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Fatigue Objectives and References

Objectives:

By the end of Family Medicine Clerkship, students will be able to:

    1.  Conduct a patient interview so as to:

a. Define what the patient means by “fatigue” and distinguish from other concerns eg. mood concerns, muscle weakness, decreased exercise tolerance +/- SOB

b. Identify clinical symptoms/red flags that suggest a secondary etiology, e.g. depression, anemia, hypothyroidism, malignancy, sleep apnea, cardiac disease

c. Identify context red flags that may suggest psychosocial concerns and impact differential diagnosis and/or management, eg. homelessness, isolation, single parent, addiction, recent losses, sleep quality/shift work

    2.  Conduct a relevant physical exam to refine DDx.

    3.  Include “watchful waiting” when appropriate as a diagnostic and/or management tool.

    4.  Propose and act on initial investigations based upon DDx and avoid over-investigation/”shot-gun” approach.


References:

Recommended Resources Addressing the Objectives

Fatigue: an overview (7 pages)

Objectives covered: all

http://www.ncbi.nlm.nih.gov/pubmed/19035066

Rosenthal TC, Majeroni BA, Pretorius R, Malik K. Fatigue: an overview. Am Fam Physician 2008 Nov 15;78(10):1173-1179.

PMID:19035066

Adult Insomnia: Assesment to Diagnosis (11 pages)

Objectives covered: 1a-c, 3, 4

http://www.topalbertadoctors.org/download/440/insomnia_assessment_guideline.pdf

Alberta Medical Association. Adult Insomnia: Assesment to Diagnosis - Toward Optimized Practice (TOP) Program Guidelines. 2010; Available at: 

        http://www.topalbertadoctors.org/download/440/insomnia_assessment_guideline.pdf. Accessed June/3, 2014.

(No PMID)

Foundational knowledge

Neural mechanisms underlying chronic fatigue (12 pages)

http://www.ncbi.nlm.nih.gov/pubmed/24114898

Tanaka M, Ishii A, Watanabe Y. Neural mechanisms underlying chronic fatigue. Rev Neurosci 2013;24(6):617-628.

PMID:24114898

Additional resources

Top 10 causes of fatigue in family medicine, plus clinical pearls (1 page):

Objectives covered: 1a-c

http://www.ncbi.nlm.nih.gov/pubmed/17872753

Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Fatigue. Can Fam Physician 2007 May;53(5):892.

PMID:17872753

Comprehensive DDx and Approach to Fatigue in Elderly (6 pages)

Objectives covered: 1a-c, 4

http://www.ncbi.nlm.nih.gov/pubmed/22062449

Morelli V. Toward a comprehensive differential diagnosis and clinical approach to fatigue in the elderly. Clin Geriatr Med 2011 Nov;27(4):687-692.

PMID:22062449

Recent, Prolonged, and Chronic Fatigue in the elderly - diagnoses and treatments (14 pages)

Objectives covered: 1a, 1c, 3, 4

http://www.ncbi.nlm.nih.gov/pubmed/22062448

Morelli V. Fatigue and chronic fatigue in the elderly: definitions, diagnoses, and treatments. Clin Geriatr Med 2011 Nov;27(4):673-686.

PMID:22062448





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