Chronic Fatigue

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍month history of fatigue

Fatigue ‍doesdoesn't get worse after physical or mental activity

Severity of fatigue: ‍mildmoderatesevereextreme, ‍not relieved with rest

Impact on daily activities: ‍minimal

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍unrefreshing sleep

‍insomnia

‍difficulty thinking

‍difficulty concentrating (brain fog)

‍dizziness

‍muscle pain without redness or swelling

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍anxiety

‍depression



Contributing factors:

‍physical trauma

‍emotional trauma

‍recent viral infection

no history of: ‍fibromyalgia, ‍hypothyroidism, ‍anemia, ‍major depressive disorder, ‍lupus, ‍multiple sclerosis, ‍heart disease

no use of: ‍antidepressants, ‍sleeping tablets, ‍pain killers, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Fatigue due to psychosocial stressors ‍likelysuspectedpossible

DDx: psychosocial stressors, adjustment disorder, depression, anemia, thyroid disease, sleep apnea, chronic fatigue syndrome, diabetes mellitus, chronic kidney disease, liver disease, heart failure, COPD, medication side effect, viral infection, mononucleosis, hepatitis, HIV, electrolyte imbalance, nutritional deficiencies, rheumatologic conditions, malignancy, chronic pain syndrome, overtraining syndrome, adrenal insufficiency, Cushing syndrome, hypogonadism, pregnancy, head trauma, long Covid, fibromyalgia, multiple sclerosis



Further evaluation with history, physical examination, and appropriate laboratory and imaging studies is warranted to narrow down the differential diagnosis and establish a definitive diagnosis. Patient education regarding lifestyle modifications, stress management, and sleep hygiene may be beneficial while workup is ongoing. Referral to appropriate specialists may be considered based on clinical findings and patient's response to initial management.





PLAN:

Investigations:

- Blood work: ‍CBC, ‍TSH, ‍electrolytes, ‍creatinine, ‍glucose, ‍LFTs, ‍vitamin B12, ‍folate, ‍ferritin, ‍iron studies, ‍CRP, ‍β-hCG, ‍monospot, ‍EBV antibodies, ‍HIV, ‍syphilis, ‍HBsAg, ‍hepatitis C, ‍Lyme disease antibodies

- Urinalysis

- ECG

- Chest X-ray

- Sleep study

Treatments:

- Regular exercise

- Healthy diet

- Good sleep hygiene

- Stress management techniques

- Multi-vitamins

- ‍Antidepressants

- ‍Stimulants

Further care:

- Referral to psychologist

- Referral to sleep specialist

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if fatigue worsens or if new symptoms develop such as weight loss, fever, or persistent sleep disturbances