A 57-year-old woman comes to the physician at the insistence of her husband; he reports that for quite some time, she has been extremely agitated when sitting, resting, or lying down at night. She has trouble falling asleep in bed, which in turn keeps him awake. The patient's discomfort occurs every night; she describes it as an "internal itch that creeps up my lower legs and is often so uncomfortable that I could cry." This strange sensation compels her to stand and pace the floor, and worsens when she feels fatigued. Her medical history is significant for well-controlled hypertension, gastroesophageal reflux disease, allergic rhinitis, and tension headaches. The patient has been on amlodipine, omeprazole, and ibuprofen for 3 years with no recent changes in dosage. She does not smoke or use illicit drugs but consumes 1-2 alcoholic drinks on weekends. There is no family history of similar problems. Physical examination is unremarkable.
Which of the following studies is most appropriate to order?

Question

A 57-year-old woman comes to the physician at the insistence of her husband; he reports that for quite some time, she has been extremely agitated when sitting, resting, or lying down at night.  She has trouble falling asleep in bed, which in turn keeps him awake.  The patient's discomfort occurs every night; she describes it as an "internal itch that creeps up my lower legs and is often so uncomfortable that I could cry."  This strange sensation compels her to stand and pace the floor, and worsens when she feels fatigued.  Her medical history is significant for well-controlled hypertension, gastroesophageal reflux disease, allergic rhinitis, and tension headaches.  The patient has been on amlodipine, omeprazole, and ibuprofen for 3 years with no recent changes in dosage.  She does not smoke or use illicit drugs but consumes 1-2 alcoholic drinks on weekends.  There is no family history of similar problems.  Physical examination is unremarkable.
Which of the following studies is most appropriate to order?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c185_bafe_8f63_19eaffe9a7c3_MD0005_00 Restless legs syndrome (RLS) occurs in 5%-10% of the population and is more common in older individuals. Nearly half of patients with idiopathic RLS have a positive family history (autosomal dominant inheritance); diagnosis is based on clinical history. RLS is characterized by spontaneous, repeated leg movements (to provide relief) in association with unpleasant sensations that occur while at rest. It is associated with iron deficiency and iron supplementation improves symptoms in some patients with the condition. Ferritin level is the most accurate measurement of iron stores; levels <75 ng/mL are consistent with clinical symptoms. A normal complete blood count does not rule out the condition as iron deficiency is frequently present in the absence of anemia. No other laboratory tests are routinely indicated. Polysomnography may assist in ruling out other contributing sleep disorders, but it is not diagnostic for RLS. Erythrocyte sedimentation rate, liver function tests, serum electrolytes, and urinalysis (Choices A, C, D and E) should be ordered if indicated by findings in the history or physical examination. This is not the case with this patient. Educational objective: Restless legs syndrome may be a symptom of iron deficiency. A serum ferritin level should be obtained as iron deficiency is frequently present in the absence of anemia. References: Latest guidelines and advances for treatment of restless legs syndrome. (http://www.ncbi.nlm.nih.gov/pubmed/24813409) Restless legs syndrome: update on pathogenesis. (http://www.ncbi.nlm.nih.gov/pubmed/24048084)

A 57-Year-Old Woman Comes to the Physician at the Insistence