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ME/CFS — RACP Adult Medicine MCQ

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ModerateRheumatologyME/CFSRACP Adult Medicine

A 35-year-old woman presents with disabling fatigue for 12 months, unrefreshing sleep, post-exertional malaise (worsening after minor physical or cognitive exertion), and cognitive difficulties (brain fog). She has orthostatic intolerance. Extensive investigation (FBE, UEC, LFTs, TFTs, iron studies, cortisol, CRP, glucose, ANA, coeliac serology, HIV) is normal. What is the most likely diagnosis?

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Correct answer: C — Myalgic encephalomyelitis/chronic fatigue syndrome

Disabling fatigue >6 months with post-exertional malaise (cardinal feature), unrefreshing sleep, cognitive impairment, and orthostatic intolerance after exclusion of other causes meets IOM/NICE 2021 criteria for ME/CFS. Post-exertional malaise (symptom worsening 12-72 hours after exertion) distinguishes ME/CFS from other fatigue conditions. Graded exercise therapy is no longer recommended. Pacing is the key management strategy.

Reference: NICE – 2021 – ME/CFS Guidelines; RACGP 2024