A 72-Year-Old Woman Comes to the Physician Because of Aching

question 309

Multiple Choice

A 72-year-old woman comes to the physician because of aching and stiffness of her neck and shoulders for the past several weeks.  This stiffness lasts for 1-2 hours after rising in the morning.  She has tried ibuprofen without relief and has also experienced increasing fatigue for 4-6 weeks.  She has no visual changes, headaches, other joint complaints, fever, or chills.  Her weight is stable.  The patient has osteoporosis, hyperlipidemia, type 2 diabetes mellitus, and hypertension.  Current medications include metformin, chlorthalidone, lisinopril, atorvastatin, and calcium and vitamin D supplements.
On physical examination, she appears to be in no acute distress.  Her temperature is 37.1 C (98.8 F) , pulse is 84/min, blood pressure is 130/84 mm Hg, and respiratory rate is 16/min.  There is some limitation in range of motion of her shoulders and neck.  There is no cervical muscle tenderness, no upper or lower extremity proximal muscle weakness, and no joint swelling or redness.
The patient's laboratory results are as follows:

Which of the following is the most likely cause of this patient's condition?

• A)Diabetic amyotrophy
• B)Fibromyalgia
• C)Hypothyroidism
• D)Medication side effect
• E)Polymyalgia rheumatica

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Definitions:

Cortisol Levels

The concentration of cortisol, a steroid hormone, in the blood, which is often used as a marker for stress.

Oxytocin

A hormone and neurotransmitter involved in childbirth, lactation, social bonding, and stress reduction.

Stress-Moderating

Involving or aimed at reducing the level of stress, especially through specific techniques or interventions.

NK Cells

Natural Killer cells, a type of white blood cell that plays a crucial role in the immune system by destroying harmful cells.