Fatigue is a common complaint defined as a feeling of tiredness and lack of energy. It can be acute or chronic lasting over 6 months. The document discusses the causes, evaluation, and management of fatigue. Psychological factors are involved in most cases of chronic fatigue. Evaluation involves taking a thorough history and physical exam to rule out underlying medical conditions. Treatment focuses on treating any identified causes, cognitive behavioral therapy, exercise, and antidepressants may help relieve symptoms in some cases. Chronic fatigue syndrome is a diagnosis of exclusion defined by persistent fatigue and additional symptoms lasting over 6 months. Its cause is unclear but may involve infections, immune dysfunction, or sleep disturbances.
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
Edema is defined and its mechanism explained with reference to the Starling's forces. The causes of localized edema and anasarca discussed.
In history taking, the site and distribution of edema, its duration, association with pain, variability, systemic illness, drug intake, trauma, radiation discussed.
The local and systemic examination described. The approach to investigation including lab tests and imaging explained.
Finally, management is discussed in short.
lupus nephritis is a autoimmune disease, commonly seen in adult and child and the medical or nursing care is also very important for this type of disease condition.
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
UG CASE PRESENTATION ON INGUINAL HERNIAAyesha Huma
I have added viva notes after this proforma for quick revision of important stuff asked in exam.
LINK FOR EXAMINATION VIDOES :
1. https://youtu.be/uO-w_9w5okI
2. https://youtu.be/Vc_ZH_-Oad4
Acute kidney injury (AKI) is a potentially life-threatening
syndrome that occurs primarily in hospitalized patients
and frequently complicates the course of critically ill
patient.
Acute Kidney Injury is is (abrupt) reduction in kidney functions as evidence by changed in laboratory values; serum creatinine, blood urea nitrogen(BUN)and urine output
ECG In Ischemic Heart Disease - Dr Vivek Baliga ReviewDr Vivek Baliga
Dr Vivek Baliga Presentation on the role of ECG in the diagnosis of ischemic heart disease. Here, he covers the very basics in ECG diagnosis of heart disease. Suitable for medical students and physicians alike. For more health articles for patients, visit http://baligadiagnostics.com/category/dr-vivek-baliga/
a syndrome of persistent widespread pain, stiffness, fatigue, disrupted and unrefreshing sleep, and cognitive difficulties, often accompanied by multiple other unexplained symptoms, and functional impairment of activities of daily living.
A functional disorder causes physical discomfort which makes everyday life difficult. It can be seen as a disorder where the mind and the body for various reasons are not functioning properly
FATIGUE ASSESMENT & MANGEMENT BY- DR. ANJALI RAIGoogle
Fatigue is a complex state characterized by a reduced mental and physical performance and lack of alertness, Lack of energy, difficulty in concentration . Which directly affects on performance of an individual - this document discuss about the fatigue its Definition, Introduction, Types, Causes, Assessment, Different scales to measure, and its Management and physiotherapy management and its prevention.
Essential Hypertension By Raheef Alatassi
Definition & classifications
Prevention & detection & importance
Causes
HTN in pregnancy
Management
Goals of treatment
Classes of drugs & side effects
Specific management in e.g. IHD,DM
HTN emergency & urgency with management
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
3. Definition
• A sensation of exhaustion during or after usual activities, or a feeling of
inadequate energy to begin these activities.
• Fatigue can be manifested as difficulty or inability initiating activity
(perception of generalized weakness); reduced capacity maintaining
activity (easy fatigability); and difficulty with concentration, memory,
and emotional stability (mental fatigue).
• Fatigue is defined as the subjective complaint of tiredness or diminished
energy level to the point of interfering with normal or usual activities.
4. Cont.
Duration of fatigue can be:
• Recent (less than one month),
• Prolonged (more than one month)
• Chronic (over six months).
• The presence of chronic fatigue does not necessarily imply the
presence of the chronic fatigue syndrome, which is discussed
separately.
6. What is the difference between Fatigue,
dyspnea and muscle weakness ?
Dyspnea
A subjective experience of breathing discomfort that is comprised of qualitatively
distinct sensations that vary in intensity.
Muscle weakness
A. Primary or true muscle weakness
B. Muscle tiredness (ASTHENIA)
7. EPIDEMIOLOGY
• A major symptom
• Found in all populations and associated with multiple factors.
• It is one of the top 10 chief complaints leading to family practice office visits
• Fatigue occurs in up to 20% of patients seeking care
• Higher in women than in men.
• Psychiatric illness is present in 60 to 80 % of patients with chronic fatigue.
• The three major psychiatric illnesses were major depression (58 percent), panic
disorder (14 percent), and somatization disorder (10 percent).
8. What is the difference between the CFS,
chronic fatigue & idiopathic chronic fatigue?
