Fatigue

Fatigue

1. Psych

   • Depression
     • SIG E CAPS
       • Beck Depression inventory
   • PTSD
     • (1) Insomnia/ nightmares (2) witnessed traumatic event (3) Avoid places
       • Beck Depression inventory
   • Adjustment
   • GAD

2. Sleep

   • OSA
     • (1) Snoring (2) daytime naps (3) nonrefreshing sleep (4) morning HA ----------- Obese
       • Polysomnography, Nocturnal pulse oximetry
   • Shift work sleep disorder
   • Narcolepsy

3. Endocrine

   • DM
     • (1) Polydipsia (2) Polyuria (3) weight loss (4) impotence -------- Obese
       • + FH, polyphagia
       • HbA1C, Fasting blood glucose
   • inc. Ca
   • Hypothyroidism
     • including Sheehan syndrome
     • (1) Weight gain (2) cold intolorance (3) Constipation (4) Dry Skin -------- slow reflexes, Thyromegally
       • Also hoarseness, Menstrual changes, thin hair
       • TSH, FT4, FT3

4. Other

   • Cancer
     • Including leukemia/lymphoma
     • (1) Dec. Appetite (2) Weight loss (3) FH of cancer
       • Constipation, night sweats (B sxs), Lumps
       • Rectal exam, FOB, colonoscopy, CT abdomen/pelvis, LN Bx, CBC
   • Anemia
     • (1) Hemorrhage (2) Lightheadedness (3) SOB ---------- Pale conjunctiva
       • coldness in hands and feet
       • CBC, Peripheral blood smear, Retic count, FOB

5. Infection

   • TB
     • (1) Dry cough (2) fever (3) night sweats (4) weight loss -------- abnormal chest exam
       • ill contacts
       • PPD, CXR, sputum acide fast stain & Cx
   • HIV, STD
     • infectious mononucleosis
     • (1) Unprotected sex with male partner (2) Lumps in neck/groin (3) weight loss
       • HIV antibodies & viral load