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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM
ROSH REVIEW Orthopedics Practice
Questions and Answers | 100% Pass
A 29-year-old woman presents to your clinic for fatigue and myalgias that have been
worsening over the past few months. In addition to daily headaches, she feels chronic
aching and stiffness in her back, arms, and legs. On exam she has distinct tender points
at her buttocks, trapezius, lateral elbow epicondyles, and medial aspects of her knees.
Strength testing is 5/5 throughout. An erythrocyte sedimentation rate, rheumatoid factor,
TSH, and serum phosphate level all return within normal limits. Which of the following
conditions does she most likely have?
Fibromyalgia
Oncogenic osteomalacia
Polymyalgia rheumatica
Polymyositis - Answer✔️✔️-Correct Answer ( A )
Explanation:
Fibromyalgia is characterized by chronic, widespread musculoskeletal pain and stiffness
with tenderness at discrete "trigger points" on physical exam. Points include the
trapezius, medial fat pads of the knees, and lateral epicondyles of the elbows. A review
of systems will usually show fatigue, frequent headaches, sleep disorders, and
subjective numbness; co-existing depression and irritable bowel symptoms are also
common. Fibromyalgia is a diagnosis of exclusion, and requires ruling out other
rheumatologic conditions including systemic lupus erythematous and rheumatoid
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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM
arthritis, as well as underlying hypothyroidism. Treatment is multifaceted. Patient
education should emphasize that the disease is not progressive; exercise programs and
cognitive behavioral therapy may be beneficial. Many medications (including
amitriptyline, duloxetine, gabapentin, and muscle relaxants) show modest symptom
relief; corticosteroids and opioids should be avoided as these have not be proven
effective.
Polymyalgia rheumatica (C) causes musculoskeletal pain that is concentrated in the
shoulder and pelvic girdle. It is most common in patients over 50, and is usually
associated with an anemia of chronic disease and an elevated ESR. Polymyositis (D) is
more likely to produce proximal muscle weakness, which this patients does not have.
Additionally, though a quarter of patients with polymyositis may have concurrent muscle
pain and tenderness, this is rarely the chief complaint.
One Step Further
Question: When occurring in males, which underlying condition is commonly associated
with symptoms of fibromyalgia? - Answer✔️✔️-Answer: Fibromyalgia may be a
complication of sleep apnea, particularly in male patients.
What is the recommended treatment for polymyositis?
Antibiotics
NSAIDs
Prednisone
Radiation therapy - Answer✔️✔️-Correct Answer ( C )
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, ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Tuesday, September 3, 2024 10:30 AM
Explanation:
Polymyositis is an inflammatory myopathy that is classified by patient age at onset or by
coexisting diseases, such as myositis associated with neoplasia or myositis associated
with collagen vascular diseases (e.g., systemic scleroderma, systemic lupus
erythematous). They have a bimodal distribution and are seen most often between age
10 to 15 and 45 to 60 years. Myositis is most common after age 50. The cause of
inflammatory myopathies is unknown, but evidence suggests a genetic predisposition
(associated with certain HLA markers) combined with an environmental insult, such as
viruses, thereby initiating an autoimmune process. Patients usually experience
progressive, symmetric, proximal muscle weakness with fatigue, malaise, and morning
stiffness. Muscles often affected are those of the shoulder, neck, and pelvic girdle.
Pulmonary (interstitial pneumonitis or fibrosis), cardiac (cardiomyopathy, congestive
heart failure, arrhythmias), pharyngeal (dysphagia), and musculoskeletal (myalgias,
arthralgias) symptoms might occur, although most patients do not experience synovitis.
CK as well as aldolase, ALT, AST, and lactate dehydrogenase (LDH) levels might be
elevated. ESR is elevated only half the time. Muscle biopsy can also be helpful in
diagnosis. Prednisone, 1 mg/kg/day for up to several months, is the drug of choice; the
earlier started in the disease process, the more effective it is. If prednisone is not
sufficient, methotrexate, azathioprine, or another immunosuppressant is added.
A young woman presents with ankle pain and edema. While wearing high-heel shoes,
she twisted her ankle upon stepping off a curb. She is tender about the lateral
malleolus. Skin and neurovascular examination are normal. She has no medial
tenderness. Ligament testing is negative. Radiographic examination reveals a non-
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