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ROSH REVIEW Orthopedics Practice Questions and Answers | 100% Pass
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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 ...

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  • September 15, 2024
  • 222
  • 2024/2025
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©SOPHIABENNETT
EXAM_SOLUTIONS GUARANTEED SUCCESS 2024/2025 ACADEMIC YEAR




©SOPHIABENNETT 9/3/24 2024/2025

, ©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 )


Page | 2

, ©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-



Page | 3

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