Fatigue

Question 1

where is chronic fatigue in higher prevalence?

Answer 1

Women, minority groups, and people with lower educational and occupational statuses have a higher prevalence of chronic fatigue

Question 2

what are the red flag symptoms of a patient presenting with fatigue?

Answer 2

• significant weight loss
• lymphadenopathy with signs of malignancy
• focal neurological signs
• symptoms and signs of inflammatory arthiritis, vasculitis or connective tissue disease
• symptoms and signs of cardiorespiratory disease
• sleep apnoea

Question 3

what should you ask for in the history?

Answer 3

• define fatigue aka SOB? mental or physical? time of day?
• duration aka Precipitating factor? getting worse?
• previous energy levels
• any other changes
• recent start/change in meds
• weight and appetite
• polyuria or nocturia
• menstrutration
• bowel habits
• sleep
• lifestyle e.g drugs, alcohol, work
• any recent significant affects that may have caused it

Question 4

what should you check for in an examination?

Answer 4

• observe general appearance aka weight loss, tired, oedema from HF etc.
• examine pulse e.g tachycardia with pulse, anaemia and thyrotoxicosis has a bounding, hyper dynamic pulse. Bradycardia in hypothyroid. AF and flutter have their unique pulses also.
• weigh patient and record BMI
• further examination from clinical suspican and history

Question 5

what are the differentials for fatigue?

Answer 5

• depression
• obesity
• obstructive sleep apnoea
• poor sleep pattern,
  hard work, stress
• treatment with sedative, caffeine withdrawal
• chronic fatigue syndrome
• physical illness e.g anaemia, iron deficiency, cancer, renal/liver disease, HF, thyroid disease, diabetes, autoimmune disease

Question 6

what investigations can be done into fatigue?

Answer 6

• urinalysis for glucose and albumin in diabetes and renal disease respectively
• FBC for anaemia
• B12 and folate is FBC shows macrocytosis
• U&E for renal disease
• random/fasting blood glucose
• LFTs may suggest alcohol misuse
• ESRM CRP and monospot test for glandular feather
• IgA tissue transglutaminase in coeliac
• bone biochemistry if 60+
• serum ferritin in women of child bearing age
• vit D deficiency
• HIV and hepititis if at risk
• TB (chest radiograph and sputum) if at risk

Question 7

how can the physical causes of fatigue be managed?

Answer 7

• manage diabetes/HF/anaemia etc as appropriate
• consider iron supplements for menstruating women with unexplained fatigue with no anaemia but low ferritin levels
• sleep apnoea, loss of weight is beneficial
• aerobic exercise is beneficial for cancer felated fatigue

Question 8

how can the psychological causes of fatigue be managed?

Answer 8

Management of underlying or contributing psychological disorders may be required - eg, depression, anxiety.

Question 9

how can lifestyle factors in fatigue be managed?

Answer 9

• doctor can help identify factors that contribute
• having a sympathetic ear may be therapeutic and help
• drug and alcohol misuse can be addressed

Question 10

what factors are associated with increased/faster recovery?

Answer 10

• Male.
• Reduced severity and duration of fatigue.
• No expectation of fatigue becoming -chronic.
• Perception of better general health.
• Lower levels of pain.
• No carer responsibilities.
• Good social support.
• Better mental health.
• Willingness to accept fatigue is due to psychological factors.