keepgoing
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A 31 year old female executive presented with a 12 year history of intermittent fatigue, headaches, neck pain, "aching all over," particularly in the morning and generalized stiffness. She notes that the fatigue is extreme on waking and she wakes feeling poorly refreshed. The patient believed that her joints have been swollen on occasions. The fatigue has become so severe that she has found that she is unable to work and wants to go onto disability. Her symptoms are unrelieved by NSAID. Post history includes a prior diagnosis of irritable bowel
syndrome and tension headaches. Physical examination revealed: Anxious white female. No evidence of synovitis. Numerous " tender points" in trapezius, sternomastoid, upper anterior chest wall. Overthe greater trochanter, over the lateral epicondyles above the ankles. The best way to establish the diagnosis is:
a. ANA, anti-ds-DNA and anti Sm antibody studies.
b. muscle biopsy from a tender point
c. nerve conduction studies
d. all of the above
e. none of the above
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| sigh
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E.
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| GoodGirl
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sounds like me , all sore in the mornings ! 
Fibromyalgia it could be . answer E
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| grechita12
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E. tender points make the Dx of fibromyalgia, which is a clinical Dx, so no studies are indicated at this time
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| drnadeemusmani
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e
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| keepgoing
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yes E.
As a physician, you should always be alert when a patient indicates that they want to go on disability. It is possible that the patient is suffering from depression, which would explain her fatigue in the morning. She believes that her joint may have been swollen, yet NSAIDS offer no help. The best way to diagnose in this case might be to conduct a polysomnogram. Patients with depression will have a short REM latency. They will also tend to wake up early in the morning, fatigued.
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| vaibhavbora
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is TX for this amyltryptiline ?
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| drnadeemusmani
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i think steroid is doc
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