Clinical Scenarios

Clinical Scenario



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.

Clinical Cards



Recommended Resources Addressing the Objectives

Fatigue: an overview (7 pages)

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

Adult Insomnia: Assesment to Diagnosis (11 pages)

Objectives covered: 1a-c, 3, 4
Alberta Medical Association. Adult Insomnia: Assesment to Diagnosis – Toward Optimized Practice (TOP) Program Guidelines. 2010; Available at: Accessed June/3, 2014.

Foundational Knowledge

Neural mechanisms underlying chronic fatigue (12 pages)
Tanaka M, Ishii A, Watanabe Y. Neural mechanisms underlying chronic fatigue. Rev Neurosci 2013;24(6):617-628.

Additional Resources

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

Objectives covered: 1a-c
Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Fatigue. Can Fam Physician 2007 May;53(5):892.

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

Objectives covered: 1a-c, 4
Morelli V. Toward a comprehensive differential diagnosis and clinical approach to fatigue in the elderly. Clin Geriatr Med 2011 Nov;27(4):687-692.

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

Objectives covered: 1a, 1c, 3, 4
Morelli V. Fatigue and chronic fatigue in the elderly: definitions, diagnoses, and treatments. Clin Geriatr Med 2011 Nov;27(4):673-686.