Abstract
Answer C. Chronic fatigue syndrome
There are a few points to note from this question. This lady clearly has a stressful job. Chronic fatigue syndrome can be suspected in patients who have had persistent (more than 4 months) of fatigue, which has a specific onset. All other conditions should be ruled out and the fatigue must cause a substantial reduction in activity levels. There should also be an element of post-exertional malaise with slow recovery. The patient should also have one of the following: sleeping difficulties, muscle pains, headaches, painful lymph nodes, sore throat, cognitive dysfunction, dizziness or nausea, palpitations. All red flags should be elicited. Investigations must be arranged to eliminate any differential diagnoses.
National Institute for Health and Care Excellence. Clinical knowledge summaries, tiredness/fatigue in adults. http://cks.nice.org.uk/tirednessfatigue-in-adults#!diagnosis