Rheumatology: polymyalgia rheumatica: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Rheumatology: polymyalgia rheumatica

Sample item

A 70-year-old woman has had three weeks of bilateral shoulder and hip girdle pain with morning stiffness lasting over an hour. Examination shows no true weakness. ESR is 85 mm in the first hour, and creatine kinase and ANA are normal. What is the most likely diagnosis?

ALate-onset seropositive rheumatoid arthritisBPolymyositisCPolymyalgia rheumaticaDFibromyalgia

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Polymyalgia rheumatica

Polymyalgia rheumatica affects people over 50 with symmetrical girdle pain and prolonged morning stiffness, high inflammatory markers and normal CK. It responds dramatically to low-dose prednisolone, typically starting at 12.5 to 25 mg daily. Because it is associated with giant cell arteritis, new headache or visual symptoms need urgent attention.

Option by option

A. Late-onset seropositive rheumatoid arthritis
Rheumatoid arthritis typically causes small joint synovitis rather than isolated girdle pain.
B. Polymyositis
Polymyositis produces true proximal weakness with a high CK.
C. Polymyalgia rheumatica (correct)
Correct. Girdle stiffness with high ESR and normal CK and no weakness is typical.
D. Fibromyalgia
Fibromyalgia has normal inflammatory markers and tender points.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Polymyalgia rheumatica. Polymyalgia rheumatica affects people over 50 with symmetrical girdle pain and prolonged morning stiffness, high inflammatory markers and normal CK.

Why is "Late-onset seropositive rheumatoid arthritis" not the answer?

Rheumatoid arthritis typically causes small joint synovitis rather than isolated girdle pain.

Why is "Polymyositis" not the answer?

Polymyositis produces true proximal weakness with a high CK.

Why is "Fibromyalgia" not the answer?

Fibromyalgia has normal inflammatory markers and tender points.

What concept does this question test?

It tests Rheumatology: polymyalgia rheumatica in General Medicine. It responds dramatically to low-dose prednisolone, typically starting at 12.5 to 25 mg daily. Because it is associated with giant cell arteritis, new headache or visual symptoms need urgent attention.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: polymyalgia rheumatica?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.