Fatigue

- Subjective complaint of tiredness and diminished energy

level to point of interfering with normal or usual activities
History
- Time course, exacerbating and alleviating factors, stressors,
variability in symptoms and associated symptoms
Psychogenic
- Fatigue that persist for >6months and fluctuates in severity
 functional
- Mood disturbance
- Sleep disturbance with insomnia or early morning
awakening
- Fatigue is worse in morning and alleviated by activity
Physiologic
- Not getting enough sleep  shift work, overtrain
Organic diseases
- Stressors are absent and supportive environment
- Fatigue worse with activity
Physical examination
- Pallor  anemia
- Darkening of skin  addisons disease
- Thyroid palpation for hyper/hypothyroidism
- Heart and lung examination
 Murmurs
 Gallops
 Wheezing or rales
Diagnosis
- CBC
- ESR
- Metabolic profile
- Urinalysis
- Thyroid function test
- Pregnancy test in women with childbearing age
- HIV for individuals at risk
- Other tests will depend on history and physical exam
Treatment
- Psychiatric evaluation for patients with depression and
anxiety
- For identified medical condition  treat the cause