- Weight loss?
Why: must consider cancer, hyperthyroidism, diabetes mellitus, malnutrition, gut malabsorption and chronic infectious disease (e.g. tuberculosis, subacute bacterial endocarditis).
- Fever?
Why: should consider tuberculosis, subacute bacterial endocarditis, toxoplasmosis, infectious mononucleosis, brucellosis.
- Pallor of the skin?
Why: most likely cause is a type of anemia such as associated with malabsorption syndrome, iron deficiency, pernicious anemia or anemia due to blood loss.
- Polyuria (excessive urination)?
Why: may suggest hyperthyroidism, diabetes mellitus, hyperparathyroidism and chronic renal failure.
- Orthopnea (breathlessness lying down flat)?
Why: suggests left ventricular heart failure.
- Paroxysmal nocturnal dyspnea (inappropriate severe breathlessness causing waking from sleep)?
Why: suggests left ventricular failure.
- Symptoms of depression?
Why: e.g. sadness, crying spells, lack of interest in activities, poor energy, poor concentration and attention span, poor sleep, reduced libido, poor self esteem and sometimes suicidal thoughts.
- Symptoms of anxiety?
Why: e.g. nervousness, shakiness, tremor, tiredness, restlessness, irritability, insomnia, poor concentration, heart palpitations, racing heart, sweating, dizziness, diarrhea, lump in throat and frequency of urination. Range of somatic (physical) symptoms? - e.g. tiredness, headache, constipation, indigestion, weight loss, dry mouth, unusual pains or sensations in the chest and abdomen - not uncommonly occur with depression and tend to mask a diagnosis of depression. Depression can be associated with many illnesses but it is important to realize that these somatic symptoms may be the presentation of depressive illness. Depression is a common cause of lethargy.
- Symptoms of chronic fatigue syndrome?
Why: e.g. extreme exhaustion (with minimal physical effort), headache (or a vague "fuzzy" feeling in the head), aching in the muscles and legs, poor concentration and memory, excessive sleep, waking feeling tired, emotional lability, aching joints, sore throat, tender swollen lymph nodes and depressive-like illness.
- Symptoms of diabetes mellitus
Why: e.g. frequent urination, excessive thirst, weight loss, lethargy.
- Symptoms of hypothyroidism?
Why: e.g. husky voice, tiredness, weight gain, constipation, cold intolerance, loss of hair.
- Symptoms of hemochromatosis?
Why: e.g. lethargy, painful joints, impotence, bronze discoloration of skin.
- Symptoms of Conn's syndrome?
Why: e.g. weakness, frequency of urine, excessive thirst, lethargy.
- Symptoms of Addison's disease?
Why: e.g. pigmentation, tiredness, weight loss, loss of appetite, nausea and diarrhea.
- Symptoms of hyperthyroidism?
Why: e.g. loose bowel motions, intolerance to heat, sweating of hands, muscle weakness, increased appetite, weight loss, heart palpitations, emotional lability, lethargy.
- Menopausal symptoms?
Why: e.g. palpitations, hot flushes, night sweats - lethargy is a common symptom in menopausal women and is often associated with these other symptoms.
- Symptoms of obstructive sleep apnea?
Why: e.g. loud snoring, daytime sleepiness and lethargy, unrefreshed sleep, restless sleep, morning headache, nocturnal choking, reduced libido.
- Symptoms of Parkinson's disease?
Why: e.g. coarse hand tremor most marked at rest, rigidity of limbs, slowness in initiating and executing movements and speech, expressionless mask-like face, lethargy and dementia.
- Symptoms of Myasthenia gravis?
Why: e.g. easy muscle fatigability especially eyelids, neck, shoulders, lower legs and trunk, droopy eyelids, double vision, weak voice.
