Master the board step 3

Master the Boards: USMLE Step 3
Chronic Fatigue
Syndrome
Fibromyalgia
Polymyalgia
Rheumatica
Fatigue/malaise +++++ > 6 months ++ ++
Nonrefreshing sleep +++++ ++ No
Trigger points No Yes No
Blood tests All normal All normal ↑ESR
Treatment None Pain relief Prednisone
Vasculitis
All forms of vasculitis have some features in common:
Methotrexate causes liver
and lung fibrosis.
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On presentation, they can all have:
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Fatigue, malaise, weight loss
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Fever: May present as a fever of unknown origin (FUO)
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Skin lesions: Palpable purpura, rash
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Joint pain
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Neuropathy: Mononeuritis multiplex
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Common laboratory features:
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Normocytic anemia
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Elevated ESR
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Thrombocytosis
Diagnostic Testing
Biopsy is the most accurate test for vasculitis. See also the lab features noted
above.
Treatment
Best initial therapy: Prednisone and glucocorticoids
If steroids are not effective, alternate and/or additional therapies are the following:
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Cyclophosphamide
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Azathioprine/6-Mercaptopurine
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Methotrexate
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