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CSI > Tiredness > Flashcards

Tiredness Flashcards

1
Q

Why does Mina come in to see the GP?

A

feels tired all the time
cannot understand why
feels like being surrounded by fog

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2
Q

How has the tiredness been impacting Mina’s life?

A

has to change her working patterns because the later it gets the less productive she is

takes afternoon naps on the weekend

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3
Q

What does her lifestyle look like?

A

vegetarian
but quality of diet depends
works hard at staying fit - put on weight over the summer

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4
Q

Any other symptoms?

A

skin is dry

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5
Q

Family history?

A

sister went to the doctor for tiredness but was diagnosed with vitamin D deficiency

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6
Q

What does the GP suggest?

A

MOT
simple blood tests
look at lifestyle to see if there are any contribution factors

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7
Q

What is the difference between tiredness and fatigue?

A

Fatigue is when the tiredness is often overwhelming and isn’t relieved by sleep and rest.

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8
Q

What are the 10 medical reasons for feeling tired?

A 
Anaemia
Sleep apnoea
Underactive thyroid
Coeliac disease 
Chronic fatigue syndrome 
Diabetes 
Glandular fever
Depression
Restless legs
Anxiety
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9
Q

What is the most common medical reasons for feeling run down?

A

Iron deficiency anaemia

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10
Q

Who is prone to anaemia?

A

Women with heavy periods

Pregnant women

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11
Q

What are less common causes of anaemia?

A

Ulvers

NSAIDS

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12
Q

What is sleep apnoea?

A

condition where your throat narrows or closes during sleep and repeatedly interrupts your breathing

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13
Q

What does sleep apnoea result in

A

loud snoring and a drop in your blood’s oxygen levels

The difficulty in breathing means you wake up often in the night and feel exhausted the next day

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14
Q

Who is sleep apnoea most common in?

A

overweight middle-aged men

Drinking alcohol and smoking makes it worse

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15
Q

What is an under-active thyroid?

A

Too little thyroid hormone (thyroxine) in your body

This makes you feel tired

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16
Q

What are other symptoms of having an under-active thyroid?

A

Weight gain

Aching muscles

Dry skin

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17
Q

What is coeliac disease?

A

lifelong disease caused by the immune system reacting to gluten

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18
Q

What are the symptoms of coeliac disease?

A

tiredness, diarrhoea, bloating, anaemia and weight loss

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19
Q

What is chronic fatigue syndrome also known as?

A

myalgic encephalomyelitis, or ME

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20
Q

What is chronic fatigue syndrome?

A

severe and disabling fatigue that goes on for at least 4 months.

There may be other symptoms, such as muscle or joint pain.

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21
Q

What is glandular fever?

A

common viral infection that causes fatigue, along with fever, sore throat and swollen glands

22
Q

What is restless legs?

A

overwhelming urge to move your legs, which can keep you awake at night

23
Q

What is GAD?

A

Generalised anxiety disorder

24
Q

What percentage of GP consultations are for fatigue?

A

7%

25
Q

To the nearest 10%, what percentage of patients who present to a GP with fatigue have a diagnosis made?

A

66%

26
Q

To the nearest 10%, what percentage of patients who present to a GP with fatigue have a condition that is detected on blood tests?

A

<10%

27
Q

Give other possible causes of fatigue?

A 
Cancer
Autoimmune disease
Side effects of medication
Diabetes
Vitamin D deficiency 
Eating Disorder 
Fibromyalgia
Pregnancy
28
Q

What to BMJ Best Practice say are causes of fatigue?

A

Chronic heart failure
TB
Stroke
Addison’s

LOTS

29
Q

Suggest 4 differentials for Mina?

A

Hypothyroidism
Vitamin D deficiency
Anaemia
Diabetes

30
Q

What suggests that Mina has hypothyroidism?

