Fatigue HYHO Flashcards
What is the high yield query for fatigue?
“is there anything in your life that changed around the onset of your fatigue that might account for your symptoms?”
What is the broad differential for fatigue?
Depression
Environmental/lifestyle
Anxiety, Anemia
Diabetes
Thyroid, tumors Infection Rheumatologic Endocarditis Drugs
What exam findings would point towards endocrine etiology?
unintentional weight change, constipation, polyuria, polydipsia, polyphagia, palpitations, hair or skin changes, cold intolerance, anorexia
skin: turgor, flaking/dryness
Hair: tug test, alopecia
Nails: brittle, dry
neuro: DTR and muscle strength
What exam findings would point towards Anemia etiology?
PMH of renal disease ROS: pica, blood loss, heart burn, dental problems, dizziness, syncope, weakness, unintentional weight loss Diet: vegans HEENT: glossitis, angular chelitis, general: pallor or palmar pallor Nails: cyanosis, capillary refill abdomen: masses rectal: fecal occult test
What is chronic insomnia?
insomnia lasting at least 3 nights a week for 3 months. irregular sleep cycle.
What is the treatment of acute insomnia?
review sleep hygiene
aerobic exercise
limit caffeine, alcohol
benzos
what is the gold standard of diagnosis for obstructive sleep apnea?
polysomnography: assess sleep, breathing and movement.
How do you treat OSA?
weight loss, smoking cessation, avoid alcohol, CPAP
What are the 5 complications of untreated OSA?
increase of motor vehicle accidents hypertension heart failure impaired glucose tolerance increase risk of CVA
What is periodic limb movement disorder?
urge to move the legs accompanied by the uncomfortable or unpleasant sensation of crawling on legs
the legs twitch or move ever 20-24 seconds. bed partner complains of kicking or restlessness
How is restless leg syndrome diagnosed?
during polysomnography
how is restless leg syndrome treated?
dopamine agonist or antiepileptics
What are the management steps (3) of fatigue?
- identification of acute stressors that may interfere with sleep
- identification of lifestyle or behaviors that disrupt sleep cycle
- screen for depression or anxiety
What should you not miss in your work up of fatigue?
anemia, hypothyroidism, diabetes
depression or anxiety
obstructive sleep apnea
Five model approach to hypothyroid:
biomechanical: thoracic somatic, OA and rib SD
respiratory circulatory: lymph restrictions, mesenteric lift
neurologic model: sympathetics T1-T4, T12-L2 for distal colon, parasympathetics Vagus and pelvic splanchnic, chapmans points
metabolic model: hormone treatment **. rule out autoimmune disorders. consider iodine if needed.
behavior: exercise, proper nutrition, therapy
