Case Presentation 1 - Asem

1. CASE PRESENTATION 1
Asem Mustafa shadid

2. PERSONAL DATA
• Name: lamya
• Gender: Female
• Age: 26 years old
• Occupation: teacher.
• Nationality: Saudi
• Residency: Riyadh city
• Birth: Riyadh city
• Historian: patient who was reliable.

3. PERSONAL DATA

4. CHIEF COMPLAINS AND DURATION:
• I feel tiredness and exhaustion
• For 1 year increased in the last month

5. THIS IS A CASE OF WHAT ?

6. WHAT DO YOU WANT TO ASK ?

7. HISTORY OF PRESENTING ILLNESS:
• What do you mean by tiredness ?
• Inquires about onset and duration of fatigue ( 1 month )
• Asks patient what she believes is causing her fatigue
• Patients' ideas, concerns, and expectations (ICE)

8. HISTORY OF PRESENTING ILLNESS:
• Inquires about patient’s mood (“I often feel low” for 2 year or so )
• Excessive sleep (yes)
• Feelings of worthlessness/guilt/isolation ( not always )
• Poor concentration ( yes )
• Symptoms of anxiety ( yes )
• Symptoms suggestive of thyroid disease - cold intolerance, skin/hair changes
• Increasing weight, increasing appetite (no)
• Symptoms of DM
• Inquires about association with other systemic symptoms – fever, chills, nausea (none)
• Anaemia symptoms: breathlessness on exertion ( yes )
• Suicidal ideation
• Suicide attempts

9. PAST MEDICAL HISTORY
• decreased blood pressure attacks (multiple times)
• History of HAV 10y ago ( 16 y old ) treated in
Alshmaisy

10. CON.
• Past admission: HAV ( 10 y ago )
• Past surgical: null
• Medication: null
• Blood transfusion: null
• Allergy: no known allergy of food or medication
• Family history: null
• Social history: No recent travel , not smoker , No recent contact with unwell person .
• Vaccination: influnza vaccination ( 2 weeks )
• Pregnancy and periods cycle ?

11. WHAT DO YOU WANT TO TELL HER ?

12. MANAGEMENT OPTION (CRAPRIOP)
Clarifications
Reassurance
Advice
Prescribing
Referral
Investigation
Observations
Prevention

13. DIFFERENTIAL DIAGNOSIS

16. OUR DDX ?
• Depression ? MDD or PERSISTENT DEPRESSIVE DISORDER (DYSTHYMIA)
• Anxiety ?
• DM ?
• Thyroid ?
• Anemia ?
• Other ?

17. MDD VS (DYSTHYMIA)

18. WHAT KIND OF INVESTIGATIONS YOU
WILL ORDER ?

21. OUR LAB

22. OUR LAB

23. OUR LAB

24. OUR LAB

25. SO ?
WHAT IS THE DIAGNOSIS ?

26. IRON DEFICIENCY ANEMIA
• iron with folic acid
• Advice ?

27. NOTE
she is having multiple visit
every month or so different specialty
what is your advice ?

28. REFERENCES :
▸ https://www.uptodate.com/contents/approach-to-the-adult-patient-with-
fatigue?search=fatigue&source=search_result&selectedTitle=1~150&usage_type=default&
display_rank=1
▸ https://www.aafp.org/afp/2008/1115/p1173.html

29. THANK YOU