Quiz 6 Flashcards
A 45-year-old woman presents to her naturopathic doctor with complaints of persistent fatigue and unrefreshing sleep for the past 8 months. She says that she feels worse after any physical or mental exertion and that she has reduced her work hours and social activities because of her symptoms. She denies any fever, weight loss, snoring, gasping, or mood disturbances.
What question is most important for the naturopathic doctor to ask this patient in order to establish a diagnosis of systemic exertional intolerance disease?
Question 1 Answer
a.
Have you experienced any cognitive impairment?
b.
In the last year, have you gone camping or hiking?
c.
Have you ever been diagnosed with orthostatic hypotension?
d.
In the past 2 weeks, have you experienced little interest or pleasure in doing things?
a.
Have you experienced any cognitive impairment?
A naturopathic doctor has completed their assessment of a patient and believes they have systemic exertion intolerance disease (SEID). In addition to relating this diagnosis, what should the naturopathic doctor say?
Question 2 Answer
a.
“For now, avoid activity altogether, since this is likely to worsen your fatigue. When you are feeling more energetic, you can resume your previous activities”
b.
“In truth, it is not clear what is going on, and I admit that your symptoms are not well-explained. However, we will continue with our diagnostic work-up”
c.
“I know this is a very challenging condition to live with and I am here to support you”
d.
“There are a lot of treatment options, and supplementation can have significant benefits when combined with pharmacotherapy”
c.
“I know this is a very challenging condition to live with and I am here to support you”
A 35-year-old man presents to his naturopathic doctor with a 4-month history of fatigue. He reports feeling tired all the time, regardless of his level of physical activity or sleep quality. He has no other symptoms, such as fever, weight loss, night sweats, shortness of breath, or joint pain. He denies any history of depression, anxiety, substance abuse, or chronic medical conditions. He works as an accountant and has no recent travel history or exposure to sick contacts.
What is the most appropriate next step in the evaluation of this patient?
Question 3 Answer
a.
Recommend he seek referral to a psychiatrist for evaluation of possible psychogenic fatigue
b.
Perform a thorough physical examination
c.
Refer him to his family doctor for a trial of antidepressants and book a visit to reassess his response in 4-6 weeks
d.
Recommend he seek a sleep study to rule out obstructive sleep apnea
b.
Perform a thorough physical examination
When is it most important that patients with fatigue be referred?
Question 4 Answer
a.
Infections not responsive to standard treatment
b.
Fatigue impacting activities of daily living
c.
Fatigue due to adverse life events
d.
All of the situations given in these options require referral
a.
Infections not responsive to standard treatment
Results of laboratory studies affect management in what percentage of patients with fatigue?
Question 5 Answer
a.
10%
b.
5%
c.
15%
d.
1%
b.
5%
