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DDx > Fatigue and Weight Loss > Flashcards

Fatigue and Weight Loss Flashcards

1
Q

History of Fatigue Questions

A
  • Use Specific Questions
  • What does tired mean to you?
  • What can you not do now that you could before?
  • Trouble initiating activity or sustaining it?
  • Sleep habits and psychiatric, drug EtOH screening
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2
Q

Common Presenting Symptoms with Fatigue

A
  • Affects performance

- Strains social relations

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3
Q

T/F: Fatigue is always due to a primary issue.

A

False, it could be secondary to other medical conditions, physiologic, or chronic.

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4
Q

How often does lab work assist in creating a dx for Fatigue?

A

5% of the time

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5
Q

T/F: If initial lab results are normal, repeat testing is generally not helpful.

A

True

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6
Q

When approaching a history in a patient with fatigue, how do you want to ask questions?

A

Search Grid; Initial Questions may give you the most likely place to look more in depth

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7
Q

Diseases that can cause fatigue or weight loss in HEENT system:

A
  1. Thyroid Dz (Nodules)
  2. Chronic Sinusitis (patent nares, when laying supine)
  3. Lymphadenopathy (infection, lymphoma)
  4. Facial asymmetry
  5. Hearing loss on one side
  6. Temporal Wasting
  7. Temporal Arteritis
  8. Queen Anne Sign
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8
Q

Diseases that can cause fatigue or weight loss in Cardiovascular system:

A
  1. Endocarditis
  2. Myocarditis
  3. Flow murmur from anemia
  4. CAD –> Cardiomyopathy (Pedal Edema)
  5. Xanthelsmas
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9
Q

Diseases that can cause fatigue or weight loss in Neuro system:

A
  1. Visual Field Defect from MS
  2. Festinating Gait from Parkinson’s
  3. Shuffling gait
  4. Focal weakness
  5. Atrophy
  6. Tremor
  7. Vertigo
  8. CN deficits
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10
Q

Diseases that can cause fatigue or weight loss in Renal system:

A
  1. Uremia (lack of clearing toxins from blood)
  2. Lupus
  3. Hypercalcemia
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11
Q

Diseases that can cause fatigue or weight loss related to sleep medicine:

A
  1. Insomnia (causes: depression, anxiety)
  2. Sleep Apnea
  3. Fe Deficient Anemia (good correlated with sleep apnea)
  4. Thick neck, large uvula, falling asleep during interview
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12
Q

Diseases that can cause fatigue or weight loss in Endocrine system:

A
  1. DM - hypoglycemia (commonly due to meds)
  2. Hypothyroidism
  3. Hypoadrenalism
  4. Hypogonadism
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13
Q

Diseases that can cause fatigue or weight loss in Heme system:

A
  1. Hypotension, Tachycardia
  2. Pale (Clubbing, Cyanosis, Pallor)
  3. Jaundice (Hemolytic Anemia)
  4. Murmur
  5. Lymph Nodes
  6. DVT, Thrombus
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14
Q

Differential Dx for Fatigue/Weight Loss (MIDNITE)

A 
Metabolic
Infectious
Drugs
Neoplasm
Immune
Toxic
Endocrine
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15
Q

When thinking about DDx for Fatigue or Weight Loss, what should you take into consideration?

A
  1. Patient’s CC and characteristics
  2. Alternatives that are most common
  3. Alternatives that would be bad to miss
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16
Q

Red Flag Symptoms of Fatigue

A
  1. Weight Loss
  2. Anemia
  3. Drug Abuse
  4. Chest Pain
17
Q 
Case Study:
22 year old student complains of tiredness all the time.  Started 6 months ago in the spring time. Used to be avid runner and weight trainer now goes to class and comes home and watches TV, plays games or sleeps. Girlfriend urged him to get help due to his inactivity causing strain on relationship.

What is your initial hypothesis?
Most common alternatives?
Most devastating to miss?

A

Initial: Depression/Drugs
Common Alternatives: Hypothyroid, Sleep Disorder
Devastating to miss: HIV, Renal Failure, Cancer

18
Q 
Case Study:
22 year old student complains of tiredness all the time.  Started 6 months ago in the spring time. Used to be avid runner and weight trainer now goes to class and comes home and watches TV, plays games or sleeps. Girlfriend urged him to get help due to his inactivity causing strain on relationship.

Using the search grid method, what systems should we look in to? Which shouldn’t we?

A

Focus: Neuro, Psych, Heme
Unlikely: GI, Cardiac, Pulm

19
Q 
Case Study:
22 year old student complains of tiredness all the time.  Started 6 months ago in the spring time. Used to be avid runner and weight trainer now goes to class and comes home and watches TV, plays games or sleeps. Girlfriend urged him to get help due to his inactivity causing strain on relationship.

After asking ROS, you find that:

  • Neuro: + decreased attention span, headaches, no muscle weakness
  • Psych: Poor concentration, no interest in friends, or sex, sleeps 12 hours per night, and naps during the day.

PE showed:

  • Normal
  • No tachycardia or weight loss, no murmur, no LAD, no thyroid mass, no pain, no muscle weakness.

BASED ON THIS WHERE ARE WE GOING?

A
  • Depression is still a good case

Still could be:

  • Drug Abuse
  • Chronic infection viral HIV, EBV
  • Depression Screening Tool
  • EtOH and Drug Screening Tool (CAGE)
  • CBC, TSH, HIV
20
Q

Most common causes of unintentional weight loss in the elderly (in order of prevalence)

A
  1. Psychiatric (Depression) – 10-42%
  2. Malignancy – 16-36%
  3. Unknown – 10-35%
  4. GI Disorder – 6-19%
  5. Hyperthyroidism – 4-11%
  6. Nutrition (Alcoholism) – 4-8%
  7. Respiratory Dz – 6%
  8. Neuro – 2-7%
  9. Chronic Infection – 2-5%
  10. Renal – 4%
  11. Connective Tissue – 2-4%
  12. Drugs/Meds Side Effects – 2%
21
Q

Tips on assessing weight loss history

A
  1. Check old records (do no rely on patient’s guesses)
  2. Quantify time over which the loss has occurred
  3. Ask for old pictures from wallet or Driver’s License.
22
Q

What types of cancer metastasized to the liver?

A
  • GI
  • Pancreas
  • Colon
  • Gastric
  • Rectal
  • Breast
  • Lung
  • Melanoma
23
Q

T/F: SSRIs may worsen the symptoms of pre-existing Parkinson’s Dz or Depressive Symptoms or Anhedonia and Social Isolation

A

True

24
Q

T/F: SSRI-induced Parkinsonism does not indicate the patient will likely get PD because the signs of Parkinsonism are solely based on the SSRI medication.

A

False!

SSRI induced Parkinsonism may be an early sign of Parkinson’s Dz in vulnerable geriatric patients.

DDx (9 decks)

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