Question

Susan, a 23 year old part time graduate student who works full time in food service has started to feel chronic fatigue. She started to also experience frequent headaches. She notes that her pants are feeling loose lately.

a.) what questions might Susan's provider ask her as part of her history when she has her first telehealth visit?

b.) what observations will the provider want to make over the screen when speaking with Susan?

c.) What additional questions outside of family history will the provider want to ask to help figure out a differential diagnosis?

d.) What are your initial thoughts on what is causing Susan's fatigue and headaches and why do you think this?

Answer 1

Susan 23 year old girl has been studying part time and has been working full time in food service. As a result, she begins to experience fatigue and headache. By means of first Tele health visit, Susan providers can ask questions regarding the present complaints, personal history, family history and past medical history

1.

a) Fatigue: she can be questioned regarding the past experiences of fatigue and headache, how many hours it lasts and when it get relieved

b) She can be asked regarding the Last weight and height checked and how much it was and when it was checked

c) Sleep: she can be questioned about hours of sleep, location of sleep.

d) Nutrition: she can be asked regarding the per day intake of food, type of food, kind of food, preparation of food.

e) Menstrual history : she can be asked regarding duration of cycle, what are the triggering factors, overflow or down flow of cycle

f) Addiction habits: she can be asked any addiction habits that triggers experiences such as smoking

g) Family history : she can be questioned about any family history of chronic fatigue syndrome, thyroid disorders

h) Past medical history: she can be asked about any past medical history of admission and medication intake such as thyroid medication.

2. She can be assessed for her facial expression, voice tone and concentration of speaking with providers. She is assessed regarding the loosely fitted clothes, her hand movements such as keeping the hand on the head. She is noted on thyroid glands for any over active thyroids glands while speaking and her eyes for any exopthalmas

3. Fatigue is main symptoms of fibromyalgia, depression whereas headache occurs as a results of sleep disorders and migraine and hormonal imbalances and caffeine intake

a.     Sleep: she can be questioned about hours of sleep, location of sleep. Sleep disorders can cause fatigue and headache.

b. Nutrition: she can be asked regarding the per day intake of food, type of food, kind of food, preparation of food. She can be asked caffeine intake while in the food service. Because It stimulates central nervous system and become active in her working time

c. Menstrual history : she can be asked regarding duration of cycle, what are the triggering factors, overflow or down flow of cycle

d. Addiction habits: she can be asked any addiction habits that triggers experiences such as smoking

e. Past medical history: she can be asked about any past medical history of admission and medication intakes such as overactive thyroid glands. Because over active thyroid gland causes weight loss, fatigue and headache. She can be asked regarding the any depressive disorder because it might prevent her to consume foods and cause fatigue and may complain headache

4. Excessive tiredness, fatigue, and weight loss occurs mostly occurs as a results of poor nutrition intake, sleep disorders, excessive strain on work, over active thyroid gland. She may consume less food and followed decreased sleep pattern and excessive burden of work cause stress on her. Because she is part time graduate student along with full time in food service department.