Chronic Fatigue Syndrome

Chapter 48 Chronic Fatigue Syndrome




Clinical Case Problem 1 A 25-Year-Old Woman with Chronic Fatigue


A 25-year-old woman comes to your office with a 9-month history of “unbearable fatigue.” Before the fatigue began 9   months ago, she worked as a high-school chemistry teacher. Since the fatigue began, she has been unable to work at all. She reports an influenza-like illness at the time this started. She feels like she “got sick” and never recovered. She tells you that “one day it just hit me. I literally could not get out of bed.”


Her past history is unremarkable. She has a husband and two children who have been very supportive during her 9-month illness. She has no history of any significant illnesses, including no history of any psychiatric disease. She has not expressed any signs of depression.


The other symptoms that the patient describes are difficulty concentrating, headache, sore throat, tender lymph nodes, muscle aches, joint aches, feverishness, difficulty sleeping, abdominal cramps, chest pain, and night sweats.


On physical examination, the patient has a low-grade fever (temperature of 38.2°C), nonexudative pharyngitis, and palpable and tender anterior and posterior cervical and axillary lymph nodes.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. major depressive illness

b. masked depression

c. chronic fatigue syndrome

d. fibromyalgia

e. malingering

2. What is the etiology of the condition presented here?


a. unequivocally related to a viral infection

b. associated with an imbalance of neurotransmitters in the brain

c. a factitious illness

d. associated with major psychiatric disease in almost all cases

e. unknown

3. Which of the following statements regarding the condition described is (are) false?


a. this condition is relatively new

b. this condition is also known as epidemic neuromyasthenia

c. this condition is also known as myalgic encephalomyelitis

d. this condition is also known as multiple chemical sensitivity syndrome

e. none of the above is false

4. Which of the following statements concerning the epidemiology of the condition described is (are) true?


a. patients with this condition are twice as likely to be women

b. the patients with this condition are likely to be in the 20- to 55-year-old age bracket

c. clusters of outbreaks of this condition have occurred in many countries during the past 60   years

d. the primary symptom of this condition may be found in up to 24% of patients attending a primary care clinic in the United States

e. all of the above

5. Which of the following best describes the onset of chronic fatigue syndrome in the majority of patients?


a. gradually increasing symptoms during a 3-month period

b. gradually increasing symptoms during a 6-month period

c. acute onset of symptoms in a previously healthy, well-functioning patient

d. chronic onset of symptoms during 1 or 2   years

e. the onset of symptoms is extremely variable; it is impossible to predict them with any degree of certainty

6. Regarding the laboratory diagnosis of the condition, which of the following statements is true?


a. no laboratory test, however esoteric or exotic, can diagnose this condition or measure its severity

b. a well-defined laboratory test that is sensitive but not specific exists for diagnostic purposes

c. a well-defined laboratory test that is specific but not sensitive exists for diagnostic purposes

d. a well-defined laboratory test that is both sensitive and specific exists for diagnostic purposes

e. a number of laboratory tests in combination are used for definite confirmation of the condition

7. Which of the following has been shown to be the most effective therapy for the condition described?


a. a tricyclic antidepressant

b. a nonsteroidal antiinflammatory drug (NSAID)

c. a sensitive, empathetic physician who is willing to listen

d. cognitive psychotherapy

e. none of the above

8. Chronic fatigue syndrome is associated with all of the following except


a. hypothalamic dysfunction

b. conversion disorder

c. alpha-intrusion sleep disorder

d. chronic immune activation

e. myofascial pain

9. Chronic fatigue syndrome is associated with which of the following symptoms?


a. sleep disruption

b. cognitive dysfunction

c. anxiety or depression

d. neurologic symptoms

e. all of the above

10. Empirical evidence suggests that the best drug(s) to treat symptoms of the disorder is (are) which of the following?


a. NSAIDs

b. antidepressants

c. clarithromycin

d. tryptophan

e. a and b

11. When antidepressant medications are used to treat either the sleep disorder or the mood disorder associated with chronic fatigue syndrome, what should the dose be?


a. the usual dose given to treat depression

b. 1½ times the usual dose given to treat depression

c. ½ the usual dose given to treat depression

d. ¼ or less of the usual dose given to treat depression

e. twice the usual dose given to treat depression

12. Which of the following nonpharmacologic measures has (have) been shown to help with chronic fatigue syndrome?


a. acupuncture

b. cognitive-behavioral therapy

c. exercise

d. b and c

e. all of the above

13. Most patients with chronic fatigue syndrome


a. fully recover within 2   years

b. partially recover within 2   years

c. never recover

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Chronic Fatigue Syndrome

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