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A 73-Year-Old Woman Comes to the Office Because of Achiness

question 434

Multiple Choice

A 73-year-old woman comes to the office because of achiness. She began to notice pain around her shoulders and hips six weeks ago. The symptoms developed abruptly without an antecedent illness. She notes considerable stiffness around her neck and shoulders in the morning when she gets out of bed and has difficulty dressing herself. She has some soreness in both hips, but these symptoms slowly clear by midday. She denies any cranial complaints. She has never had similar muscle or joint achiness before. She has no fever, chills, weight loss, or headache. She tried over-the-counter ibuprofen, which did not relieve her pain.
Her past medical history is notable for hypertension, hyperlipidemia, coronary artery disease, transient ischemic attack. Her medications include aspirin, hydrochlorothiazide, hydralazine, isosorbide, a statin, and a beta blocker. She has had no medication changes in the last year. She is allergic to angiotensin converting enzyme inhibitors.
Physical examination is within normal limits except for some mild restriction of bilateral shoulder abduction. She does not have any swollen joints.
Her laboratory results are as follows:

Her complete blood count, serum electrolytes, and liver and kidney function studies are normal.
Which of the following is the most appropriate next step in management?

Definitions:

Independent Variable

In experimental and research settings, it is the variable that is manipulated or changed to observe its effects on a dependent variable.

Dependent Variable

The variable in an experiment that is expected to change in response to manipulations of the independent variable.

Measured Variable

A specific entity or characteristic that can be quantified or observed in a research study.

Dependent Variable

In an experiment, it's the variable being tested and measured, affected by manipulations of the independent variable.