Repeated USMLE Questions Step 2 CK (1)

A 25 year-old woman presents to the clinic complaining of general aches for two years. Pain is getting worse over the past 3 months. Every morning, she has stiffness all over her body, which is usually relieved in about 5-10 min. She has no history of trauma or any medical condition. Her BMI is 21 and she has no rash or joint swelling. She has multiple tender points. All laboratory investigations are within normal limits. What is the most appropriate management of this patient?

A-Perform electromyogram (EMG)

B-Perform nerve conduction studies

C-Start duloxetine

D-Start hydrocodone

E-Start prednisone

Answer: 

This patient most likely has fibromyalgia. It is diagnosed clinically depending on the presence of multiple tender points with the absence of any rash or joint swelling. The treatment of choice of fibromyalgia is duloxetine as it is approved to have positive results in many cases. In case of failure of medical treatment, investigations as EMG and nerve conduction studies can be done to exclude other conditions.
The correct answer is C