Fibromyalgia: ABFM practice questions

4 board-style questions on fibromyalgia in the PulseMD family medicine question bank, written against current guidelines with the reference cited on each question. Two free samples below; the full set with answers, explanations, and spaced review is free to start.

Sample question 1

A 42-year-old woman presents with widespread body pain for the past 6 months. She reports pain in her neck, shoulders, upper and lower back, and both legs. She also describes chronic fatigue, unrefreshing sleep, and difficulty concentrating ("brain fog"). She has seen multiple specialists without a diagnosis. Physical examination reveals diffuse tenderness to palpation but no joint swelling, deformity, or warmth. Her labs including CBC, CMP, ESR, CRP, TSH, and ANA are all normal. X-rays of affected areas are unremarkable. According to the 2016 modified ACR criteria, what is the most likely diagnosis?

  1. Hypothyroidism
  2. Fibromyalgia
  3. Polymyositis
  4. Systemic lupus erythematosus with negative ANA

Sample question 2

A 48-year-old woman with fibromyalgia diagnosed 2 years ago is inadequately controlled on pregabalin 150 mg twice daily. She reports persistent widespread pain (6/10), poor sleep quality, fatigue, and worsening depressive symptoms (PHQ-9 score of 14). She has comorbid obesity (BMI 34 kg/m2) and is sedentary. She tried duloxetine previously but discontinued it due to nausea at 30 mg daily. She asks for opioid therapy since "nothing else works." What is the most appropriate management plan?

  1. Prescribe tramadol 50 mg as needed since traditional opioids are contraindicated in fibromyalgia
  2. Retry duloxetine with a slower titration starting at 20 mg daily, initiate a graded exercise program, and address sleep hygiene and depression
  3. Discontinue pregabalin and start oxycodone 5 mg every 6 hours since she has failed multiple first-line agents
  4. Increase pregabalin to maximum dose (225 mg twice daily) and add cyclobenzaprine at bedtime

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