Type Definition
chronic fatigue syndrome
(Based on CDC 2006)
Clinically evaluated, unexplained, persistent or relapsing fatigue.
that is of new or definite onset.
is not the result of ongoing exertion;
is not alleviated by rest;
Cause reduction in previous levels of occupational, educational, social,
or personal activities
chronic fatigue The presence of fatigue for longer than six months.
idiopathic chronic fatigue No medical or psychiatric explanation can be found .
persists for over six months and is debilitating.
but does not meet the criteria for the chronic fatigue syndrome.
12. History
• The history is the most important component of the evaluation of chronic fatigue.
• The physical examination and laboratory studies provide supporting data.
• Fatigue that is due to an underlying medical or psychiatric disorder usually presents
as one of several reported symptoms.
• The clinician should rely upon open-ended questions ?
• Patients with organ-based medical illness often Associate their fatigue with
activities they are unable to complete.
• In contrast, patients with fatigue that is not organ-based are tired all the time; their
fatigue is not necessarily related to exertion.
• Nor does it improve with rest.
13. History
• ID: Age, Gender, Nationality, occupation.
• CC.:
• HPI:
o Onset - abrupt or gradual, related to event or illness?
o Course - stable, improving or worsening?
o Duration and daily pattern
o Factors that alleviate or exacerbate symptoms
o Impact on daily life - ability to work
o Accommodations that patient/family has made to adjust to fatigue symptoms
14. History
• P.M Hx. ??
• P.S Hx.
• Family Hx.
• Social Hx. ??
• Drug Hx. ???
• Allergy Hx.
• Systemic review
15. Physical examination
• General appearance: level of alertness, psychomotor agitation or retardation,
grooming (psychiatric disorder)
• Presence of lymphadenopathy: a possible sign of chronic infection or malignancy.
• Evidence of thyroid disease: goiter, thyroid nodule, ophthalmologic changes
• Cardiopulmonary examination: signs of congestive heart failure and chronic lung
disease
• Neurologic examination: muscle bulk, tone, and strength; deep tendon reflexes;
sensory and cranial nerve evaluation
16. Specific clinical signs of organic disease associated with
fatigue include the following:
• Pallor, tachycardia, systolic ejection murmurs: anaemia
• Blue sclera: iron deficiency
• Jaundice, palmar erythema, Dupuytren's contracture: chronic liver disease
• Goitre or thyroid nodule, dry skin, delayed deep tendon reflexes, peri-orbital
puffiness, ophthalmological changes: hypothyroidism
• Weight loss, hyper-reflexia, tachycardia, atrial fibrillation, fine tremor, goitre:
hyperthyroidism
• Hypotension, pigmentation in skin creases, scars, and buccal mucosa: Addison's
disease
• Pulmonary stasis, elevated jugular venous pressure, ankle oedema: heart failure
17. Laboratory studies
• Reasonable initial laboratory studies to obtain
include:
• Complete blood count with differential
• Chemistry screen (including electrolytes, glucose,
renal and liver function tests)
• Thyroid stimulating hormone
• Creatine kinase, if pain or muscle weakness present
• Other ???
18. TREATMENT
• The doctor-patient relationship is of profound importance.
The physician will act as a guide in establishing therapeutic goals:
o Accomplishing the activities of daily living
o Returning to work
o Maintaining interpersonal relationships
o Performing some form of daily exercise
• Brief regularly scheduled appointments
19. TREATMENT
• Treat the underlying cause
• Antidepressants :
patients whose illness has features of depression.
response to antidepressant therapy ????
Antidepressants may themselves provoke or exacerbate fatigue.
• Cognitive behavioral therapy
Is effective in patients with CFS and idiopathic chronic fatigue.
• Graded exercise therapy
Is effective in patients with CFS and idiopathic chronic fatigue.
20. TREATMENT
Other measures
• Provision of general sleep hygiene advice and discouraging over-sleeping
• Provision of patient education brochures and other materials, discussion
of various aspects of chronic fatigue, and referral to support groups
• Iron therapy in non-anemic patients with low serum ferritin may improve
symptoms of fatigue
22. chronic fatigue syndrome
A case of chronic fatigue syndrome is defined by the presence of:
1. Clinically evaluated, unexplained, persistent or relapsing fatigue that is of new or definite onset; is not the result of
ongoing exertion; is not alleviated by rest; and results in substantial reduction in previous levels of occupational, educational,
social, or personal activities
and
2. Four or more of the following symptoms that persist or recur during six or more consecutive months of illness and that
do not predate the fatigue:
Self-reported impairment in short term memory or concentration
Sore throat
Tender cervical or axillary nodes
Muscle pain
Multijoint pain without redness or swelling
Headaches of a new pattern or severity
Unrefreshing sleep
Post-exertional malaise lasting ≥24 hour
23. EPIDEMIOLOGY
• Is an extremely common complaint
• Represents a very small subset of those who complain of
chronic fatigue < 5%.
