CCFP priority topic 39 of 105
Fatigue on the CCFP exam
6 key features, the mistakes that cost marks, and a practice question.
Checked by a Canadian family physician, MD, CCFP. Updated October 20, 2026.
What the exam tests
Key features
The CFPC’s 6 key features for Fatigue. Each one below has how the exam asks it, the common mistakes and the approach.
Practice question
Try one before you read
A real case from the bank, in the new short-menu format. Answer it first. Then read the key features.
Key feature 1 of 6
Depression
Whenever a patient says they are tired, think of depression as a possible cause.
CFPC skill Clinical reasoningPhase Hypothesis generation
On the exam
A tired adult with a normal exam and broken sleep. Expect a short menu (pick several from a list) of causes to consider.
Pick the causes to keep in mind.
Common mistakes
Leaving depression off the list because a stressor explains the tiredness. The reverse costs marks too: listing only depression and dropping medical causes because the exam is normal.
Approach
- Put depression on the list for every tired patient, at any age. Adolescents too.
- Ask about low mood and loss of interest or pleasure. Ask about sleep, appetite and focus as well.
- Score mood with a questionnaire you know, and record the result.
- If depression is likely, ask about thoughts of suicide at the same visit.
- A normal mood screen counts against depression. Do not start an antidepressant for tiredness alone.
- Depression does not end the search. Still do the whole-body screen and the medicine review.
Key feature 2 of 6
Whole-body screen
Screen for serious medical illness by asking about whole-body symptoms beyond tiredness.
CFPC skill Clinical reasoningPhase History
On the exam
A woman of 54 with new tiredness for three months. Expect a short menu (pick several from a list) of questions.
Pick the questions that screen for illness.
Common mistakes
Questions about one organ, such as thyroid or hair change, or about caregiving or a recent virus. None screens for infection, cancer or inflammation.
Approach
- Ask about fever, night sweats, weight loss and loss of appetite.
- Ask about new pain, lumps, bleeding, bruising, cough or breathlessness.
- Time it: when it started, what came before it, and whether rest helps.
- In infants and children, ask about fever, feeding, weight gain, pallor and bruising. Plot growth.
- Examine for pallor, swollen lymph nodes, a large liver or spleen, and listen to heart and lungs.
- Do this screen before the stress and sleep questions. Those come once illness is excluded.
| Looking for | Adults | Infants and children |
|---|---|---|
| Infection | Fever, night sweats, cough | Fever, poor feeding, irritability |
| Cancer or blood disease | Weight loss, lumps, bleeding | Pallor, bruising, poor weight gain |
| Inflammation | Joint pain, rash, morning stiffness | Joint swelling, limp, rash |
Key feature 3 of 6
Medicine review
Check whether a prescribed or over-the-counter drug is making the patient tired.
CFPC skill Clinical reasoningPhase Hypothesis generation, diagnosisSources Choosing Wisely Canada
On the exam
A woman of 54, tired and dizzy on standing weeks after a second blood pressure drug. Expect one best answer.
Pick the most likely cause.
Common mistakes
Chasing heart disease, adrenal failure or sleep apnea, or checking hormone levels. Dizziness on standing after the new drug points to low blood pressure from that drug.
Approach
- List every drug: prescribed, over the counter, herbal, plus alcohol and cannabis.
- Ask what was started, or changed dose, around when the tiredness began.
- On blood pressure drugs, check blood pressure lying and standing.
- In older adults, taking many drugs is linked to side effects, falls, memory problems and loss of function.
- If a drug is the likely cause, lower the dose, stop it or switch. Then reassess.
Key feature 4 of 6
Tests need a reason
Order tests for tiredness only when the history or exam gives a clear reason.
CFPC skill SelectivityPhase InvestigationSources Choosing Wisely Canada
On the exam
A tired patient asks for a full blood panel. Expect a short menu (pick several from a list) of tests to order or skip.
Pick the tests the findings justify.
Common mistakes
A panel because the patient or family asked. Skipping tests is wrong too when a finding, like a new drug and falling blood pressure, points somewhere.
Approach
- Let the history and exam choose each test. A request or a worry alone is not a reason.
- Test when there is a clear reason: a red flag, an exam finding, or a likely drug effect.
- In people without symptoms, routine yearly blood tests add little. They are more likely to find false positives, which can lead to more tests.
- Thyroid-stimulating hormone (TSH) screening is not advised in adults who have no symptoms and are not pregnant. In a tired patient, let the history and exam decide on TSH, as for any test.
- Treating a mildly high TSH with normal thyroid hormones did not improve tiredness.
