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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