Dr. Cole and Class,
Briefly and concisely summarize the H&P findings
is ar stu ed d vi y re aC s o ou urc rs e eH w er as o. co m
This is a 56-year-old Caucasian female that presents today with c/o constant, generalized fatigue for the last 2-3 months. Reports that fatigue is progressively getting worse and that she feels tired all the time even though she gets 8 hours of sleep per night. States “No energy to do anything I normally can do”. Exertion aggravates her fatigue and denies relieving factors. She denies home tx as well as pain and missed 1 day of work d/t “couldn’t get out of bed” feeling. She has a 5lbs weight gain since her last visit 6 months ago and reports worsening depression symptoms but thinks it is d/t her being “unproductive” and tired all the time. She denies suicidal or homicidal ideations. Also reports generalized weakness and intermittent muscle cramping in calves. Her hx. is significant for HTN, Depression, and Menopause. She takes Bisoprolol-HCTZ 2.5mg/6.25mg for her BP and Prozac 20mg for her Depression. Her Physical exam was significant for elevated BP of 146/95, dry skin and coarse hair, and DTRs +1 at knees and ankles.
Provide a differential diagnosis (min. 3) which might explain the patient’s CC. Brief statement of pathophysiology for each DDx Diagnosis # 1: Chronic fatigue syndrome (CFS)
The exact cause of Chronic fatigue syndrome is unknown, but research suggest that CFS can be triggered by a variety of infections, vaccines, exposure to organophosphate chemicals, and that the pathogenesis involves prolonged immune activation (Kerr, 2015). Diagnosis # 2: Hypothyroidism
The hypothalamus produces thyrotropin-releasing hormone (TRH) which then stimulates the anterior pituitary to secrete TSH. After TSH is released, the thyroid is stimulated to release, synthesize, and secrete trioiodothryonine (T3) and thyroxine (T4) from the thyroid itself. T3 and T4 both feed back to the hypothalamus and the pituitary to inhibit TRH and TSH (Dubbs & Spangler, 2014). Diagnosis # 3: Anemia
There are several different forms of Anemia and the pathophysiology is depending on the specific anemia. Anemia is a decrease in Hgb and can be due to excessive bleeding, vitamin deficiencies, and mutations in the DNA sequence (Hallek, M., 2015)
Th
Analyze the differential and rank the differential in order of most likely to least likely. Diagnosis # 1 Hypothyroidism
sh
This is my first differential for this patient. Hypothyroidism should be R/O in patients that present with chronic fatigue to prevent potential complications from prolonged hypothyroidism like Goiter or Myxedema.
Pertinent positive findings: 5 lbs weight gain within the last 6 months, generalized weakness and intermittent muscle cramps in the calves, dry skin and coarse hair, thick nails, and DTRs +1 at knees and ankles
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