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Miss F, a 23-year-old teacher, is worried about her progressively worsening tiredness. Her symptoms started soon after she took up a new position at a local school. She is generally healthy.
The following is a summary of her doctor's notes:
History
Over the last month:
1. Feeling tired for the most part of the day.
2. Struggles to get up in the mornings because of a feeling of malaise.
3. Poor sleep despite going to bed before 10 every night.
4. Noticed that she has been feeling more emotional recently.
5. Finds it difficult to concentrate at work and easily snaps at the children.
6. Despite being invited by friends, she prefers staying at home.
7. Appetite seems to be normal.
8. Not currently in a relationship.
9. Family lives far from home.
10. Previously enjoyed painting as a hobby, but currently doesn't have the energy.
- No family history of disease.
- Smoker and uses alcohol.
Examination
Generally appears to be healthy.
Cardio: normal heart sounds, regular pulse
Respiratory: normal
Abdominal: normal
Neurological: normal
Side room:
Normal blood pressure, pulse and temperature
Urine: clear
Use the above information and answer the following questions:
1. What other questions would you like to ask Ms F?
2. Are there any other important sideroom investigations?
3. Is there anything else you will look out for on examination?
4. Would you consider doing blood tests? If yes, what tests would you do?
5. What is the most likely diagnosis?
NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.
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