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Clin Med: Fatigue

Terms in this set (71)

normal MCV, High RDW
Early iron, folate or B12 Deficiency
hIGH mcv, high RDW
folate or B12 deficiency x
thalassemia
group of hereditary hemolytic diseases caused by faulty Hb synthesis
microcytic Anemias
iron deficiency anemia
thalassemia
anemia of chronic disease
iron deficiency anemia serum ferritin level
decreased
iron deficiency anemia RDW
increased
iron deficiency anemia serum iron level
decreased
iron deficiency anemia TIBClevels
increased
iron deficiency anemia transferrin saturation levels
decreased
iron deficiency anemia soluble transferrin receptor levels
increased
thalassemia serum ferritin levels
increased
thalassemia RDW level
normal to increased
thalassemia serum iron level
normal to increased
thalassemia TIBC level
normal
thalassemia transferrin saturation
normal to increased
thalassemia soluble transferrin receptor
increased
anemia of chronic disease serum ferritin level
normal to increased
anemia of chronic disease RDW level
normal
anemia of chronic disease serum iron level
normal to decreased
anemia of chronic disease TIBC level
slightly decreased
anemia of chronic disease transferrin saturation level
normal to slightly decreased
anemia of chronic disease soluble transferrin receptor levels
normal
megaloblastic anemia
-type of macrocytic anemia
inhibition of DNA synthesis during RBC production
if reticulocytes are low- indicates
bone marrow is not capable of producing more RBCs
Elevated MMA indicates
B12 deficiency
elevated reticulocytes indicates
B12, folate Deficiency
elevated Homocysteine indicates
folate or B12 deficiency
MMA normal, Elevated Homocysteine
folate deficiency
sickle cell anemia symptoms
ulcers
- all organs become damaged
- hemolysis
sickle cell anemia prevalence
• 5-7% globally are carriers
• mostly from sub-Saharan Africa ( Nigeria), asia
sickle cell anemia diagnosis
•newborn screening in US and Canada
•seen on peripheral blood smear

openicillin prophylaxis to decreased bacteremia/sepsis
orespiratory vaccinations
o early recognition of bacterial infections
o pain management
o reduce risk of occlusion ( make sure they have oxygenation)
obstructive sleep apnea syndrome symptoms
- breathe fine during the day
- restless sleep
- loud snoring, gasping
- daytime sleepiness, morning fatigue
- decreased performance and vigilance
- memory loss
- decreased cog function
-indigestion and GERD
- depression and psychosis, personality changes
-decreased libido
- headaches
-dry mouth
- nocturnal sweating, enuresis
obstructive sleep apnea syndrome prevalence
- neck circumference is a strong indicator
- enlarged adenids
> 60
70% obese
co morbidities
obstructive sleep apnea syndrome diagnosis
- elbow sign ( LR= 11.9)
STOP bang ( snoring, tired, observed, pressure, BMI, Age, Neck Size, gender) - though not diagnostic
-noctural polysomnography- diagnostic!
lyme disease stage 2 symptoms
- occurs from a couple days to a few weeks
- systemic spread
- b cell response
- neurologic ( 15%)- bells palsy, meningitis, radiculopathy
- cardiac symptoms ( 5%)- arrhythmia, pericarditis, myocarditis
- skin rashes
-arhtritis
-extreme fatigue and weakness
lyme disease stage 1 symptoms
-occurs from a couple days to a few weeks
- immune response
- erythema migrans ( 70%)
- bulls eye appearance
- not painful or pruritic
- localized symptoms
- maybe lymphadenopathy, constitutional symptoms
- myalgia/ arthralgia
lyme disease stage 3 symptoms
- from months to years
- chronic fatigue
- arthritis ( most commonly of the knee)
- polyneuropathy
- encephalitis)
lyme disease cause
tick bite
- B burgsdorfi
- in spring and summer
- binds to saliva in tick, transmitted into mammal when bitting
- salvia coats it and protects it from human immune system
- ticks become nymphs in spring
lyme disease prevalence
• Whites> blacks
o But could be that blacks don't notice it right away because harder to see on darker skin
• Increasing in prevalence in Ontario/ Canada in the spring/ summer
lyme disease diagnosis
• Don't usually use serology for screening- need high pretest probability, because there are a lot of false positives
• ELISA (~70% sensitivity) if positive do:
• Western Blot (~94-96% specificity)- confirms diagnosis
lyme disease treatment
refer for antibiotics
- teach prevention methods: protective clothing, shower or bathe after being outdoors
- prompt removal of tick and keep it
rheumatic disease prevalence
• Leading cause of disability
• Most prevalent chronic conditions
rheumatic disease risk factors modifiable
-obesity: from inflammation

-joint injuries: may expose antigenic component

- infections:might damage self cells

- occupational risks/ environment : tissue injury, heavy repetitive lifting, chemicals

-stress: cortisol modulates immune response- adrenal insufficiency
rheumatic disease risk factors non modifiable
- female: child bearing age- estrogen activated humeral immunity
- older age
-genetics
rheumatic disease treatment
labs: ANA- high specific
ESR
CRP
RF
polymyositis symptoms
- no skin symptoms and Four of:
- pros muscle weakness
- elevated serum creatine kinase or aldolase level
-muscle pain
- electromyography ( stimulantes muscle contraction)
- positive anti Jo1 antibody test _ nondestructive arthritis or arthralgia
- systemic inflammatory signs ( fever,)
- muscle biopsy compatible with inflammatory myositis
dermatomyositis symptoms
skin lesions: ( eliotrope= red purple edematous erythema on eyelid, erythema on extensor surfaces: elbows, knees)
- fascial swelling

