Tiredness History Taking | OSCE Tips
Tiredness history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a tiredness history during an OSCE.
Presenting complaint (PC):
What brought you here today?
Describe symptoms of tiredness?
History presenting complaint (HPC):
Onset: when did it start? Is the tiredness constant or intermittent?
Duration of tiredness: how long have you been feeling tired for?
Severity: affecting daily life?
Any trigger or relieving factor?
Associate symptoms: sleep disturbance, loss of apetite, fever, weight loss, any recent infections or illness?
Any patterns: related to meal times? related to physical activities? occuring during the day or night?
Now is a good idea to ask Ideas, Concerns & Expectations (ICE)
Past medical history (PMH):
Is there any chronic illness that I should know about that we have not covered?
Ask about any previous treatment or investigations for tiredness?
Drug history (DH):
Are you taking any medication? If so, any side effects.
If taking any medication, ask if the tiredness started after starting the medication.
Family history (FMH):
Is there any family members who have similar symptoms?
Social History (SH):
Ask about living condition
Ask about sleep hygeine, diet and exercise habits
Ask about use alcohol use, smoker and any recreational drug use
Possible differential diagnosis:
Nutrition deficiencies:
Iron-deficiency anaemia.
Vitamin B12, folate and Vitamin deficiency.
Sleep disorders:
Obstructive sleep apnoea.
Insomnia.
Restless leg syndrome.
Metabolic & Endocrine disorders:
Diabetes.
Hypothyroidsm.
System review:
Review each body system to check for any other symptoms that might be causing tiredness.
Summaries your findings.
Investigation:
Bedside: general examination (cardio, resp, abdo), Oxygen saturation (SPO2), pulse/heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature.
Bloods : full blood count (FBC), vitamin B12 and folate levels, ferritin/iron studies, thyroid-stimulating hormone (TSH), urea and electrolyte (U&E), c-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR).
Sleep studies (if suspecting obstructive sleep apnoea).
Imaging: Chest XR (if suspecting malignancy), echocardiogram (is suspecting heart failure) and other imaging studies as appropriate.
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