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General PA > tired all the time > Flashcards

tired all the time Flashcards

1
Q

define fatigue

A

sensation of exhaustion during or after usual activities – feeling of inadequate energy to begin these activities

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2
Q

how may fatigue present?

A
  • Lack of energy, feeling weak, being too tired to participate in family, work, leisure activities
  • Unpleasant physical, cognitive and emotional symptom described as tiredness not relived by common strategies that restores energy – varies in duration, intensity and reduces ability to perform usual daily activities
  • Extreme tiredness, weakness or exhaustion of mental/ physical origin that is not relieved by rest
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3
Q

how do classify TATT

A

origin
attribution
duration

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4
Q

what can attribute to TATT?

A

physical illness (infection, malignancy etc), psychological, social, physiological, occupational

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5
Q

how do you classify duration of TATT?

A

recent (<1 month), prolonged (>1 mth), chronic (>6mths)

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6
Q

who is more common to have TATT has POC?

A

women

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7
Q

in primary care what causes 2/3 of cases of TATT?

A

physical / psychological

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8
Q

in primary care what fraction of TATT is idiopathic?

A

1/3

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9
Q

what can be organic causes of TATT?

A

asthma, DM, hypothyroidism, anaemia

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10
Q

what can be physiological causes of TATT?

A

pregnancy, menopause, menstruation

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11
Q

what can be psychological causes of TATT?

A

depression

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12
Q

what is chronic fatigue syndrome AKA?

A

myalgia encephalomyelitis

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13
Q

what is chronic fatigue syndrome?

A

systemic exertion intolerance disease

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14
Q

how would you suspect chronic fatigue syndrome?

A
  • Needs to have fatigue with new/sudden onset, persistent/ recurrent >4mths, unexplained from other conditions, reduction in activity, post-exertional malaise from activities – can be delayed or slow recovery
  • Also seen with one of the following – difficulty sleeping, muscle/ joint pain with no inflammation, headaches, painful lymph nodes and no pathology, sore throat, cognitive dysfunction, physical/ mental exertion exacerbates symptoms, general malaise/ flu like symptoms, dizzy/ nausea, palpitations with no cardiac pathology
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15
Q

what is the aetiology of chronic fatigue syndrome?

A

idiopathic but seen in within other conditions – inflame, immune, viral, endocrine dysfunction

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16
Q

is children and chronic fatigue worrying?

A

RED FLAG – need urgent referral

17
Q

when would you refer an adult with suspected chronic fatigue syndrome?

A
  • Mild symptoms - <6mths
  • Moderate – 3 to 4 mths
  • Severe: immediately
18
Q

what is the prognosis of chronic fatigue syndrome?

A

most people will recover and be able to resume normal activities but some may relapse and remain housebound. The prognosis in children and young people is more optimistic

19
Q

how do you manage chronic fatigue syndrome?

A
  • Ideally want to manage symptoms and improve functional capabilities
  • Initial: counselling and supportive care
  • Focus on severe symptoms and address individually one at a time
  • Cognitive strategies such as coping skills can improve tolerance
20
Q

what supportive care can be used within chronic fatigue care?

A
  • Exercise programmes
  • Body awareness therapy
  • Mindfulness
  • Sleep hygiene
    occupational therapy
    treat comorbidities - depression etc
21
Q

what is sleep hygiene?

A

normalisation of sleep/ wake rhythm begins by stopping daytime napping, proceeds to improve quality of sleep through relaxation therapy – reducing screen time before bed

22
Q

what is needed with fatigue as POC history?

A
  1. Characterise fatigue – struggle to fall asleep? Cant stay asleep?
  2. Assess presence of complaints suggesting organic illness associated with fatigue – systems review
  3. Evaluate medicines used or substance missuse – drug and social history
  4. Perform psychiatric screening
  5. Ask questions based on sleep quantity/ quality
  6. Perform physical exam
  7. Undertake investigations
23
Q

how do you characterise fatigue?

A
  • Duration
  • Sudden/ progressive onset
  • Recovery period
  • Impact of rest
  • Impact of physical activity
  • Presence of weakness
  • Seasonality – SAD
24
Q

what are red flags alongside fatigue?

A
  • Significant weight loss
  • Lymphadenopathy suggestive of malignancy
  • Other malignancy symptoms – haemoptysis, dysphagia, rectal bleeding, breast lump, postmenopausal bleeding
  • Localising focal/ neurological signs may suggest neurodegenerative condition
  • Carbon monoxide poisoning

General PA (7 decks)

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