Practice your clinical English and reasoning skills with this realistic fatigue case, perfect for OET and USMLE-style preparation.
🚪 Doorway Information
- Age: 45
- Gender: Female
- Chief Complaint: “I’ve been feeling really tired lately.”
- Vital Signs: BP 112/68, HR 72, RR 14, Temp 36.8°C, SpO2 98%
📋 Structured History
- Onset: “It started around a month ago.”
- Course: “It’s been gradually getting worse.”
- Severity: “I feel drained even after 8 hours of sleep.”
- Associated Symptoms: “Some hair loss, and I’ve been feeling cold lately.”
- Sleep: “I sleep well, but I still feel tired.”
- Diet: “No major changes. I’m vegetarian.”
- Period: “Yes, heavy and irregular periods.”
- Medical History: “Nothing serious. I had anemia in college.”
- Medication: “Only occasional painkillers.”
- Family History: “My mother has hypothyroidism.”
🩺 Physical Exam
- Pale conjunctivae
- Cool, dry skin
- No lymphadenopathy or hepatosplenomegaly
- Normal heart and lung sounds
🧠 Differential Diagnosis
- Iron-deficiency anemia – due to vegetarian diet and heavy menstruation
- Hypothyroidism – fatigue, cold intolerance, family history
- Depression – often overlaps with fatigue, though not strongly suggested
- Chronic fatigue syndrome – diagnosis of exclusion
🧪 Suggested Workup
- CBC with differential
- Ferritin, serum iron, TIBC
- TSH and free T4
- Vitamin B12 and folate
❔ Interpretation Clues
- Low hemoglobin with microcytic indices → iron-deficiency anemia
- Elevated TSH with low free T4 → primary hypothyroidism
💬 Clinical Reflection
This is a classic presentation of fatigue in a menstruating female with both nutritional and endocrine considerations. Always consider iron-deficiency and hypothyroidism in patients with insidious fatigue, especially if they have risk factors such as diet, menstruation, and family history.
📌 Clinical Pearls
- Ask about dietary iron sources in vegetarians.
- Heavy menstruation is a red flag for iron loss.
- Hypothyroidism often presents subtly — look for cold intolerance and dry skin.
- Check for underlying depression or burnout even if the patient doesn’t verbalize it.