Learning something new...

I'm sitting here reading one of my "less-reputable" Step 1 review books and I get to the following case presentation:

34 yo obese woman complains of muscle aches "all over" and increasing fatigue over the past 6 months. Despite sleeping 8-10 hours per night, she feels more tired in the morning than when she went to bed. She admits to a long history of anxiety and depression but is adamant that the aches are real. PE is remarkable for tenderness at 14 0f 18 trigger points, lab, biopsy and EMG studies are all negative.

I was completely stumped at what this phantom illness was...until I read the answer: Fibromyalgia


MonkeyGirl said...

Fairies and fibromyalgia: great in theory, but alas, make-believe all the same.

The Lone Coyote said...

Any time you see __ out of ___ trigger points, the answer is almost always fibromyalgia. I think I had a couple of those questions on Step 2.

Bostonian in NY said...

I never covered fibromyalgia in any of my classes since it straddles the line somewhere between psych, neuro, and rheumatology and is so controversial that none of the departments want to touch it with a 10-foot pole. It's one of those oh-so-fun wastebasket diagnoses without a firm pathological definition that's not completely psychological and not completely neurological enough for anyone to claim it.

There is no formally agreed-upon diagnostic criteria for the disease (nor even a consensus on whether it exists or not) but there it is popping up on the USMLE's!

LC- Thanks for the heads up...I don't even know what a trigger point is, but I'll file away that association for anything that might come up.

The Lone Coyote said...

Yeah, actually, now that I think about it (since I did that Pain Medicine class) I think technically they are called "tender points." Basically, to dx fibromyalgia they have widespread pain in the 4 quadrants of the body and you palpate 18 different points on the body and if 11 are tender they get the diagnosis.

"Trigger points" technically goes with another pain syndrome called the myofascial pain syndrome, and you can actually feel tight bands of muscle when you palpate.

I don't think the Step 2 (or the Step 1) would get that technical on this distinction.

Bostonian in NY said...

Looks like those hours forced memorization on your Pain rotation stuck! Thanks again