- TSH can vary by up to 50% between tests. A borderline result can mislead.
| Situation | Test? | Why |
|---|---|---|
| Tired, normal exam, no red flags | No routine panel | Nothing points to a cause yet |
| Dizzy on standing after a new blood pressure drug | Yes | A finding with a likely cause |
| Fever, pallor and new bruising | Yes, today | Can signal blood cancer or serious infection |
| Asks for a yearly thyroid test, no symptoms | No | Screening without symptoms is not advised |
Key feature 5 of 6
Daily life and tiredness
Once illness is excluded, help the patient see how their daily life drives the tiredness.
CFPC skill Patient-centred approach, communicationPhase TreatmentSources Choosing Wisely Canada
On the exam
A carer woken each night by her father, with normal tests. Expect a short menu (pick several from a list) of next steps.
Pick the plan that fits her life.
Common mistakes
Reassurance and closing the visit, a sleeping pill, or caffeine advice. None stops her father waking her, and a pill adds sedation and falls.
Approach
- Start this only once illness, depression and drug effects are dealt with.
- Ask what a normal day and night look like: caregiving, shift work, a new baby, money, a crowded home.
- Name the link with the patient, in plain words. Normal results with no plan leave the patient stuck.
- Agree on one or two changes the household can make. Examples: respite care (someone else takes over the care for a while) or shared night duties.
- Fit the advice to the home. A separate room is no use where many people share two bedrooms.
- Avoid a sleeping pill as the answer. In older adults, sleeping pills (sedative-hypnotics) can more than double the risk of falls and hip fractures.
- Book a follow-up visit to see whether the plan worked.
Key feature 6 of 6
Chronic fatigue
When tiredness lasts, support the patient over time and watch for a new illness.
CFPC skill Patient-centred approach, clinical reasoningPhase Hypothesis generation, treatmentSources Choosing Wisely Canada
On the exam
A tired infant, weeks into a sleep plan, now has fever, pallor and bruising. Expect one best answer.
Pick the next step today.
Common mistakes
Staying the course because sleep improved, or blaming the bruises on falls. Fever, pallor and bruising on the back need a work-up today, not a routine referral.
Approach
- Book regular visits. Do not wait for the patient to come back in crisis.
- Set goals together, and treat the most troubling symptom first.
- At each visit, ask what is new. Recheck fever, sweats, weight and appetite.
- Do not repeat a full set of tests when nothing has changed.
- A new sign restarts the work-up. Fever, pallor and new bruising need assessment the same day.
- Bruises from learning to walk sit on the shins and forehead. Bruises on the back or belly need another explanation.
- Review the medicine list before adding a new drug.
Flashcards
Answer it first, then check.
KF 1A tired 30-year-old has a normal exam. Which cause must your list always include?
Depression. Ask about low mood and loss of interest in every tired patient.
KF 1Tired, but the mood screen is normal. Start an antidepressant?
No. Nothing supports depression, and the drug would not treat the real cause.
KF 2New tiredness for three months. Name four whole-body symptoms to ask about.
Fever, night sweats, weight loss and loss of appetite. Then new pain, lumps or bleeding.
KF 3Tired and dizzy on standing, weeks after a second blood pressure drug. First suspect?
The new drug. Check blood pressure lying and standing before chasing heart or adrenal disease.
KF 4A patient with no symptoms asks for a yearly thyroid test. Order it?
No. Thyroid screening without symptoms is not advised, and a borderline result can mislead. Source: Choosing Wisely Canada
KF 5Tests are normal and a carer is still exhausted from night waking. Prescribe a sleeping pill?
No. It does not stop the waking. Plan with the patient how to share the night care.
KF 6A tired infant on a sleep plan now has fever, pallor and bruising. Next step?
See and work them up today. New signs restart the work-up and cannot wait for a referral.
FAQ
Which guideline does the exam follow for fatigue?
No Canadian guideline covers fatigue as a whole. The exam tests an approach: depression on the list, a whole-body screen, a medicine review, chosen tests, then support over time.
Should every tired patient get a basic blood panel?
No. Choose tests from the history and exam. A red flag, an exam finding or a likely drug effect is a reason. A request or a worry alone is not.
If the fatigue is chronic, can I stop looking for a cause?
No. Support the patient with regular visits and shared goals, but keep watching. A new sign such as fever, weight loss or bruising needs its own work-up.
Does the same approach apply to children?
Yes, from infancy on. In a tired infant, ask about fever, feeding, weight gain, pallor and bruising first. Teething and sleep explain a lot, but not new signs.
Sources
Written from the CFPC Assessment Objectives and Canadian guidelines first. Checked by a Canadian family physician, MD, CCFP.
Last reviewed October 20, 2026For exam study. Not advice for a patient in front of you.
- Assessment Objectives for Certification in Family Medicine, 2nd editionCollege of Family Physicians of Canada · 2020
- Choosing Wisely recommendationsChoosing Wisely Canada