11-03-2007, 02:00 PM
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) Discontinue the amitriptyline
B) Discontinue the naproxen
C) Prescribe oral corticosteroids
D) Prescribe topical corticosteroids
E) Prescribe topical 5-fluorouracil