Tiredness Flashcards
Anaemia
SOB exertion
Weakness
Palpitations, worsening angina or claudication
Hypothyroidism
Constipation Cold intolerance Weight gain despite reduced appetite Low mood Feeling slow FH of autoimmune disease
Diabetes
Polydipsia Polyuria Weight loss Visual disturbance Increased appetite NB- could be a known type 1 not taking their insulin
Depression
Low mood, anhedonia, poor sleep,lack of energy, hopelessness, suicidal thoughts
Sleep apnoea
Loud snoring (collateral from partner), waking up at night gasping, excessive daytime sleepiness, obesity
Cancer
Constitutional Sx
Think breast prostate lung and colorectal
Haematological in adolescent
Cardiac, renal, liver failure
Ankle oedema and Sx specific to the failing system
Iatrogenic
Ask what medications they are taking and have any been changed recently eg,. Beta blockers
Post viral fatigue
Short history of flue like Sx
Environmental
Poor sleeping environment or an unstructured sleeping routine
Working long hours/ stressful job
Having small children/ being a carer
Chronic fatigue syndrome
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
Infectious mononucleosis
Suspect in adolescents
History of sore throat and flu like symptoms that persist longer than would be expected from other viruses
Sequence of events
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
Symptom analysis
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?
Systems review
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
Patients perspective
Effect on life Feelings Ideas Concerns- concerned about what may be causing it Expectations- from this appointment
PMH
Medical or psychiatric conditions eg. Diabetes malignancy thyroid disease
DH
Do you take any medications. Have these been changes recently?
Are you taking any over the counter medications
Do you have any allergies
FH
Medical or psychiatric conditions eg. Diabetes malignancy thyroid disease
SH
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
Investigations
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
Management
Personal circumstances- sleep hygiene, can work situation be altered, counselling
Viral- bed rest and hydration
CFS- non vigorous exercise and CBT
Malaria
Consider in someone who has been travelling recently to an endemic area (comes back generally unwell with fever)
HIV
General symptoms of malaise (flu-like illness) during the seroconversion period
Consider asking about sexual history/ IVDU/ travel abroad to rule in/out HIV
