A 27-year-old woman comes to the office for follow-up. She was | Surgery collections Videos and quizez 2021

A 27-year-old woman comes to the office for follow-up. She was last seen 2 months ago for generalized musculoskeletal pain and several months of fatigue. Evaluation revealed multiple soft-tissue tender points, negative inflammatory and serological markers, and normal thyroid studies. The patient was diagnosed with fibromyalgia and prescribed a low-impact exercise program and pharmacotherapy. Her pain and fatigue have subsequently improved, but she now notes intermittent episodes of dizziness. Most of the episodes are short-lived, but she occasionally needs to brace herself against a wall or sit until the dizziness resolves. There have been no associated falls or loss of consciousness. She also notes worsened lethargy and frequent dry mouth. Other medical history includes migraines and irritable bowel syndrome. The patient currently takes daily amitriptyline for fibromyalgia, occasional acetaminophen for muscular pains, and polyethylene glycol as needed for constipation. She does not use tobacco, alcohol, or illicit drugs and has no known drug allergies. Temperature is 36.8 C (98.2 F), blood pressure is 110/70 mm Hg, pulse is 70/min, and respirations are 14/min. BMI is 21 kg/m2. Mucous membranes are pink and moist and there is no jugular venous distention. Cardiopulmonary auscultation is normal. The abdomen is soft and nontender. Neurologic examination reveals intact cranial nerves and normal muscle strength in all extremities.