JACQUELINE RUSELL IHUMAN : ”FATIGUE” WITH THE SOLUTION AS PER THE MARKING SCHEME Best Rated A+ Guaranteed Best Exam Solution 

JACQUELINE RUSELL IHUMAN

:”FATIGUE” WITH THE

SOLUTION AS PER THE

MARKING SCHEME

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Jacqueline Russell is a 17-year-old female who comes in the clinic with complaints of generalized

fatigue which started two months ago. Accompanying symptoms include anxiety, anhedonia,

irritability, and problems concentrating. Major life changes include recent breakup with her

boyfriend and pressure in school while expected by her parents to have a scholarship. She stated

that she gets enough sleep but still feel tired upon waking up. Key findings include being

overweight, easily cries, unintentional 25-30 weight gain last year, history of marijuana use,

Acanthosis Nigricans, and striae on abdomen and buttocks. She denies taking any medications

other than Ibuprofen for menstrual cramps. She occasionally drinks beer. The patientskips breakfast

but eats high calorie foods like pizza and French fries several times per week.

The patient denies any suicidal ideations but stated that she wants to “disappear” and not deal

with her situation. Risk factors include family history of diabetes II and obesity. Lab findings are

negative for anemia, negative urine drug screen, normal T4, TSH levels, and CBC.

Key Findings:

BMI 28.8 (overweight)

Patient is reluctant to make eye contact

Crying

Pressure from being a senior at school

Mother made her come, pressure from parents

Per patient gets enough sleep but wakes up tired

Unintentional 25-30 weight gain last year

Stretch marks

Marijuana use Hx with old boyfriend

Breakup with boyfriend

Low self-esteem

Skips breakfast, eats high calorie foods like pizza and french fries several times per week

Constantly snack at night to keep going

Anhedonia in school and leisure activities

Upset, irritable, angry, frustrated, and cries daily

Feels irritable and annoyed a lot by family and parents, they blame on her periods.

Problems concentrating daily

Wants to disappear and not deal with situation

Occasionally drinks beer

Acanthosis Nigricans at nape

Striae on abdomen and buttocks

Meds:

Takes Ibuprofen for menstrual cramps, pain is not bad per patient.

Social

Tried marijuana last year with old boyfriend, denies any other recreational drugs

Used to baby sit for a family neighbor

Primary Dx:

Major Depressive Disorder – Symptoms similar to Jacqueline are depressed mood, irritability,

markedly diminished interest and pleasure in usual activities, and symptoms that lasts at least

two weeks. Common symptoms of depression also include change of appetite (25-30 lbs. weight

gain), low energy and fatigue, and difficulty concentrating. MDD is diagnosed if there have been

at least two weeks of depression with at least four accompanying symptoms of depression.

General Anxiety Disorder – The most common comorbidity with depression is anxiety disorder.

Major symptoms similar to Jacqueline are unexplained fatigue, irritability, difficulty

concentrating,

DDx:

Type II Diabetes Mellitus

Hypothyroidism

Fatigue

O-2 months ago

L-generalized

D-Constant per mother

CA-Pressure from school as a senior

A-Gets enough sleep but still wakes up tired

R-?

TS-Don’t feel like doing anything