A physical therapist examines a 74-year-old female patient who reports aching and stiffness affecting the upper arms, lower back, and thighs. Laboratory testing reveals an elevated erythrocyte sedimentation rate. Which medical condition is MOST consistent with the described clinical presentation?

1. Duchenne muscular dystrophy
2. Hodgkin’s lymphoma
3. Systemic lupus erythematosus
4. Polymyalgia rheumatica

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist examines a 74-year-old female patient who reports aching and stiffness affecting the upper arms, lower back, and thighs. Laboratory testing reveals an elevated erythrocyte sedimentation rate. Which medical condition is MOST consistent with the described clinical presentation?

1. Duchenne muscular dystrophy
2. Hodgkin’s lymphoma
3. Systemic lupus erythematosus
4. Polymyalgia rheumatica

Yet another question that focuses on clinical presentation. The more comfortable you are with the clinical presentation of commonly encountered medical conditions, the more success you will have when answering this type of question. 

The question indicates that the patient has an elevated erythrocyte sedimentation rate. Let’s take this opportunity to review this laboratory test.

Erythrocyte Sedimentation Rate

Erythrocyte sedimentation rate is a non-specific test for inflammatory disorders often associated with conditions such as cancer, autoimmune diseases, and infection. The test is based on how quickly red blood cells sink to the bottom of a test solution containing anticoagulated blood.

Let’s explore each of the options:

Option 1 – Duchenne muscular dystrophy

Duchenne muscular dystrophy is a sex-linked disorder characterized by progressive muscular weakness beginning between the ages of two and five. It is a progressive disorder caused by the absence of the gene required to produce the muscle proteins dystrophin and nebulin. Erythrocyte sedimentation rate is typically not affected with this condition. A creatine phosphokinase determination is the most specific test for muscular dystrophy.

Option 2 – Hodgkin’s lymphoma

Hodgkin’s disease is a type of cancer found in the lymphatic system and lymph tissues. Hodgkin’s disease can metastasize to extralymphatic sites including the liver, spleen, and lungs. This condition produces an elevated erythrocyte sedimentation rate. Common symptoms include swelling of the lymph nodes, fever, night sweats, and unexplained weight loss.

Option 3 – Systemic lupus erythematosus

Systemic lupus erythematosus is an autoimmune condition characterized by numerous organ and joint issues. Typically, a patient with systemic lupus erythematosus exhibits a trademark butterfly rash and experiences joint pain primarily affecting smaller joints. This condition produces an elevated erythrocyte sedimentation rate.

Option 4 – Polymyalgia rheumatica

Polymyalgia rheumatica is a systemic inflammatory condition that is experienced primarily by older adults. It is characterized by aching and stiffness affecting multiple body regions (i.e., shoulders and hips). This condition produces an elevated erythrocyte sedimentation rate. Symptoms often begin relatively quickly and are typically worse in the morning. The majority of patients with polymyalgia rheumatica are older than 65 and rarely younger than 50.

The correct answer is Option 4. 

Let’s explore the all student data:

14% of students selected Option 1 – Duchenne muscular dystrophy
12% of students selected Option 2 – Hodgkin’s lymphoma
26% of students selected Option 3 – Systemic lupus erythematosus
48% of students selected Option 4 – Polymyalgia rheumatica– the correct response

System Classification
This question is a Neuromuscular and Nervous Systems question which represents approximately 24% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content?

Check out pages 323, 344-345 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!