Fatigue

Question 1

List five diagnosis for symptoms of fatigue, pain, sleep disturbance, and cognitive symptoms

Answer 1

1. Fibromyalgia
2. Myalgic encephalomyelitis Chronic Fatigue Syndrome
3. Environmental sensitivities-Multiple chemical sensitivities
4. DEPRESSION
5. Somatization
6. Hypothyroidism
7. Neoplasm
8. Infection
9. Anemia

Question 2

List three features of Myalgic, encephalomyelitis-Chronic Fatigue Syndrome

Answer 2

1. > 6 months
2. Impacting function (profound fatigue)
3. Post exertional malaise
4. unrefreshing sleep
5. Cognitive i mpairment OR orthostatic intolerance

Question 3

List three features of Fibromyalgia

Answer 3

1. Diffuse body pain
2. Present for at least 2 months
3. No other explanation
4. Fatigue
5. Sleep disturbances
6. Mood symptoms
7. Cognitive symptoms

Question 4

List three features of Environmental sensitivity multiple chemical sensitivity

Answer 4

1. Triggered by chemicals
2. Neucognitive symptoms
3. Resp. symptoms

Question 5

Important questions on history to ask in patient with fatigue (3)

Answer 5

1. B symptoms
2. Medications
3. Mood
4. Chest pain/dyspnea
5. Effect on function

Question 6

Improtant on physical exam for fatigue

Answer 6

Signs of inflammation to joints 
Wt. loss 
Lymphadenopathy 
Fever 
Focal neuro deficits

Question 7

When should you investigate

Answer 7

If symptoms >3 months or 4 weeks after initial presentation

Question 8

Investigations

Answer 8

CBC
Lytes
LFTs
TSH
HGC
CRP
CK
HIV/HepC
Celiac screen

Question 9

DDX for fatigue (Try for 10)

Answer 9

CHF
COPD
OSA
Diabetes
Hypothyroidism 
Malignancy
Celiac
Anemia
Iron deficiency
HIV
Mono
Hepatitis 
RA
MS
Parkinsons 
ALS
Lupus