Lethargy history

Question 1

What are the most common tiredness diagnoses you would want to exclude?

Answer 1

1. Cardiovascular system: Heart failure, Infective endocarditis
2. Haematological system: Anaemia, Lymphoma, Leukaemia
3. Endocrine system: Hypothyroidism, Diabetes, Addison’s disease
4. Gynaecological system: Menorrhagia, Menopause
5. Psychiatric: Depression, anxiety, eating disorders
6. Others: Poor sleep hygiene, other cancers e.g. prostate cancer, breast cancer, illicit drug use, alcoholism, Human Immunodeficiency Virus

Question 2

How would you structure your inquiry into the presenting complaint?

Answer 2

1. Defining tiredness
2. Sleep
3. Associated symptoms
4. Excluding red flags

Question 3

What questions would you ask to define tiredness?

Answer 3

1. Starts with an open-ended question
2. Clarifies the duration of symptoms
3. Asks the character of the symptoms (clarifies what the patient means by tiredness)
4. Asks about anything which improves her symptoms
5. Asks about anything which makes them worse
6. Asks about the impact of tiredness on the patient’s day to day activities

Question 4

What questions would you ask to understand sleep?

Answer 4

1. Clarifies the patient’s sleep pattern
2. Asks about snoring
3. Asks about waking up suddenly during the night

Question 5

What questions would you ask to understand associated symptoms?

Answer 5

1. Enquires about recent illnesses
2. Checks for any menstrual problems
3. Asks about shortness of breath
4. Rules out chest pain
5. Rules out palpitations
6. Asks about dizziness
7. Asks about any changes in mood

Question 6

What questions would you ask to exclude red flags?

Answer 6

1. Asks about thyroid dysfunction: sweating
2. Asks about thyroid dysfunction: tremor
3. Asks about potential diabetes problems: polydipsia
4. Asks about potential diabetes problems: polyuria
5. Asks about any bleeding problems: blood in stool
6. Asks about any bleeding problems: blood in urine
7. Asks about any bleeding problems: menorrhagia
8. Asks about any bleeding problems: blood in sputum
9. Asks about potential kidney issues: ankle swelling
10. Asks about bowel habits generally
11. Asks about bladder function generally
12. Checks for night sweats
13. Checks for weight loss
14. Checks for recurrent temperatures
15. Checks for loss of appetite
16. Checks that the patient hasn’t noticed any lumps or bumps

Question 7

What would you ask about the social history?

Answer 7

1. Asks about smoking
2. Asks about alcohol consumption
3. Asks about effects on her work
4. Asks about effects on her social life
5. Asks about foreign travel
6. Asks about diet and elicits that the patient is vegan
7. Demonstrates empathy when told about loss of husband
8. Clarifies family history