AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 55-year-old female presents with a 6-month history of widespread musculoskeletal pain, fatigue, and difficulty sleeping. She reports tenderness in multiple specific areas upon palpation, along with subjective memory problems and anxiety. Laboratory tests including CBC, ESR, CRP, and thyroid function are all within normal limits. Based on these findings, which of the following is the most likely diagnosis?
- ASystemic lupus erythematosus
- BPolymyalgia rheumatica
- CFibromyalgia
- DRheumatoid arthritis
Show answer & explanationAnswer & explanation
Correct answer: C. Fibromyalgia
The patient's presentation of widespread chronic pain, fatigue, sleep disturbance, cognitive issues ('fibro fog'), and multiple tender points, with normal inflammatory markers, is highly consistent with fibromyalgia.
Why the other options are wrong
- A. Systemic lupus erythematosus presents with diverse systemic symptoms, often including rash, joint pain, serositis, and abnormal autoimmune markers, not widespread tender points as the primary feature.
- B. Polymyalgia rheumatica typically affects older adults (>50), causes pain and stiffness in the shoulders and hips, and is associated with elevated ESR and CRP, which are normal in this patient.
- D. Rheumatoid arthritis involves inflammatory joint pain, swelling, and elevated inflammatory markers (ESR, CRP), which are absent here.
Fibromyalgia
A chronic disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues.
- Widespread pain (above and below waist, both sides of body).
- Fatigue, non-restorative sleep, cognitive dysfunction ('fibro fog').
- Multiple tender points on physical exam.
- Normal inflammatory markers (ESR, CRP).
Memory trick: Fibromyalgia is 'Foggy' pain, 'Fatigue', and 'Fuzzy' brain with 'Normal' labs.