ngaybinhyen
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A 43-year-old woman comes to see her primary care physician- The patient complains of poor sleep, general weakness, fatigue, headaches, mood disturbances, musculoskeletal pain, and joint tenderness. The patient has had these symptoms for the last 8 months. Her most recent laboratory evaluation, which consisted of a complete blood count, basic metabolic panel, erythrocyte sedimentation rate, thyroid function tests, and muscle enzymes, was within normal limits. In addition, urinalysis. ECG. and chest x-ray were all within normal limits. Physical examination is significant for multiple areas of point tenderness. What would be appropriate initial management of this patient?
O A. Amitriptyline
O B. Cognitive behavioral therapy
O C. Fluoxetine
O D. Ibuprofen
O E. Low-impact aerobic exercise
O F. Prednisone
O G. Tramadol
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| Eagle_303
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Fibromyalgia
Amytriptiline
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| ngaybinhyen
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Bro, you can take the test right now
Slepwise Fibromyalgia Management 
1) Confirm the diagnosis and offer an explanation to the patient
2) Start a low dose of a tricyclic medication (amitriptyline. choice A)
3) Nonsteroidal anti-inflammatory drugs, including ibuprofen (choice D) are not recommended as first-line therapy, but may be useful in combination therapy.
4) Start low-impact aerobic exercise (choice E).
5) Referral for cognitive behavioral therapy (choice B).
7) Addition of an SSRI such as fluoxetine (choice C) to a tricyclic. or use of a dual norepinephrine and SSRI (duloxetine) may be considered. Alternatives include gabapentin or pregabalin.
8) Tramadol (choice G) may be added to assist in pain management if necessary.
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| kpmle2
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Very nice Q thanks a lot ngaybinhyen.
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| ngaybinhyen
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