

DDx of PV

Answer 16

hemoconcentration, COPD, EPO producing tumors (RCC and neuroendocrine), hemoglobinpathy w high affinity Hb

Question 17

Evaluation of PV

Answer 17

PE, CBC, CMP, dehydrated? EPO and US of kidneys maybe.

Want to evaluated lungs w PFT

Question 18

what is a common mutation in PV?

Answer 18

JAK, esp w normal EPO levels

Question 19

Tx of PV?

Answer 19

Phelbotomy

Question 20

What is the typical definition of fatigue?

Answer 20

Difficulty initiating or maintaining voluntary mental or physical activity

Question 21

If a patient complains of fatigue and is then also noted to have muscle weakness, what should be your next step?

Answer 21

Localize to CNS, PNS, NMJ, or muscle

Question 22

What disease has fatiguability of muscle power as a presenting sx?

Answer 22

Myasthenia Gravis - diminution of force that muscle generates on repeat contraction

Question 23

Episodic fatigue can be a premonitory sx of _____

Answer 23

migraine

Question 24

Fatigue combined w true muscle weakness, hair loss, dry skin, weight gain, cold intolerance, constipation is likely to be ______

Answer 24

Hypothyroidism

Question 25

If a person is fatigued, and has heat intolerance, sweating, and palpitations they probably have _______

Answer 25

hyperthyroidism

Question 26

Adrenal insufficiency can manifest w fatigue and ?

Answer 26

Anorexia, weight loss, nausea, myalgia, and arthralgia

Question 27

Mild hypercalcemia v severe hypercalcemia

Answer 27

Mild –> a lil fatigue

Severe –> lethargy, stupor, coma

Question 28

Which two chronic organ specific diseases can cause fatigue?

Answer 28

Liver failure and chronic kidney disease

Question 29

Which two cardiopulm diseases often have fatigue as a sx negatively affecting QOL?

Answer 29

Congestive heart failure and COPD

Question 30

Which symptoms associated w fatigue should raise the alarm for malignancy or occult infection?

Answer 30

fever, chills, night sweats, weight loss

Question 31

What should be given special attention in the SHx?

Answer 31

Life stressors, work hours, social support, domestic affairs

Question 32

Fatiguable weakness does not have ______ like patients with fatigue normally do

Answer 32

Breakaway weakness

Question 33

If at pt has widespread MSK pain w tender points what should you be considering?

Answer 33

Fibromyalgia

Question 34

What is a reasonable lab workup in pt presenting w faitgue?

Answer 34

CBC w diff
Electrolytes 
Glucose 
Renal fxn
Liver fxn
Thyroid fxn

Question 35

Which cytokines in early aggressive leukemia or lymphomas are responsible for causing fatigue?

Answer 35

IL-1, IL-6, IL-8

Question 36

Which drugs could reduce fatigue sx?

Answer 36

Psychostimulants like amphetamines, modafinil, and armodafinil