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2 out of 2

Wimberger'ssign is seen in ? (LQ)

A Vitamin A deficiency

B Vitamin D deficiency

C Vitamin C deficiency

D Vitamin E deficiency

Figure: Sites of hand or wrist involvement and their potential disease associations

Joints affected by osteoarthritis (Ref: H-18th edition, Pg-2829 Fig, 332.1)

Ans. C Vitamin C deficiency

This sign is also seen in Congenital syphilis

This sign is also seen in Congenital syphilis

True about fibromyalgia is ?

1. More common in females

2. Tender points are there

3. Amitriptyline is use in treatment

4. All of the above

Fibromyalgia (FM)

1. FM is characterized by chronic widespread musculoskeletal pain and tenderness.

2. FM is far more common in women than in men, with a ratio of about 9:1.

3. Pain and Tenderness

4. The most common presenting complaint of a patient with FM is "pain all over." Patients with FM have pain that is typically above and below the waist on both sides of the body and involves the axial skeleton (neck, back, or chest).

5. The pain attributable to FM is poorly localized, difficult to ignore, severe in its intensity, and associated with a reduced functional capacity. Pain should have been present most of the day on most days for at least 3 months.

6. The clinical pain of FM is associated with increased evoked pain sensitivity. This is determined by a tender points examination in which the examiner uses the thumbnail to exert pressure.

7. 11 out of 18 sites should be perceived as painful for a diagnosis of FM.

8. In addition to widespread pain, FM patients typically complain of fatigue, stiffness, sleep disturbance, cognitive dysfunction, anxiety, and depression.


Table 335-3 Pharmacologic Agents Effective for Treatment of Fibromyalgia

Antidepressants: (Balanced serotonin & norepinephrine reuptake inhibition)

1. Amitriptyline 2. Duloxetine 3. Milnacipran

Anticonvulsants: (ligands of the alpha-2-delta subunit of voltage-gated calcium channels)

1. Gabapentin 2. Pregabalin

Recent Advances - New Drugs


It is a serotonin–norepinephrine reuptake inhibitor (SNRI) used in the clinical treatment of fibromyalgia.


1. Milnacipran inhibits the reuptake of serotonin and norepinephrine in an approximately 1:3 ratio, respectively; in practical use this means a relatively balanced action upon both neurotransmitters.

2. Inhibition of both neurotransmitters simultaneously works synergistically to treat both depression and fibromyalgia. Milnacipran exerts no significant actions on H1,α1, D1, D2, and mACh receptors, as well as on benzodiazepine and opioid binding sites.


1. It is a synthetic cannabinoid with therapeutic use as an antiemetic and as an adjunct analgesic for neuropathic pain.

2. It is a synthetic cannabinoid, which mimics the main chemical compound of cannabis (THC).

3. It is for treatment of chemotherapy-induced nausea and vomiting that has not responded to conventional antiemetics.

4. It is also for use in treatment of anorexia and weight loss in patients with AIDS.

5. Nabilone is used as an adjunct therapy for chronic pain management.

Various benefits for conditions such as fibromyalgia and multiple sclerosis.