fibromyalgia and chronic fatigue syndrome

Question 1

characteristic features of fibromyalgia

Answer 1

chronic pain, fatigue, sleep disorder (poor non restorative sleep), impaired cognitive function, mood disorders (headache, GI symptoms, and paresthesia)

Question 2

men with fibromyaglia

Answer 2

don’t have tender points

Question 3

Do tenderpoints matter with diagnosis of fibromyalgia?

Answer 3

no they do not.

Question 4

clinical presentation of fibromyaglia

Answer 4

widespread MSK pain, fatigue, cognitive difficulties (impaired attention), non specific GI symptoms, depression and anxiety, examination shows tenderpoints (mid trapezius, costochondral junction, greater trochanter)

Question 5

diagnosis of fibromyaglia

Answer 5

symptoms >3 months, normal inflammatory markers WPI>7 and SS score>5 OR WPI of 3-6 and SS score> 9

Question 6

treatment of fibromyalgia

Answer 6

educate pts that fibromyaglia has a favorable prognosis lifestyle: aerobic exercise, sleep hygiene Medication: TCA or SNRI

Question 7

who has fibromyaglia

Answer 7

commonly middle aged women

Question 8

what is the scale we use to determine fibromyaglia severity

Answer 8

the Widespread Pain index (score 0-19) and the symptom severity score (0-12 pts)

Question 9

any role for NSAIDS and fibromyaglia

Answer 9

not first line treatment.

Question 10

treatment of fibromyaglia is

Answer 10

patient education, regular aerobic exercise, good sleep hygiene Those who don’t respond to conservative medications need TCA (amitriptyline) as first line If they don’t respond to TCA try (pregabalin, duloxetine, milnacipran)

Question 11

refractory fibromyalgia tx

Answer 11

combination of drug therapy referral for supervised rehab or pain management referral or cognitive behavioral therapy

Question 12

Chronic fatigue syndrome is also known as

Answer 12

systemic exertion intolerance dx (SEID)

Question 13

Chronic fatigue syndrome symptoms:

Answer 13

sudden onset fatigue after a URI, resolution of infection but residual intense fatigue and sleep or cognitive disturbances symptoms exacerbated by physical activity pts are healthy and high functioning prior to onset of fatigue physical exam is normal

Question 14

Chronic fatigue syndrome tx

Answer 14

cognitive behavioral therapy and graded exercise therapy

Question 15

diagnosis of Chronic fatigue syndrome

Answer 15

can be misdiagnosed as malingering due to lack of objective findings diagnosis excludes other causes of fatigue like a thorough history, PE, and lab evidence Check CBC, CMP, TSH, ESR are all normal

Question 16

potential comorbid or differential diagnoses for Chronic fatigue syndrome

Answer 16

depression or anxiety

Question 17

difference between Chronic fatigue syndrome and fibromyalgia:

Answer 17

fibromyaglia will have diffuse MSK pain and tenderness on exam Chronic fatigue syndrome will have fatigue without pain and PE is normal.

Question 18

sudden onset of intense fatigue that is worse with exertion and not relieved by rest, and see marked deterioration from previous level of functioning. see sleep and and cognition affected

Answer 18

Chronic fatigue syndrome

Question 19

What is chronic fatigue syndrome?

Answer 19

systemic exertional intolerance disease (SEID) hx of fatigue, exhaustion after exertion, lack of restful sleep and inability to function at work

Question 20

Who gets chronic fatigue syndrome?

Answer 20

young to middle age adults with high level of functioning prior to onset of illness. 2x common in women

Question 21

Diagnosis of chronic fatigue syndrome:

Answer 21

psychiatric disorders, medical conditions, thorough history, physical examination, TSH, CMP, CBC and ESR

Question 22

1st line tx for chronic fatigue syndrome?

Answer 22

cognitive behavioral therapy to targets thoughts or behaviors that hinder recovery or graded exercise therapy (slowly increasing exercise tolerance over time under supervision of a PT)

also known as systemic exertion intolerance dx

Question 23

What is biofeedback and can be used for chronic fatigue syndrome?

Answer 23

use of electronic devices to help patients recognize and control physiological processes. Used for treatment of pain

Question 24

what is systemic exertion intolerance dx is also known as

Answer 24

chronic fatigue sydnrome