Que - 20 years old female presented to see in your general practice clinic with feeling tired all the time. He has no other complains and otherwise he is well. Examination is unremarkable. What initial investigation will you order? Choose the best answer from following.
Ans -
1 - CBE, LFT
2 - CBE, LFT, EUC
3 - CBE, LFT, EUC, TFT
4 - CBE, LFT, EUC, TFT, CMV serology and EBV serology
5 - None
(CBE - Complete blood examination, LFT - Liver function test, EUC - Electrolytes, Urea and Creatinine, TFT - Thyroid function test, CMV - Cytomegalovirus serology, EBV - Ebstain Barr virus serology)
Ans -
1 - CBE, LFT
2 - CBE, LFT, EUC
3 - CBE, LFT, EUC, TFT
4 - CBE, LFT, EUC, TFT, CMV serology and EBV serology
5 - None
(CBE - Complete blood examination, LFT - Liver function test, EUC - Electrolytes, Urea and Creatinine, TFT - Thyroid function test, CMV - Cytomegalovirus serology, EBV - Ebstain Barr virus serology)
In my view, answer 3 is correct. In young healthy female with normal examination, we need to exclude anaemia, thyroid function abnormalities, renal failure and hepatitis. Some people will argue that 4 will be correct, but I would wait until liver function test comes back and will add those serology depending on result, so I think best correct answer is 3.
ReplyDeleteI thought it was 2, for 20 yr old female with only symptom weakness, is it necessary to have TFT...??
ReplyDeleteIf you will read Murtagh, he talks about 7 masquerades (which includes Depression, Diabetes, Drugs, Anaemia, Thyroid abnormality, Spinal abnormalities and UTI)and can present without major symptoms and often missed. I do agree with him. I have seen one pregnant lady with hyperemesis who had no other symptoms, but found to have severe hypothyroidism and got better post thyroxine replacement!
ReplyDeleteI would suggest you to read Fatigue article written by Dr John Murtagh.
Regards,