and Four of:
- pros muscle weakness
- elevated serum creatine kinase or aldolase level
-muscle pain
- electromyography ( stimulantes muscle contraction)
- positive anti Jo1 antibody test _ nondestructive arthritis or arthralgia
- systemic inflammatory signs ( fever,)
- muscle biopsy compatible with inflammatory myositis
polymyositis risk factors
HIV, unprotected sex
myositis cause
- infectious
- non infectious: statin use, cushings
myositis diagnosis
electromyography- creatine kinase
- biopsy
myositis treatment
- suppress immune response
- physical therapist, dermatologist, sam doctor
- avoid sun
- start tx early!
multiple sclerosis symptoms
-blurred vision or sensation: impaired colour and contrast sensitivity ( affects just 1 eye )
-Pain over lateral eyebrow; worse on lateral eye movement
-Nystagmus on lateral or vertical gaze
- fatigue,weakenss- worse with exertion or heat depression
- bladder urgency, freq, incontinence, retention, UTIs, constipation
- weakness- impaired balance/ coordination
- hyperreflexia, babinskis, ataxia, tremor
- loss of vibration sense of pain
- formations ( feels like ant crawling)
- parasthesia
- burning, aching, radiculopathy
- sensory and motor changes distal to proximal
- low libido
- fatigue
- sensitive to heat
- sxs decrease during pregnancy
multiple sclerosis prevalence
young, white woman
- northern latitudes
- increase in prevalence in recent years
- less common in asian pop
course of multiple sclerosis
oRelapsing, remitting (85-90%)- days/ weeks

A.Secondary progressive
-Evolves from above after 20-40 years
-6 months of worsening with no remitting

B. Primary progressive (10-15%)
-Deterioration from onset
-More often in men and involvement of spinal cord as opposed to brain
multiple sclerosis pathogenesis
-autoimmune mediated attack of myelin
a. t cell mediated inflammation, macrophages
B. degranulation of free radicals causing demyelination, scarring, axonal damage
c. pro inflammatory cytokines directly damage myelin
multiple sclerosis risk factors
-1st degree affected relative/ autoimmune disease
•low Vitamin D
-Smoking
•Diet
-Sodium
-Saturated fat; EFAs (Swank diet)
-Antioxidants
-Moving from low risk to high risk environment can increase
-BMI
-mercury
Viral vaccines
o Hep B
multiple sclerosis Diagnosis
- at least 2 demyelinating lesions disseminated in time and space
-mcDonalds criteria
- MRI
multiple sclerosis prognosis
o Lifespan about 8 years less than normal
o Suicide rates significantly higher
o 2/3 will be prevented from working
o 50% will require assistive devices- or husband
o 1/3 will require use of a wheelchair
hypothyroidism cause
autoimmune- hashimotos most common
-Iatrogenic, idiopathic, I-deficiency, enzymatic defect, secondary
hypothyroidism symptoms
- bradycardia
- delayed reflexes
-coarse, cold skin
- weight gain
- hearing loss
- mental sluggishness
- depression
- very dry
- increased thirst
- swollen, waxy skin
- decreased libido
- constipation
- hoarseness
- poor wound healing g
- slow and low pitched speech
-goitre
hypothyroidism diagnosis
• No individual sx has high LRs, therefore minor suscpision should do blood test
- high TSH levels
hashimotos thyroiditis pathogenesis
• Inhibition of TSH receptors by Ab-secreting-B-cells
- causes destruction of thyroid gland
hashimotos thyroiditis prevalence
45-65 yoa
women> men
hashimotos thyroiditis risk factors
- familial
-hisotry of autoimmune diseases,
- diabetes
- radiation
- thyroid surgery
- drus
- goiter
-down syndrome
subclinical hypothyroidism
TSH above the upper limit, despite normal levels of T4
o May or may not have symptoms attributable to hypothyroidism.
Sublaboratory Hypothyroidism
hypothyroidism with normal labs
o Look for a cause:
o Causes of poor conversion?
♣ Age, stress
♣ Warm environment
♣ Fasting/starvation/malnutrition
♣ Chronic disease, drugs, nutritional deficiency, toxicity
♣ DM
chronic fatigue syndrome symptoms
-Significant impairment of daily activities

Oxford Criteria:
-Primary symptom is fatigue
-Definite onset of symptoms
-Fatigue is severe, disabling, and affects physical and mental functioning
-Symptoms for at least six months and present more than 50 percent of the time
-Other symptoms must be present, particularly myalgia, and mood and sleep disturbances
-Certain patients should be excluded:with medical condition


Centers for Disease Control and Prevention Diagnostic Criteria
-Severe fatigue for longer than six months, and at least four of the following symptoms:
-Headache of new type, pattern, or severity
-Multijoint pain without swelling or erythema
-Muscle pain
-Postexertional malaise for longer than 24 hours
-Significant impairment in short-term memory or concentration
-Sore throat
-Tender lymph nodes
-Unrefreshing sleep
red flag symptoms in persons with suspected chronic fatigue syndrom
chest pain
focal neurologic deficits
inflammatory signs or joint pain
lymphadenopathy or weight loss
sob
addison disease symptoms
- extreme fatigue
- weight loss
- darkening of the skin
- low BP
addison disease cause
• 75-90% autoimmune destruction of cortex
• infections - TB
• metastatic neoplasms ( LU, breast)
addison disease pathogenesis
stress and pro inflammatory cytokines( shifts inflammation to th2) --> causes neg feedback loop do decrease glucocorticoids
- inhibits hypothalamus and pituitary
- hypogonadism
- low GH
- inhibits bone formation
Over time ...
o Adrenal cortex can't keep up
o Sustained high levels may damage hippocampus and hypothalamus
o HYPOCORTISOLEMIA
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