diagnosis unknown.

chief complaint: "constant fatigue."

history of present illness: amanda has just worked for about 32 hours straight. she is status-post call, and has been so for about the last hour and a half. she was able to drive, but reports being unable to form complete sentences. symptoms began just over a week ago and are exacerbated by soccer games, scrabble and algebra homework, but seem to be the worst around 4:45 am when she begins to hear ringing in her ears. symptoms improve when patient self medicates with oral caffeine intake, and she reports needing to use this treatment 3-4 times per day.

past medical/surgical history: negative for history of disease of the reticular activating system, which mediates arousal and daytime alertness.

medications: moderate-to-large doses of caffeine every 4-6 hours

allergies: crying 2 year olds with asthma exacerbations (patient breaks out in hives); grumpy 12 year olds with multiple infections and rashes on their butts (patient's airway closed completely off at last exposure); nervous interns, screaming residents and questioning attendings (patient reports varied vague reactions to different exposures)

family/social history: there is no family history of similar symptoms. there is also no history of heroine use or chlamydia infection. and even if there was, you would not be told about this.

Physical Exam:
general: patient is difficult to arouse and appears to have not changed her clothes or showered in at least 48 hours.
HEENT: normal appearing head. patient drools while sleeping.
Heart: beating
Respiratory: breathing. sometimes.
GI: alternating diarrhea and constipation.
Neuro: patient scores disturbingly low on mental status exam.
extremities: cold and clammy.

Assessment and Plan:
this patient is a 25 year old white female who reports to her bed with extreme fatigue following a 32 hour shift.

1. monitor drooling, heart beat and breathing for signs of distress and ongoing fatigue.
2. attempt to regulate dietary intake to normal eating hours of the day.
3. discourage operation of heavy machinery.
4. STOP WHINING ABOUT THE LACK OF POSTING!

******

just kidding. about all of it but number 4. wait. that's backwards. history and physical is accurate up to #4. i'm going to sleep.