Miscellaneous
What is the difference between fatigue and sleepiness?
fatigue - A feeling of exhaustion or tiredness that is pervasive, not relieved by rest, and often worsened by exertion.
sleepiness - A feeling of tiredness that gives a patient the tendency to fall asleep, and is often relieved by either rest or exertion.
What makes a good screening test, and what makes a disease worth screening for?
Screening tests that detect early forms of the disease and early tx leads to better outcomes. Diseases for which there is a detectable and treatable risk factor that can lead to the disease if left untreated (e.g. cervical cancer, CRC)
What are the four broad ddx categories fatigue?
Primary (Chronic fatigue syndrome and fibromyalgia), Secondary (DM, CHF, malignancy, etc.), Psychological (depression, anxiety, etc.), Physiologic (poor sleep from sleep disorders, lifestyle, or medical issues)
What goes into a diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)?
Symptoms of fatigue present for > six months w/ moderate, substantial, or severe intensity at least half of the time. Must have: significant impairment in ability to engage in activities, post-exertional malaise, and unrefreshing sleep, and either cognitive impairment or orthostatic-related symptoms.
What are potential complications/risks of colonoscopy?
Infection or tears in the lining of the colon, Perforation, Major bleeding, False-negative or false-positive test results.
What are some initial labs you would order for someone presenting with fatigue?
CBC, serum glucose, ESR, TSH, Iron studies w/ ferritin
What should be included in a referral letter to a specialist?
What 4 things can be found with colonoscopy?
Hemorrhoids, diverticuli, polyps, cancer
What are the main causes of Iron Deficiency Anemia?
GI blood loss (colorectal carcinoma, colon polyps, bleeding diverticuli, peptic ulcer disease, and gastritis), impaired absorption (celiac sprue), and more rarely chronic hematuria and insufficient dietary intake
What is standard treatment for iron deficiency anemia?
ferrous sulfate 325 mg three times daily
docusate sodium 100 mg twice daily as needed for constipation
What are the screening options for CRC, how often does each need to be performed, and at what age do you start?
50-75yrs (Grade A rec) and age 45-49 (Grade B)
colonoscopy every 10yrs, flexible sigmoidoscopy every 5yrs, FOBT every yr, FIT every yr, FIT-DNA every 1-3yrs, CT colonography every 5yrs, flexible sigmoidoscopy + FIT every 10yrs
What are 4 risk factors for CRC?
Age (90% of CRC occurs after 50), Hereditary conditions, personal hx (of CRC, UC or Chron's, DM, ovarian, endometrial, or breast cancer), first-degree relative w/hx, obesity
What are the steps of the SPIKES strategy for delivering bad news?
Setting up the interview, Perception ("before you tell, ask"), Invitation (ask permission), Give Knowledge and information to the patient, Address the patient's Emotions with empathic responses, Strategy and Summary
When the bleeding is truly bright red, the source of bleeding is generally ___________. GI docs may choose to do ___________, which incurs less risk to the patient.
When the bleeding is truly bright red, the source of bleeding is generally distal to the splenic flexure. In a younger patient, a doctor might do a flexible sigmoidoscopy, which shows all they need to see at less risk to the patient
What are 3 clinical ways to stage CRC?
endorectal ultrasound provides fairly accurate estimates of the depth of invasion of the bowel wall, CT scan of the chest, abdomen, and pelvis can look for metastasis to the pelvic lymph nodes, liver and lung, and CEA (carcinoembryonic antigen) is elevated in many CRCs as well as some benign conditions (Elevation >5 ng/ml is associated with a worse prognosis at each stage)