Fatigue

Question 1

Apply the Murtagh model to the presentation of fatigue

Answer 1

P
   - Depression/anxiety
   - Post viral illness
   - Disordered sleep
R
    - Malignancy 
   - Bacterial infection 
   - Anaemia
   - Arrhythmia 
   - Cardiomyopathy
   - Haemachromatosis
   - HIV/Hep C
O/M
   - Renal failure
   - Coeliac
   - Pregnancy
   - Metabolic disturbance
   - DM
   - Medication

Question 2

What are the most useful blood tests for the Ix of fatigue?

Answer 2

Hb
ESR
BSL
TSH

Question 3

What are the red flags for fatigue?

Answer 3

Recent fatigue in a older patient
Unintentional weight loss
SOB
Abnormal bleeding
Unexplained lymphadenopathy
Fever
GI, CV, Neuro, Rheu symptoms

Question 4

What is a sensible approach to Ix/Mx fatigue?

Answer 4

Thorough hx and ex (particularly red flags)
Office tests - BSL and dipstick
If red flags present - further Ix
If absent - counsel on lifestyle and wait 4 weeks