• Disorder of young to middle aged adults ( at 30 years)
• CFS is about twice as common in women
• More in Caucasians
24. ETIOLOGY
• Idiopathic
• Infection
Epstein-Barr virus (EBV), xenotropic murine leukemia related virus (XMRV), and
others (retroviruses, human herpesvirus type 6 (HHV-6), enteroviruses, coxsackie B virus)
• Immune dysfunction
• Endocrine-metabolic dysfunction
Low serum cortisol levels, under secretion of corticotropin-releasing hormone, enhanced
serum levels of insulin-like growth factor.
• Depression
• Sleep disruption
25. Clinical presentation
• Sudden onset of fatigue associated with a typical
infection such as an upper respiratory infection.
• Altered sleep and cognition.
• Excessive physical activity exacerbates the
symptoms
• Numerous other subjective features of CFS
fluctuate with time but do not appear to progress
• Once the inciting illness (if any) is resolved, the
physical examination typically is normal
Symptom
Percent
of
patients
Easy fatiguability 100
Difficulty concentrating 90
Headache 90
Sore throat 85
Tender lymph nodes 80
Muscle aches 80
Joint aches 75
Feverishness 75
26. Diagnosis
• History
• Physical examination
• Laboratory testing
• The diagnosis of CFS is one of exclusion
It is generally made if the patient has a typical history, and no abnormality
can be detected on physical examination or in the screening tests.
27. TREATMENT
Promote sleep hygiene.
Non pharmacological:
Regular physical activity.
Optimal diet.
Psychotherapy: CBT, GET, family therapy.
Pharmacological:
To relieve the symptoms: antidepressant, NSAID, antimicrobial, Rituximab,
acyclovir,
28. KEY POINTS
Fatigue occurs in up to 20% of patients seeking care.
Psychological causes should be at the top of the
differential diagnosis for all patients presenting with
fatigue, as the majority of cases have psychiatric causes.
The history can help in determining a psychiatric
versus organic cause and thus aid in directing the
evaluation of fatigue.
Many patients who complain of weakness are not objectively weak when muscle strength is formally tested. A careful history and physical examination will permit the distinction between asthenia, motor impairment due to pain or joint dysfunction, and true weakness.
There is debate, however, whether depression in individual patients is the cause or consequence of symptoms of chronic fatigue.
The clinician should rely upon open-ended questions, encouraging the patient to describe the fatigue in his or her own words. Questions and comments such as "What do you mean by fatigue?" or "Please describe what you mean" may elicit responses that help distinguish fatigue from dyspnea, somnolence, and true weakness.
Age: people 60 years or older usually have an underlying cause for chronic fatigue, whereas in the 30 to 39 years age group the cause is more likely to be idiopathic chronic fatigue.
Nationality: Residence in, or travel to, areas where certain infections are endemic (TB).
Occupation: Occupational, recreational, and residential exposure to tick-infested woods or fields near woods (Lyme disease)
HPI:
Duration (recent, prolonged, or chronic)
Sudden or progressive onset (e.g., chronic fatigue syndrome is usually sudden-onset)
Recovery period (e.g., the course of chronic fatigue syndrome is associated with intermittent periods of recovery lasting hours or days)
Impact of rest (physiological versus non-physiological fatigue)
Impact of physical activity or mental activity (e.g., chronic fatigue syndrome is typically exacerbated by relatively minor physical or mental activity)
Level of physical activity (sedentary lifestyle is a cause of fatigue, and patients may benefit from exercise therapy) and concomitant presence of weakness (e.g., reduced muscle power at rest may point to a neuromuscular disorder)
Seasonality and any current influenza outbreak (which occur most commonly in the winter).
P.M Hx and Family Hx : anaemia, chronic liver disease, hypothyroidism, psychiatric disorder.
Drug Hx: Anti-arrhythmics, Antidepressants,Anti-emetics,Antiepileptics,Antihistamines,Antihypertensives,Corticosteroids,Diuretics
Social Hx: Alcohol
Other: Other laboratory studies can be obtained based on history. ( Erythrocyte sedimentation rate can be considered in older patients who also have symptoms consistent with polymyalgia rheumatica or giant cell arteritis).
The doctor-patient relationship is of profound importance. Two-thirds of patients with CFS reported that they were dissatisfied with the quality of their medical care and felt their clinicians lacked communication skills and education regarding their diagnosis.
Brief regularly scheduled appointments can be used to monitor progress in these areas and are preferred to having the patient being seen on an "as needed" basis.
Antidepressants — A trial of antidepressant drugs should be offered to patients whose illness has features of depression, regardless of whether strict criteria for depression have been met.
Patients should be advised that immediate response to antidepressant therapy is not expected, and that treatment for several weeks would be needed before their response could be assessed. Antidepressants may themselves provoke or exacerbate fatigue, however, and should be discontinued in patients who do not demonstrate symptom improvement within a reasonable time frame (six to eight weeks)