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Fatigue is one of the common presentations in USMLE Step 2 CS. Fatigue can be due to a very long list of differential diagnoses.

The most important ones that you should think on the exam are as follows:

Hypothyroidism: Ask about cold intolerance, weight gain, constipation, excessive sleep, concentration difficulty, and skin & hair changes.
Depression: Ask about mood disturbances and use SIGECAPS mnemonic
Anemia: Ask about dyspnea, palpitations, blood loss, pallor ...etc
Obstructive Sleep Apnea: Ask about snoring, day time sleepiness, and witnessed apnea
Infectious Mononucleosis: Ask about ill contacts, sore throat, fever, abdominal pain.
Malignancy: Ask about constitutional symptoms, weight loss, family history of cancer.
Diabetes: Ask about polyuria.
Chronic Fatigue Syndrome: Look for long lasting history and muscle aches.
Sleep Deprivation: Night shifts at work could be the reason.
Generalized Anxiety Disorder: Look for clues in the exam as the SP will be looking really worried.
Hypercalcemia: Ask about constipation and abdominal pain.
Adjustment Disorder: See if there's any precipitating traumatic event.
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