Tiredness

Question 1

Anaemia

Answer 1

SOB exertion
Weakness
Palpitations, worsening angina or claudication

Question 2

Hypothyroidism

Answer 2

Constipation 
Cold intolerance 
Weight gain despite reduced appetite 
Low mood
Feeling slow 
FH of autoimmune disease

Question 3

Diabetes

Answer 3

Polydipsia 
Polyuria 
Weight loss
Visual disturbance
Increased appetite 
NB- could be a known type 1 not taking their insulin

Question 4

Depression

Answer 4

Low mood, anhedonia, poor sleep,lack of energy, hopelessness, suicidal thoughts

Question 5

Sleep apnoea

Answer 5

Loud snoring (collateral from partner), waking up at night gasping, excessive daytime sleepiness, obesity

Question 6

Cancer

Answer 6

Constitutional Sx
Think breast prostate lung and colorectal
Haematological in adolescent

Question 7

Cardiac, renal, liver failure

Answer 7

Ankle oedema and Sx specific to the failing system

Question 8

Iatrogenic

Answer 8

Ask what medications they are taking and have any been changed recently eg,. Beta blockers

Question 9

Post viral fatigue

Answer 9

Short history of flue like Sx

Question 10

Environmental

Answer 10

Poor sleeping environment or an unstructured sleeping routine
Working long hours/ stressful job
Having small children/ being a carer

Question 10

Chronic fatigue syndrome

Answer 10

Persistent fatigue for 6 months in a previously healthy individual that isn’t due to exertion/ not relived by rest/ not explained by a medical condition
Myalgia/ memory problems/ headaches
PMH- IBS/ fibromyalgia

Question 10

Infectious mononucleosis

Answer 10

Suspect in adolescents

History of sore throat and flu like symptoms that persist longer than would be expected from other viruses

Question 11

Sequence of events

Answer 11

Can you tell me what has been going on
What exactly do you mean by tired eg. No energy or sleep doesn’t refresh you
Timeline- hen did you first notice it and how has it progressed

Question 12

Symptom analysis

Answer 12

Ideas- can you think of anything causing the tiredness
Sleep- how are you sleeping, does it refresh you?
Timing- do you ever feel not tired if so when
Exacerbation/ relieving factors- does anything worsen your tiredness eg. EXercise or emotional stress
Other Sx- how have you been besides the tiredness, any other Sx you would like to share?

Question 13

Systems review

Answer 13

Viral illness- any sore throat recently
Cancer- FWARJL & hameaturia/ melaena
Hypothyroidism- are you cold when others say it is warm
Diabetes- are you urinating more? Are you more thirsty and drinking more?
Depression- have you been suffering from low mood? Is so how long
CFS/ fibromyalgia- any pain in muscles/ headaches/ how is your memory?
Menorrhagia- do you suffer from heavy periods
Oedema- swollen legs

Question 14

Patients perspective

Answer 14

Effect on life
Feelings
Ideas
Concerns- concerned about what may be causing it
Expectations- from this appointment

Question 15

PMH

Answer 15

Medical or psychiatric conditions eg. Diabetes malignancy thyroid disease

Question 16

DH

Answer 16

Do you take any medications. Have these been changes recently?
Are you taking any over the counter medications
Do you have any allergies

Question 17

FH

Answer 17

Medical or psychiatric conditions eg. Diabetes malignancy thyroid disease

Question 18

SH

Answer 18

Are you working presently- what does it involve
Can you tell me about your home situation- occupants and difficulties
Do you smoke/ alcohol/ recreational drugs
Unprotected sex recently (STD)
DIET- COULD BE VEGAN/VEGETARIAN

Question 19

Investigations

Answer 19

Cardio resp exams definitely, then breast/ PR and thyroid exams (see what is warranted)
FBC UE LFT TFT Blood glucose, ESR CRP
urinalysis for diabetes and renal failure
Monospot test for infectious mononucleosis
Serum ferritin B12 folate is evidence of anaemia

Question 20

Management

Answer 20

Personal circumstances- sleep hygiene, can work situation be altered, counselling
Viral- bed rest and hydration
CFS- non vigorous exercise and CBT

Question 21

Malaria

Answer 21

Consider in someone who has been travelling recently to an endemic area (comes back generally unwell with fever)

Question 22

HIV

Answer 22

General symptoms of malaise (flu-like illness) during the seroconversion period
Consider asking about sexual history/ IVDU/ travel abroad to rule in/out HIV