CC: "tired all the time"
HPI: 38-year-old white woman complaining of increasing fatigue over about 4 months. Feels tired all day,
decreased interest in
... [Show More] usual activities, less able to complete routine tasks, and generally slowed up.
Sleeping more than previously (now approximately 9 pm to 7:30 am) but does not feel rested. Does not
wake during night or nap during day. No recent acute illnesses. No precipitating events for fatigue.
Family, friends and co-workers are criticizing her for low performance of usual activities and negative
attitude. Is not aware of other major symptoms. Is concerned "something is wrong" but can't specify a
concern.
Additional risk factors are female gender [Dom17]. The patient has a family history of diabetes and has a
personal history of smoking.
DIFFERENTIAL DIAGNOSES:
Hypothyroidism, unspecified (E03.9)- Hypothyroidism is an underactive thyroid, which is a common
problem with an aging adult. Signs and symptoms include weight gain, fatigue, depression, poor
concentration, muscle pain and menstrual irregularities. (Gaitonde, Rowley and Sweeney, 2012) This is
usually diagnosed by checking a TSH level and evaluation of patient symptoms. Treatment can be with
medication.
Chronic fatigue, unspecified (R53.82)- Criteria for chronic fatigue syndrome (CFS) include severe fatigue
lasting longer than six months, as well as presence of at least four of the following physical symptoms:
post exertional malaise; unrefreshing sleep; impaired memory or concentration; muscle pain;
polyarthralgia; sore throat; tender lymph nodes; or new headaches. It is a clinical diagnosis that can be
made only when other disease processes are excluded. The etiology of chronic fatigue syndrome is
unclear, is likely complex, and may involve dysfunction of the immune or adrenal systems, an association
with certain genetic markers, or a history of childhood trauma [Cen172].
Depression (F32) – The underlying pathophysiology of depression has not been clearly defined. Clinical [Show Less]