Fibromyalgia

Chapter 47 Fibromyalgia




Clinical Case Problem 1 A 35-Year-Old Woman with Total Body Muscle Pain


A 35-year-old woman comes to your office with a 1-year history of “aching and hurting all over.” She also complains of a chronic headache, difficulty sleeping, and generalized fatigue. When questioned carefully, she describes “muscle areas tender to touch.” Although the pain is worse in the back, there really is no place free of pain. She also describes headaches, generalized abdomen pains, and some constipation.


On examination, the most striking finding is the presence of discrete “tender points” (tender muscle areas when palpated). These are bilateral and include the mid to upper trapezius muscle, under the lower sternomastoid, the prominence of the greater trochanter, the medial fat pad of the knee, 2   cm distal to the lateral epicondyle, and the upper outer quadrant of the buttock.


The rest of the physical examination is normal. Her blood pressure is 120/70   mm Hg, and her cardiovascular system, respiratory, and abdomen examination findings are normal.



Select the best answer to the following questions




1. What is the most likely diagnosis in this patient?


a. polymyalgia rheumatica

b. masked depression

c. fibromyalgia

d. diffuse musculoskeletal pain, not yet diagnosed (NYD)

e. early rheumatoid arthritis

2. Which one of the following is not usually a site of tenderness in the disorder described?


a. the rectus abdominis muscle

b. origin of the supraspinatus muscle

c. 2   cm distal to the lateral epicondyle of the humerus

d. mid upper trapezius muscle

e. upper outer quadrant of the buttock

3. The differential diagnosis of the condition described includes which of the following?


a. chronic fatigue syndrome

b. hypothyroidism

c. masked depression

d. myofascial pain syndrome

e. all of the above

4. The diagnostic criteria of the disorder described include tenderness at how many of 18 specific sites?


a. 5

b. 7

c. 9

d. 11

e. 13

5. What is the most characteristic symptom of the condition described?


a. pain in at least three or four body quadrants

b. “pain all over my body”

c. pain in specific bursa and tendons

d. pain in specific joints

e. pain in both arms, the posterior neck, and the upper back

6. Choose the statement that is true for fibromyalgia.


a. because fibromyalgia is not rheumatologic, patients do not experience any symptoms in their joints

b. most patients with fibromyalgia have always had nonspecific pains, and it is rare for the condition to develop after a specific event, such as an influenza-like illness or emotional or physical trauma

c. most patients present in their teens or 20s

d. laboratory testing is important to confirm the diagnosis

e. fatigue is present in more than 90% of patients

7. What is the cause of fibromyalgia?


a. an autoimmune process

b. a chronic inflammatory process

c. an acute inflammatory process

d. a slow or chronic virus infection

e. a hypersensitivity of nerves postulated to be related to central nervous system (CNS) sensitization

8. Which of the following statements regarding sleep disorders and the condition described is true?


a. there is no association between this condition and sleep disorders

b. patients with this disorder have an abnormal sleep pattern

c. patients with this disorder have difficult sleep induction, early morning wakening, and nightmares

d. patients with this disorder have profound insomnia

e. patients with this disorder usually have profound hypersomnia

9. Regarding therapy for this disorder, which of the following statements is (are) true?


a. nonsteroidal antiinflammatory drugs (NSAIDs) have demonstrated a significant advantage over placebo

b. antidepressants are superior to placebo

c. muscle relaxants are superior to placebo

d. b and c

e. all of the above


Clinical Case Problem 2 A 54-Year-Old Woman with Fatigue and Multiple Trigger Points


A 54-year-old woman presents with pain in multiple points on her body, fatigue, and frustration that many physicians have told her there is nothing that can be done for her.


Although this patient meets the diagnostic criteria for fibromyalgia, her medical records indicate that her prior physician did not inform the patient of this diagnosis because he believed that it would reinforce the pain behavior.



10. What is the best statement regarding the prognosis of fibromyalgia?


a. patients with the diagnosis will generally deteriorate over the years and eventually be unable to work

b. patient education about this disorder generally reinforces the pain and increases the chances that the patient will eventually request disability leave from work

c. when patients are informed of the diagnosis of fibromyalgia, significantly fewer symptoms and a general improvement in health status may follow

d. once treated for depression, most patients diagnosed with fibromyalgia will no longer experience fatigue and pain

11. What are the best recommendations for exercise for a patient with fibromyalgia?


a. because some types of exercise may initially increase pain in tender points, it is best to avoid those activities

b. muscle strengthening and flexibility programs will decrease pain, improve muscle strength, and decrease the number of tender points

c. patients with fibromyalgia will quickly accept a cardiovascular exercise program into their routine because the fatigue of fibromyalgia quickly disappears with exercise

Related posts:

  1. Alcohol
  2. Pancreatic Carcinoma
  3. Urticaria Angioneurotic Edema
  4. Illustrated Review

Stay updated, free articles. Join our Telegram channel
Tags:
Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Fibromyalgia

Full access? Get Clinical Tree
Get Clinical Tree app for offline access