FATIGUE AND SLEEPINESS

Question 1

40 yo F c/o feeling tired, hopeless,
and worthless and of having suicidal
thoughts. She recently discovered that
her husband is homosexual.

Answer 1

Depression CBC
Adjustment disorder TSH
Hypothyroidism HIV/STD testing (given husband’s possible risk factors)
Anemia

Question 2

44 yo M presents with fatigue, insomnia,
and nightmares about a murder that he
witnessed in a mall one year ago. Since
then, he has avoided that mall and has
not gone out at night.

Answer 2

Post-traumatic stress disorder (PTSD) CBC
Depression TSH
Generalized anxiety disorder Calcium
Psychotic or delusional disorder Urine toxicology
Hypothyroidism

Question 3

55 yo M presents with fatigue, weight
loss, and constipation. He has a family
history of colon cancer.

Answer 3

Colon cancer Rectal exam, stool for occult blood
Hypothyroidism CBC, electrolytes, calcium,
Renal failure BUN/Cr, AST/ALT, TSH
Hypercalcemia Colonoscopy
Depression Barium enema

Question 4

40 yo F presents with fatigue, weight
gain, sleepiness, cold intolerance,
constipation, and dry skin.

Answer 4

Hypothyroidism TSH, FT3 ,FT4
Depression CBC
Diabetes Glucose,HbA1c
Anemia

Question 5

50 yo obese F presents with fatigue
and daytime sleepiness. She snores
heavily and naps 3–4 times per day
but never feels refreshed. She also has
hypertension.

Answer 5

Obstructive sleep apnea CBC
Hypothyroidism TSH
Chronic fatigue syndrome Nocturnal pulse oximetry
Narcolepsy Polysomnography
ECG

Question 6

20 yo M presents with fatigue, thirst,

increased appetite, and polyuria.

Answer 6

Diabetes mellitus Glucose tolerance test, HbA1c
Atypical depression UA
Primary polydipsia CBC, electrolytes, glucose
Diabetes insipidus BUN/Cr

Question 7

35 yo M policeman c/o feeling tired and
sleepy during the day. He changed to the
night shift last week.

Answer 7

Sleep deprivation CBC
Sleep apnea Nocturnal pulse oximetry
Depression Polysomnography
Anemia