A 
Low metabolic rate
Cold intolerance
Weight gain
Constipation
Dry skin
Slow heartbeat
31
Q

What tests would we conduct in Mina?

A 
FBC 
U&amp;E
Vitamin D
Thyroid function tests
HbA1c
32
Q

What were the results of Mina’s TFTs?

A

TSH high
T3/T4 low
Primary hypothyroidism

33
Q

What does Mina have?

A

Hashimoto’s

34
Q

Describe what happens in Hashimoto’s

A

APCs process antigens presenting them to T-cells

In hashimoto’s self-antigen is presented on MHC II to TCR

Look at POM notes (Immune tolerance)

35
Q

What are the strategies to sift out the physical causes of tiredness?

A

Define the type of tiredness

Why did the patient present with this?

Screen for red flags

Explore and psychosocial triggers

Examine the patient (pulse, BP and BMI)

The plan

36
Q

What are red flags when it comes to tiredness?

A

Lymphadenopathy
Weight Loss
Specific malignancy features focus on: lung, breast, colon, upper GI and Gynae
Join pains
Focal neurology
Infective symptoms e.g. glandular fever and lyme

37
Q

What could be psychosocial triggers?

A 
Mood
Drugs and Alchohol
Family
Work
Money
38
Q

What questions with someone with hypothyroidism ask their doctor?

A

Why did I get an underactive thyroid?
• Will I get better?
• Do I need treatment?
• What’s the best treatment for me?
• Will I need to have treatment for the rest of my life?
• What are the side effects of treatment? How can I cope with them?
• Should I change what I eat?
• What are the chances that someone else in my family will get an underactive thyroid?
Does it run in families?
• How will my treatment be managed if I wish to get pregnant (women)?

39
Q

How would you explain to a patient the action of thyroxine?

A

Helps to control how fast your body makes and uses energy from food

40
Q

What are the symptoms of hypothyroidism?

A 
Feeling tires or depressed
Thinking more slowly or less clearly than usual
Having dry skin
Putting on weight
Feeling the cold more than usual
Having constipation
Irregular periods
41
Q

What might someone with hypothyroidism notice over many years?

A 
Dry, flaky skin
Coarse hair or hair loss
Put on weight even though caloric intake is the same
Feel depressed
Feel sluggish
Have a hoarse voice
42
Q

How is hypothyroidism treated?

A

Levothyroxine replacement for life
One a day on an empty stomach (100-150mg)
Start on low dose then increase

43
Q

What might happen if you take too much thyroxine?

A

Atrial fibrilaton

Bone thinning

44
Q

What can cause hypothyroidism?

A 
Autoimmune 'Hashimoto's'
Radioactive iodine treatment
Thyroid surgery
Antithyroid drugs 
Lithium drugs
Cough medicines
Health foods in excess
Malfunction of the pituitary gland
Radiation for head and neck cancers
45
Q

What is mild thyroid failure or subclinical hypothyroidism?

A

Very slight hypothyroidism
No obvious symptoms
Raised TSH and normal FT4

46
Q

What should happen if you get pregnant?

A

Increase dose by 25-50mcg

TFTs asap

47
Q

What can trigger graves and hashimotos?

A

Stress
Pregnancy
Genetics

48
Q

What is the more appropriate name for hashimotos?

A

chronic immune thyroiditis

49
Q

How can hashimotos be detected clinically?

A

Presence of antibodies
Rise in TSH
Low blood thyroxine

50
Q

Give two ways that hypothyroidism can present

A

Goitrous autoimmune thyroiditis

Atrophic autominnue thyroiditis

51
Q

What are the main features of goitrous autoimmune thyroiditis?

A

Progressive infiltration of white cells enlarges the thyroid

Goitre formation

Worsened by increase in dietary iodine

52
Q

What are the main features of atrophic autoimmune thyroiditis?

A

most common form

thyroid gland shrinks with progressive loss of tissue

antibodies block the TSH receptors

CSI (17 decks)

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