wk6 Fatigue Flashcards
True or False: 1 in 3 adolescents report fatigue at least 4 days per week.
True
True or False: In family medicine, fatigue is the main reason in 6.5% of patient and secondary reason in 19% of patients.
True
What is the lifetime prevalence of significant fatigue (over 2 wks)?
25%
Is sleep disorder common in patients with fatigue?
Yes. Such as obstructive sleep apnea or insomnia syndromes.
Which one has a greater proportion of cases, idiopathic fatigue & fatigue related to psychiatric illness OR fatigue due to physical illness/injury/alcohol/medications?
Idiopathic fatigue & fatigue related to psychiatric illness.
- idiopathic fatigue: fatigue of unknown cause
Ture or False: up to 75% of patients with fatigue have psychiatric symptoms.
True
What is the duration of acute fatigue?
Last less than one month and is relieved with rest
What is the duration of subacute fatigue?
last between 1 to 6 months
What is the duration of chronic fatigue?
last over 6 months and is not relieved with rest
This type of fatigue is due to an underlying medical condition and last between 1-6 months. What type of fatigue is it?
Secondary fatigue
This type of fatigue is caused by a lifestyle imbalance in routines of sleep, exercise, diet or other activity not attributed to an underlying medical condition and is alleviated with rest. What type of fatigue is it?
Physiologic fatigue
What are the three components that make up of clinically relevant fatigue?
- generalized weakness (difficulty in initiating activities)
- easy fatigability (difficulty in completing activities)
- mental fatigue (difficulty with concentration and memory)
It is fatigue or sleepiness that is temporarily aroused by activity (at least short-term) and feel better after a nap?
Sleepiness
- fatigue is intensified by activity
ESS and FSS
Epworth Sleepiness Scale
Fatigue Severity Scale
Would chronic fatigue occur in children?
Yes.
What is the prevalence of idiopathic chronic fatigue?
5-40 per 100,000
What is the prognosis of chronic fatigue?
64% have limited improvement while only 2% report complete long-term resolution.
patients whose symptoms worsen longer than 24hr after physical exertion have a poor prognosis
What is the percentage of patient with chronic fatigue that a medical or psychological explanation can be determined? What is the predominant causes?
70% of patients and psychiatric disorders (depression or anxiety are the predominant causes).
True or False: 25% of the patients have an acute or chronic medical condition and it is the causes of their chronic fatigue.
True
What is the better terminology for chronic fatigue syndrom?
Systemic Exertion Intolerance Disease (SEID)
*uncertain etiology
*unexplained fatigue
Is there any physical finding or lab test can be used to confirm the diagnosis of SIDE?
No
What is the prevalence of SIDE?
1% worldwide population
1.4% of adult Canadian population
The prevalence of SIDE is significantly higher between which age?
40-70
What is the average age of onset of SIDE?
33
Does SIDE increase all-cause mortality?
No but can increase the risk of completed suicide
True or False: Patient with SIDE reports greater frequency of childhood trauma/psychopathology/emotional instability/self-reported stress.
True
Is SEID considered as biological or psychological disorder?
Biological
What are some possible etiological factors for SEID?
- Genetics
- Infection (EBV/HHV…)
- Immune system dysregulation
- dysbiosis of gut microbiota
5.toxin exposure - muscular biochemical abnormalities
and so on …
What are some physical criteria for SEID?
Low-grade fever
nonexudative pharyngitis
lymphadenopathy
What are the 3 diagnostic criteria of SEID required by IOM?
- unrefreshing sleep
- poster-exertional malaise lasting over 24hr
- substantial reduction in pre-illness ability over 6 months, not alleviated by rest.
either one
1. cognitive impairment (memory/concentration…)
- orthostatic intolerance (lightheaded/dizzy….worsen with upright position)
Do patients with SEID possess a particular alteration in metabolism?
YES.
as well as mitochondrial dysfunction
Is there existing cure for SEID?
No
Should patients with SEID avoid any activities?
No. All patients should be encouraged to engage in normal activities as much as able to and be reassured that full recovery is possible in most case. Pace exercising to avoid post-exertion fatigue.
When should we refer our patients with SEID?
- secondary organic causes
- infection that dont respond to standard treatment
- difficult to control hyper/hypothyroidism
- severe psychological illness
- malignancy
What does diagnosis of SEID rely on ?
Exclusion of chronic active organic illnesses that can produce chronic fatigue
Which physical exam would you perform for fatigue?
- vitals
- oropharyngeal exam
- lymph node assessment
What percentage of patient will be affected by lab result in management?
5%
what are some lab testing to assess fatigue?
-CBC
-ESR
-Chemistry panel
-Kidney & liver function tests
-Thyroid function
-pregnancy test
-urinalysis
