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发帖数: 364 | 1 20. A 58-year-old woman comes to the office for follow-up of fibromyalgia.
You had been treating her for the past several years for nonspecific
muscular aches and pains. In the past you noted that occasionally the pain
could be reproduced on physical examination by applying pressure to certain
muscles; however, these trigger points seemed to change on each physical
examination. Fibromyalgia was diagnosed 3 months ago and amitriptyline
therapy was started at that time. At a follow-up visit 3 weeks ago she
showed little response to the amitriptyline therapy, and naproxen was added
to her regimen. Today she returns to the office complaining that "every time
I get the least little bump on my hands the skin seems to tear." Her
physical examination is unchanged except for the lesions shown. Which of the
following is the most appropriate management?
A) Discontinue the amitriptyline
B) Discontinue the naproxen
C) Prescribe oral corticosteroids
D) Prescribe topical corticosteroids
E) Prescribe topical 5-fluorouracil
A or B and why? |
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