HYHO SPE3-4 Fatigue Flashcards
High Yield question to ask about fatigue?
Is there anything in your life that changed around the onset of your fatigue that might account for your sx?
Broad differential for fatigue?
DEAD TIRED
Depression
Environment/lifestyle
Anxiety/anemia
Diabetes/endocrine
Thyroid, tumors
Infection
Rheumatologic
Endocarditis/cardiovascular
Drugs (medication or substance abuse)
Vast majority of fatigue cases are related to what?
Lifestyle (caffeine, alcohol, poor sleep hygiene, inadequate sleep, shift-work, personal stressors, etc)
Stepwise approach to fatigue
Recent stressor
New medication or substance abuse
Sign or sx of bleeding
Stressor => provide support, discuss sleep hygiene, reevaluate 1 mo
New medication => adjust/remove substance, reevaluate 1 mo
Sign/sx bleeding => CBC
If recent stressor, medication, or sx of bleeding are absent, what 3 things must you obtain?
- Ask about anxiety, depression
- Obtain sleep hx
- Perform complete ROS and PE
Obtain CBC/TSH, CMP, UA, depending on other risk factors
7 questions to ask about sleep hx?
- What time do you go to bed?
- How long does it take you to fall asleep?
- How often do you get up during the night?
- Do you nap during the day?
- Do you drink alcohol in the evening?
- Do you feel rested when you wake in the morning?
- Do you exercise? What time of day?
The Hep C screen is recommended to what population?
MSM
Anyone with hx of injection drug use
Persons born b/w 1945-1965
For an endocrine cause of fatigue, what would you be looking for on physical?
Tachy/bradycardia
Objective weight change
Temporal/muscular wasting
Palpate thyroid
Assess turgor, flaking, dry skin
Hair - alopecia
Brittle nails
Change in DTR/muscle strength
For fatigue caused by anemia, what would you find on PE?
VS - tachycardia, hypotension, orthostatic hypotension
Gen - general pallor or palmar pallor
HEENT - glossitis, angular chelitis
CV - auscultate for new murmurs
Nais - cyanosis, cap refill
Abd - complete exam to assess mass, change in organ size
Rectal - fetal occult blood test
What is the definition of chronic insomnia?
>3 nights a week for 3 months
Irregular sleep cycle (shift workers, travel, etc)
Steps to sleep hygiene
Establish pattern - sleep/wake at the same time every day
Avoid lying in bed sleepless
Bedroom is only for sleep and sex
Avoid naps >30 min long
Avoid eating 3 hours before lying down
Avoid drinking 1 hour before lying down
Primary prevention of sleep disorder
Healthy lifestyle that includes exercise, stress reduction, proper sleep habits
Secondary tx of sleep disorder
Pharmacologic
Titrate lowest effective dose with short half-life
Limit use to 2-4x a week
Definition of obstructive sleep apnea
Temporary stop or decrease of breathing during sleep for at least 10 seconds, >15 events/hour
Incidence increases w/ age, obesity, M>W
Gold standard for dx of Obstructive sleep apnea
Polysomnography
What dx tests other than polysomnography may assist in diagnosing?
EEG - brain activity
Breathing sensors for nasal airflow, pulse ox
ECG - rate/rhythm
Limb EMG - analyze periodic limb movements
2 main tx of Obstructive Sleep Apnea
Risk factor modification (weight loss, smoking cessation, avoid alcohol or hypnotics prior to sleep)
CPAP
Complications of untreated Obstructive Sleep Apnea
Increase motor vehicle accidents
HTN
Heart failure
Impaired glucose tolerance
Increased risk of CVA
What is periodic limb movement disorder?
Restless leg syndrome
Urge to move legs, accompanied by the uncomfortable or unpleasant sensation of “crawling” on legs
Legs twitch/move every 20-24 seconds during non REM sleep
More common >30 yo
In the management of fatigue, you must not miss what dx?
Anemia, hypothyroid, DM
Depression/anxiety
Obstructive sleep apnea
Anterior chapman’s point for thyroid?
2nd ICS
Viscerosomatics for thyroid?
Sympathetic: T1-4
Parasympathetic: CN X
In the 5 model approach to hypothyroid, what is the main management for metabolic?
Hormone tx
Rule out autoimmune disorders
Consider iodine intake if needed
