Dr. Cole and Class
Briefly and concisely summarize the H&P findings
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)
Analyze the differential and rank the differential in order of most likely to least likely.
Diagnosis # 1 Hypothyroidism
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
Briefly and concisely summarize the H&P findings
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)
Analyze the differential and rank the differential in order of most likely to least likely.
Diagnosis # 1 Hypothyroidism
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
