| |
Problem
6.1
A
30-year-old white female presents with a 3 month history of chronic
fatigue. Initial physical examination and laboratory testing is
normal. You ask her to complete a multi-symptom rating-scale,
the PHQ-15. Her responses are shown in Figure 6.1 below.
| Figure
6.1: Patient's Responses on the PHQ-15
|
|---|
| During
the past 4 weeks, how much have you been bothered by
any of the following problems?
|
|---|
| Symptom
| Not
bothered at all (0)
| Bothered
a little (1)
| Bothered
a lot (2)
|
|---|
| a.
Stomach Pain |
X
| | |
| b.
Back Pain | |
X
| |
| c.
Pain in your arms, legs, or joints (knees, hips, etc.) | | |
X
|
| d.
Menstrual cramps or other problems with your periods
[women only] | |
X
| |
| e.Headaches | | |
X
|
| f.
Chest pain | |
X
| |
| g.
Dizziness | |
X
| |
| h.
Fainting spells |
X
| | |
| i.
Feeling your heart pound or race | |
X
| |
| j.
Shortness of breath |
X
| | |
| k.
Pain or problems during sexual intercourse | |
X
| |
| l.
Constipation, loose bowels, or diarrhea | |
X
| |
| m.
Nausea, gas, or indigestion | | |
X
|
| n.
Feeling tired or having low energy | | |
X
|
| o.
Trouble sleeping | | |
X
|
| (For
office coding: Total score 17 = 7 + 10)
|
|
Question
6.1
| The
patient's PHQ-15 responses make the likelihood of a multi-system
disease like systemic lupus erythematosis, hypothyroidism,
or multiple sclerosis more worrisome. |
 | True |
 | False |
|