| |
Problem
8.1
A
patient presents to a general medicine clinic with a 6-month history
of arm and leg pains and persistent fatigue. Physical examination
is unrevealing, and laboratory testing is normal including a complete
blood count, erythrocyte sedimentation rate, serum creatinine,
liver function tests, thyroid stimulating hormone, urinalysis,
rheumatoid factor, and ANA. Her PHQ-15 responses are shown in
Figure 8.1 below.
| Figure
8.1: Patient's Responses on the PHQ-15
|
|---|
| During
the past 4 weeks, how much have you been bothered by
any of the following problems?
|
|---|
| Symptom
| Not
bothered at all (0)
| Bothered
a little (1)
| Bothered
a lot (2)
|
|---|
| a.
Stomach Pain |
|
|
X
|
| b.
Back Pain |
X
|
|
|
| c.
Pain in your arms, legs, or joints (knees, hips, etc.) |
|
|
X
|
| d.
Menstrual cramps or other problems with your periods
[women only] |
X
|
|
|
| e.Headaches |
|
X
|
|
| f.
Chest pain |
X
|
|
|
| g.
Dizziness |
X
|
|
|
| h.
Fainting spells |
X
|
|
|
| i.
Feeling your heart pound or race |
X
|
|
|
| j.
Shortness of breath |
X
|
|
|
| k.
Pain or problems during sexual intercourse |
X
|
|
|
| l.
Constipation, loose bowels, or diarrhea |
|
|
X
|
| m.
Nausea, gas, or indigestion |
|
X
|
|
| n.
Feeling tired or having low energy |
|
|
X
|
| o.
Trouble sleeping |
|
X
|
|
|
(For
office coding: Total score 11 = 3 + 8)
|
|
Question
8.1
| The
most likely diagnosis in this patient based is: |
 | Fibromyalgia
only |
 |
Irritable bowel syndrome only |
 |
Both fibromyalgia and irritable bowel syndrome |
 |
Neither fibromyalgia nor irritable bowel syndrome |
|